2014 Requirements

 

The following requirements apply for health plans for plan years beginning on or after January 1, 2014

Click any of the following items to learn more.

Waiting Periods

Plans may not impose an eligibility waiting period greater than 90 days.

Annual Limits

Plans may not impose any annual dollar limits on essential health benefits.

 

Pre-Existing Conditions

Plans may not impose any pre-existing condition limits for any enrollees.

Adult Children

Grandfathered plans that cover children must provide coverage for all adult children up to age 26 regardless of eligibility for other employer-sponsored coverage.

 

Wellness Incentives

The incentives for wellness participation that an employer may provide increases to 30% of the cost of an employee’s health coverage.

Essential Health Benefits

Non-grandfathered, small group insured plans must provide coverage for all essential health benefits.*

 

Clinical Trial Participants

Non-grandfathered plans may not discriminate against clinical trial participants, as specified by regulations.*

Deductible Limits (Repealed)

Non-grandfathered, small group insured plans may not impose deductibles higher than $2,000 for individual coverage or $4,000 for family coverage.*

 

Limits on Out-of-Pocket Maximums

Non-grandfathered plans may not require a participant to pay cost-sharing in excess of the out-of-pocket maximum that applies to HSA-compatible high deductible health plans.*

Provider Nondiscrimination

Non-grandfathered plans may not discriminate against health care providers acting within the scope of their licenses.*

 

* Indicates grandfathered plans do not have to comply.

American Fidelity Assurance Company does not provide tax or legal advice.

ESB-958(0713)

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