Title I of the bill focuses on restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. Overall, the bill includes the following provisions:
Individuals would be required to maintain health insurance, and certain employers with more than 50 employees would be required to either provide insurance or pay a tax, with some exceptions. Several market reforms would be made, such as modified community rating and guaranteed issue and insurance renewal. Both the individual mandate and any employer requirements would be linked to essential health benefits coverage. Qualifying coverage would include: qualified health benefits plans (QHBPs) offered in or out of an exchange; new group or individual coverage that meets or exceeds minimum health benefits; grandfathered employment based plans; grandfathered nongroup plans; and other coverage, such as Medicare and Medicaid. Certain individuals with incomes below 400% of the federal poverty level could qualify for credits toward their premium costs and subsidies towards their cost-sharing. This financial assistance would be available only through exchanges. States would be provided the flexibility to establish basic plans for low-income individuals not eligible for Medicaid. However, existing small group plans would have to meet the applicable private market reforms by July 1, 2013. New plans could also be sold in both the individual and group market outside of an exchange, but only those new plans that meet the minimum requirements specified in the bill would satisfy the requirements for individuals and employers. Title VI includes a number of provisions to raise revenues to pay for expanded health insurance coverage. This report summarizes key provisions affecting private health insurance in Titles I and VI of America's Healthy Future Act of 2009, as ordered reported by the Senate Committee on Finance on October 19, 2009. Small employers could offer full-time employees and their dependents coverage in a QHBP. Individual and Small Group Market Reforms

S. 1796 would apply new federal health insurance standards to new, generally available health plans in the individual and small group markets. Under S. 1796 , those eligible for premium credits would also be eligible for cost-sharing subsidies. The bill provides these incentives primarily through the distribution of $6 billion in funding under the Consumer Operated and Oriented Plan (CO-OP) program. S. 1796 would define a qualified nonprofit health insurance issuer as an organization meeting the following requirements:
It must be organized as a non-profit, member corporation under State law; It must not be an existing organization that provides insurance as of July 16, 2009, and must not be an affiliate or successor of any such organization; Substantially all of its activities must consist of the issuance of qualified health benefit plans in the individual and small group markets in each state in which it is licensed to issue such plans; It must not be sponsored by a state, county, or local government, or any government instrumentality; Its governing documents incorporate ethics and conflict of interest standards protecting against insurance industry involvement and interference; Governance of the organization must be subject to a majority vote of its members; It must operate with a strong consumer focus, including timeliness, responsiveness, and accountability to members in accordance with regulations to be promulgated by the Secretary of HHS; It must be in compliance with all the other requirements that other qualified health benefits plans must meet in any state, including solvency and licensure requirements, rules on payments to providers, rules on network adequacy, rates and form filing rules, and any applicable state premium assessments. Excise Taxes and Limitations on Employer Deductions

S. 1796 would impose excise taxes on health insurers and health plan administrators.
This report summarizes key provisions affecting private health insurance in S. 1796, America's Healthy Future Act of 2009, as ordered reported by the Senate Committee on Finance on October 19, 2009.
Title I of the bill imposes new requirements on individuals, employers, and health plans; restructures the private health insurance market; sets minimum standards for health benefits; and provides financial assistance to certain individuals and, in some cases, small employers. Title VI of the bill include a number of new provisions to raise revenues to pay for health care reform. These provisions include excise taxes, annual fees on health insurers, and limits on tax deductions for out-of-pocket health care expenses.
In general, the Senate Finance bill would require adult individuals to maintain health insurance, with some exceptions. Employers would not be required to provide health insurance, although certain employers with more than 50 full-time employees who did not provide insurance could be required to pay a tax, under certain circumstances. Several insurance market reforms would be made, such as modified community rating and guaranteed issue and renewal. Both the individual mandates and the employer requirements would be linked to essential health benefits coverage. Essential health benefits coverage would include (1) coverage under a qualified health benefits plan (QHBP); (2) new group or individual coverage that meets or exceeds minimum health benefits; (3) grandfathered employment-based plans; (4) grandfathered nongroup plans; and (5) other coverage, such as Medicare and Medicaid. Individual and small group coverage under qualified health benefits plans would be allowed to be offered through non-profit, member-run health insurance companies. Such non-profit insurers would be eligible for grants and loans distributed through the new Consumer Operated and Oriented Plan (CO-OP) program. QHBP exchanges would offer a choice of private plans for coverage in the individual and small group markets. Based on income, certain individuals could qualify for a credit toward their premium costs and a subsidy for their cost-sharing; the credits and subsidies would be available only through an exchange. States would have the flexibility to establish basic health plans for low-income individuals not eligible for Medicaid. Existing plans would be grandfathered; however, once the bill is fully implemented, the private market reforms applicable to the small group market would also apply to grandfathered small group plans. New plans would be allowed to be offered in the individual and group markets outside of the Exchange, but only those new plans that meet the minimum requirements specified in the bill would satisfy the requirements on individuals and employers.