Summaries of Benefits and Coverage

Group health plans must begin providing members with a standard Summary of Benefits and Coverage so they can compare medical plans to make decisions about which plan to choose.


Form W-2 reporting for 2012 tax year

Businesses that issue 250 or more W2s must include the value of group health benefits provided to employees on the forms, which must be issued by Jan. 31, 2013.



Employer Notice of Exchange

Employers must provide a notice to employees of availability of state health insurance exchanges.




“Pay or Play” Employer Shared Responsibility

Businesses with 50 or more full-time equivalent employees must offer a minimum level of affordable health-care coverage or pay tax penalties.


“Pay or Play” Individual Mandate
Most individual taxpayers must have health coverage or purchase health coverage through  state health insurance exchange or pay tax penalties.

Wellness Incentives
Employer plans may increase permitted wellness incentives from 20 percent of average costs to 30 percent.

Pre-existing Conditions Exclusions
Employer group health plans may not impose exclusions on coverage for pre-existing conditions.

Annual Dollar Limits
Employer group health plans may not impose annual dollar limits on essential health benefits.

Automatic Enrollment
Large employers (with 200 or more full-time employees) must automatically enroll new employees in the company’s group health plan.

Non-discrimination Rule
Employer group health plans may not discriminate in favor of highly compensated employees.


“Cadillac Tax”

Insurers will be required to pay a 40 percent excise tax (the cost of which may be passed on to the employer) for plans that exceed annual inflation-adjusted cost thresholds beginning at $10,200 for individual coverage and $27,500 for family coverage.