Generally, individuals would not be required to give up their employer-provided health coverage.

Within 90 days of the bill becoming law, certain individuals without employer coverage may be able to purchase coverage through a temporary national high-risk pool. The temporary high-risk pool will offer coverage to U.S. citizens and legal immigrants who have not been insured for at least 6 months, at reduced premiums.

Beginning six months after passage of the Act, plans will not be permitted to impose lifetime limits on coverage. The law also restricts the use of annual limits. Beginning in 2014, plans may not impose annual limits on coverage.

Beginning six months from passage of the law, dependent adult children will be eligible for coverage under their parents' health plan up to age 26.

Beginning six months from passage, insurers will not be permitted to rescind coverage except in cases of fraud.

Grandfathering may relate to existing individual and group plans with respect to new benefit standards. However, these grandfathered plans must extend dependent coverage to certain adult children up to age 26 and prohibit rescission of coverage. In addition, grandfathered group plans are required to eliminate lifetime limits on coverage, and beginning in 2014, eliminate annual limits on coverage. Grandfathered group plans must eliminate pre-existing condition exclusions for children within six months and by 2014 for adults.

Beginning 2013, individuals making $200,000 and joint filers making $250,000 must pay an increase of 0.9% in the Medicare tax. A 3.8% tax on unearned income for high-income individuals will also take effect.

Starting in 2014, the law will require most U.S. citizens and legal residents to obtain health insurance. Increasing levels of penalties will be assessed on certain individuals who do not obtain coverage.

Starting in 2014, plans will not be permitted to exclude individuals from coverage on the basis of pre-existing medical conditions. The prohibition on exclusions of children on the basis of pre-existing conditions would begin 6 months from the date the law was enacted.

Starting in 2014, people without employer-sponsored coverage will be able to buy insurance on state-administered "exchanges." State-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges will be administered by a government agency or non-profit organization, and allow individuals and small businesses with up to 100 employees to buy certain coverage.

In 2014, the law will provide tax credits to individuals and families with incomes above Medicaid eligibility and below 400% of the Federal Poverty Level to buy coverage through state-based Exchanges. These individuals and families would be entitled to the credits if they are not eligible for or offered other "acceptable coverage".

Starting in 2014, the law would prohibit premiums of older individuals from being more than 3 times the cost of younger peoples' premiums.

For tax years 2010-2013, employers of 25 or fewer employees with average annual wages of less than $50,000 may be able to receive a tax credit if they contribute at least 50% of total premium costs, or 50% of a "benchmark" premium. Employers of 10 or fewer employees with average annual wages of less than $25,000 may be able to receive a full tax credit for their contributions.

Within 90 days of enactment of the law and until Jan.1, 2014, a temporary reinsurance program will provide coverage for retirees who are over age 55 but not eligible for Medicare. The reinsurance program will reimburse employers or insurers 80% of retirees' claims that are between $15,000 and $90,000.

Six months from enactment, group health plans and issuers that offer health insurance coverage will be required to provide preventive coverage. Plans and insurance providers will also be prohibited from imposing any cost sharing requirements for preventive coverage. Some of the preventive coverage includes certain immunizations and preventive care for children, adolescents and women.

Six months from passage (Jan. 1, 2011, for calendar year plans), plan sponsors of group health plans, except self-insured plans, will not be permitted to establish rules relating to coverage eligibility for full-time employees that are based on the total hourly or annual salary of the employee, or otherwise have the effect of discriminating in favor of higher wage employees.

Six months from passage (Jan. 1, 2011, for calendar year plans), group health plans and health insurance issuers will be required to have effective appeals processes for challenges to coverage and claims determinations.

Starting in 2011, the law would increase the tax on distributions from a Health Savings Account or Archer MSA if the distributions are not for a qualified medical expense. The tax on these distributions would increase to 20%, from 10% for HSAs and 15% for Archer MSAs. The threshold to itemize unreimbursed medical expenses as a deduction on tax returns would increase from 7.5% to 10% of adjusted gross income. The law also prohibits reimbursement of costs for over-the-counter drugs if they are not prescribed by a doctor, in relation to HSAs, Archer MSAs, FSAs and HRAs.

Starting in 2013, the law also limits the amount of contributions to a flexible spending account (FSA) to $2,500 annually.

For 2 years starting in 2014, eligible small businesses that buy health coverage on new state insurance exchanges may receive a tax credit of up to 50% of the contribution if the employer contributes at least 50% of the total premium cost.

Starting in 2014, small businesses with up to 100 employees will be able to buy insurance on state-administered "exchanges." State-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges will be administered by a government agency or non-profit organization. A qualified health plan, to be offered through the new American Health Benefit Exchange, must provide essential health benefits which include cost sharing limits. No out-of-pocket requirements can exceed those in Health Savings Accounts, and deductibles in the small group market cannot exceed $2,000 for an individual and $4,000 for a family. Plans participating in the Exchanges will be accredited for quality, will present their benefit options in a standardized manner for comparison, and will use one enrollment form. Individuals qualified to receive tax credits for Exchange coverage must be ineligible for affordable, employer-sponsored insurance or any form of public insurance coverage.

Starting in 2014, employers who offer coverage to their employees will be required to provide a voucher for purchasing health care to employees with incomes less than 400% of Federal Poverty Level whose share of the premium exceeds 8% but is less than 9.8% of the employee's income. These vouchers are for enrolling in a plan in the Exchange. The voucher amount is equal to the premium amount for coverage of the employee under the employer's plan and will be used to offset the premium costs for the plan in which the employee is enrolled.

Starting in 2014, employers of 50 or more employees that have employees receiving premium subsidies created by the legislation will be assessed fees. Such employers could face fines of $2,000 per full-time employee, with some exceptions.

In 2018, insurers and plan administrators will pay a 40% tax for any health insurance plan that is above the threshold of $10,200 for singles and $27,500 for families. This excise tax would apply to the amount of the premium that is above these thresholds.

Effective for plan year 2010, health plans are required to report the percentage of premium dollars spent on medical services. As of Jan. 1, 2011, enrollees will receive rebates for the amount of the premium spent on medical services that is less than 85% for large group plans, and 80% for individual and small group plans.

In 2010, the law closes the Medicare prescription drug coverage gap by $500, and provides a 50% discount on brand name drugs for beneficiaries who fall into the coverage gap. There is a current gap in coverage for total drug costs between $2,700 and $6,154. After being amended, the law authorizes a $250 rebate to all Medicare Part D enrollees who enter the "donut hole" in 2010.

By 2014, states would be required to extend Medicaid coverage to all individuals under 65 who have incomes up to 133% of the federal poverty level. The law would also fund the Children's Health Insurance Program through 2015, and require states to maintain the current eligibility levels for children in the Medicaid and CHIP programs.

The law creates a voluntary long-term care insurance program called the CLASS Independence Benefit Plan. The program will permit individuals to purchase community living assistance services and supports. The coverage would have a 5-year vesting period for eligibility of benefits and provide an average cash benefit of at least $50 per day.

The Health Care and Education Reconciliation Act of 2010 also overhauls the federal student loan program and expands access to Pell Grants. For more information on this bill, please click here.