111-148 , PPACA) was signed into law on March 23, 2010. On March 30, 2010, PPACA was amended by P.L. 111-152 , the Health Care and Education Reconciliation Act of 2010. This report summarizes the key provisions in PPACA (hereafter referring to PPACA as amended by P.L. 111-152 ) that affect private health insurance. With respect to the private health insurance market, mostly by full implementation in 2014, PPACA focuses on restructuring the market (particularly the small-group and nongroup markets), setting minimum standards for health coverage, and providing financial assistance to certain individuals and, in some cases, small employers. Overall, the law includes the following provisions:
Beginning in 2014, individuals will be required to maintain health insurance, and certain employers with more than 50 full-time equivalent employees (FTEs) will be required to pay a penalty, with some exceptions. Several market reforms will be made, such as prohibition against lifetime benefit limits and coverage for preexisting health conditions. Exchanges will not be insurers but will provide eligible individuals and small businesses with access to private plans in a comparable way. The exchange will consist of a selection of private plans as well as "multi-state qualified health plans," administered by the Office of Personnel Management (OPM). States will be provided the flexibility to establish basic plans for low-income individuals not eligible for Medicaid. Individual and small group coverage will be allowed to be offered through nonprofit, member-run health insurance companies. These reforms include the following, in the order in which they would become effective (see Appendix A for additional details and Appendix B for a chronology of implementation deadlines):
authorizing the Secretary to award grants to states to provide information and assistance to health insurance consumers; establishing a process for the annual review of unreasonable premium increases; providing coverage assistance for those who are uninsured because of a preexisting condition; creating a temporary re-insurance program to support coverage for early retirees; establishing an Internet portal to assist consumers in identifying coverage options; prohibiting lifetime limits and restricted annual limits on essential benefits; prohibiting rescissions of health insurance policies; requiring coverage of preventive services and immunizations; extending dependent coverage up to age 26; prohibiting discrimination based on salary with respect to eligibility for benefits; capping insurance company non-medical, administrative expenditures; ensuring that consumers have access to an effective appeals process; providing coverage for preexisting health conditions for enrollees under age 19; ensuring patient protections regarding the choice of a primary care provider, access to emergency services and obstetrical and gynecological care, and access to medical reimbursement data; requiring the Secretary to develop uniform summary of benefits documents so consumers can make easier comparisons when shopping for health insurance; facilitating administrative simplification to lower health system costs; and tasking the Secretary with developing requirements for quality of care. QHPs will include qualified health plans offered through the CO-OP program (described below; see " Consumer Operated and Oriented Plan (CO-OP) "). Individuals will be required to maintain minimum essential coverage for themselves and their dependents. American Health Benefit Exchanges

		Exchange Structure

In addition to establishing new federal private health insurance standards, PPACA enables and supports states' creation by 2014 of "American Health Benefit Exchanges," similar in many respects to existing entities like the Massachusetts Connector and eHealthInsurance. Premium Credits and Cost-Sharing Subsidies

Beginning 2014, some individuals will be eligible for premium tax credits toward their required purchase of health insurance, based on income. Cost-sharing subsidies will only be available for silver plans sold through an exchange, including private plans. PPACA does not change noncitizens' eligibility for Medicaid.
The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA) was signed into law on March 23, 2010. On March 30, 2010, PPACA was amended by P.L. 111-152, the Health Care and Education Reconciliation Act of 2010. This report summarizes the key provisions in PPACA (hereafter referring to PPACA as amended by P.L. 111-152) that affect private health insurance. PPACA imposes new requirements on individuals, employers, and health plans; restructures the private health insurance market; sets minimum standards for health coverage; and provides financial assistance to certain individuals and, in some cases, small employers.
In general, PPACA requires individuals, beginning in 2014, to maintain health insurance, with some exceptions. Individuals will be required to maintain minimum essential coverage, which includes eligible employer coverage, individual coverage, grandfathered plans, and federal programs such as Medicare and Medicaid, among others. Employers are not explicitly required to provide health benefits, although certain employers with more than 50 employees may be required to pay a penalty if either (1) they do not provide insurance, under certain circumstances, or (2) the insurance they provide does not meet specified requirements. Several insurance market reforms will be implemented, including some prior to full implementation in 2014, such as prohibition against lifetime benefit limits and coverage for preexisting health conditions for children.
In addition to establishing new federal private health insurance standards, PPACA will enable and support states' creation by 2014 of "American Health Benefit Exchanges." An exchange cannot be an insurer, but will provide eligible individuals and small businesses with access to insurers' plans in a comparable way. The exchange will consist of a selection of private plans as well as "multi-state qualified health plans," administered by the Office of Personnel Management. Individuals will only be eligible to enroll in an exchange plan if they are not enrolled in Medicare, Medicaid, or acceptable employer coverage as a full-time employee. Based on income, certain individuals may qualify for a tax credit toward their premium costs and a subsidy for their cost-sharing; the credits and subsidies will be available only through an exchange. States will have the flexibility to establish basic health plans for low-income individuals not eligible for Medicaid.
Individual and small group coverage will be allowed to be offered through nonprofit, member-run health insurance companies. Such nonprofit insurers will be eligible for grants and loans distributed through the new Consumer Operated and Oriented Plan (CO-OP) program.