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  • Effective January 1, group health plans and health insurance issuers could no longer impose pre-existing condition exclusions on any covered individual, regardless of the individual’s age.
  • Plans and issuers could no longer impose annual limits on the coverage of essential health benefits.
  • Permitted wellness incentives increased from up to 20 percent of the total premium to 30 percent of the premium for employee participation in the program or meeting certain health standards. Following a governmental study on wellness programs, the incentive may be increased to as much as 50 percent if it includes a smoking cessation program.
  • Tax credits made available to people with incomes above Medicaid eligibility and below 400 percent of poverty level who are not eligible for or offered other acceptable coverage.
  • Second phase of small business tax credit for qualified small employers implemented. These employers can receive a credit for contributions to purchase health insurance for employees, up to 50 percent of premiums.
  • Employers encouraged to voluntarily comply with information reporting provisions that will become mandatory in 2015.
  • Most individuals required to obtain acceptable health insurance coverage or pay a penalty. Initial penalty was the higher of $95 per person or 1 percent of income and will increase in subsequent years.
  • Health Care Exchanges established in each state and open to individuals and small employers (100 employees or fewer).


  • Employers with 100 or more employees that failed to offer affordable coverage of minimum value to their employees became subject to penalties if any employee received a government subsidy for health coverage.
  • Applicable Large Employers (ALEs) required to report to the federal government on health coverage they provide (Section 6056 Reporting).
  • The penalty for individuals who don’t have acceptable health insurance coverage increased to the higher of $325 per person or 2 percent of income.


  • Employers with 50-99 or more employees that do not offer affordable coverage of minimum value to their employees will be subject to penalties if any employee receives a government subsidy for health coverage.
  • The penalty for individuals who don’t have acceptable health insurance coverage increases to the higher of $695 or 2.5 percent of income.
  • Community rating will expand to include any employer with less than 100 eligible employees (traditionally, the threshold has been 50 employees).
  • Employers with between 50 and 100 employees will be able to purchase coverage through an exchange’s small business health insurance marketplace (SHOP).


  • Large employers with over 100 employees will be allowed to participate in the Exchanges.
  • Transitional reinsurance, a program which uses funds collected from group and individual health insurance plans to partially reimburse high claims in the individual ACA market will be phased out.
  • The risk corridor program, which reimburses insurance plans when claims incurred by subscribers on an Exchange significantly outpaces the premiums paid, will be phased out.


  • The 40 percent excise tax on high-cost employer-sponsored health plans, also known as the “Cadillac Tax,” will take effect.  While the tax was originally non-tax deductible, changes in December 2015 made it tax deductible for employers who pay it.