March 26, 2010

Health Care Reform Legislation
 
On March 23, President Obama signed the health care reform bill into law. While
the bill will extend coverage to millions of Americans, there are still significant
questions about how reform will affect health insurers, health plan members and
the agents who support us.

BlueCross BlueShield of South Carolina is closely following the legislation as it
begins to take effect. We are confident that, although the new law will bring
changes for our company and our agents, BlueCross is well positioned to adapt
to these changes and to remain the health insurance carrier of choice in South
Carolina.

View the complete health care reform legislation:

H.R. 3590 The Patient Protection and Affordable Care Act
H.R. 4872 Reconciliation Bill

Attached is a timeline created by America’s Health Insurance Plans (AHIP) that
shows requirements and impacts based on the House Reconciliation Bill. We will
continue to keep you advised of future developments.


BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
This bulletin is for producer purposes only and should not be forwarded to accounts or members. All information
contained in this bulletin is educational and should not be considered legal advice.

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Health Care Reform Bill Insurance Market Provisions Timeline (as revised by the House Reconciliation Bill)*
State grants to establish or expand
Prohibits lifetime benefit limits
Discrimination based on salary
GRANDfATHERED PLANS
Health insurance exchange is
GRANDfATHERED PLANS
ombudsman programs are awarded
is prohibited
established
Al ows restricted annual limits
Prohibits lifetime benefit limits
Pre-existing condition
New federal rate review process
for essential benefits
Internet portal to facilitate
Guarantee issue is required
exclusions are prohibited
is established
(as determined by HHS)
consumer and small employer
Recissions are prohibited
Rating restrictions that, among
shopping is created
(except for fraud or intentional
Prohibits annual benefit limits
other things, limits use of age as a
National risk-pool is created 90
Recissions are prohibited
misrepresentation)
rating factor are imposed
days from enactment
(except for fraud or intentional
T
S
Coverage for emergency
misrepresentation)
services at in-network cost-
Dependent coverage up to age
Individual and employer responsi-
Temporary retiree reinsurance
e
n
sharing level with no prior-
26 is mandated
bility requirements are established
program is established
Cost-sharing obligations
authorization is mandated
for preventive services are
Pre-existing condition
Individual affordability
Small business tax credit is
I
R
e
M
prohibited
Pre-existing condition
exclusions for dependents
tax credits are created and smal
established
u
exclusions for dependent children
business tax credits are expanded
Dependent coverage up to age
are prohibited
(under 19 years of age) are
eq
26 is mandated
prohibited
Al ows restricted annual limits
Essential benefit plan is created
for essential benefits
Internal and external appeal
New health plan disclosure
Pre-existing condition
(as determined by HHS)
processes must be established
and transparency requirements
exclusions are prohibited
are created
e
l
e
C
T
R
CO-OPs are established
Lifetime and annual dol ar limits
f S
are prohibited for essential benefits
Coverage for approved clinical
R
y o
trials is mandated
a
M
Uniform coverage documents and
Health insurance fee to fund
Multi-state qualified health plans
High-cost
standard definitions are developed
Comparative Effectiveness
M
are created and offered through the
insurance
by HHS (in consultation with NAIC)
is imposed
Exchange
excise tax is
S
u
85% MLR for large group (with
established
refund) is mandated
80% MLR for individual and small
Health insurance
Health insurance
Health insurance
Health insurance
Health insurance
group (with refund) is mandated
provider fee
provider fee
provider fee
provider fee
provider fee
imposed
increased
remains at
increased
increased
$8 billion
$11.3 billion
$11.3 billion
$13.9 billion
$14.3 billion**
January 1
d
OctOber 1 January 1
d d
January 1
d
January 1
January 1
d
January 1
d
January 1
d
January 1
d
d
2010
2011
2012
2013
2014
2015
2016
2017
2018
Health plans create and file
Health plans create and file new
new policy forms
policy forms
Health plans develop and file
Health plans develop and file
Health plans develop and file
new rates
new rate filings
new rates
States approve (or disapprove)
States approve (or disapprove)
State approve (or disapprove)
P
a
C
T
new rate filings
new policy forms
new policy forms
I
M
HHS Secretary and states create
States approve (or disapprove)
Health plans develop and file
State approve (or disapprove)
new rate review process
new rate filings
new rates
new rate filings
HHS Secretary establishes new
HHS Secretary and states
States approve (or disapprove)
HHS Secretary and states
national risk-pool
approve (or disapprove) premium
new rate filings
approve (or disapprove) premium
HHS Secretary establishes
rate increase requests
HHS Secretary and states
rate increase requests
temporary retiree
HHS Secretary establishes new
approve (or disapprove) premium
States (and/or HHS Secretary)
reinsurance program
internet portal
rate increase requests
establish exchanges
*Assumes April 1, 2010 enactment **In years following 2018, the tax amount would increase in an amount proportionally equal to overall premium growth.

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Document Outline

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