Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will

Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for

calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand!name drugs in the donut

hole; also completely closes the donut hole by 2020.)

Eliminates co!payments for preventive services and exempts preventive services from deductibles

under the Medicare program. Effective beginning January 1, 2011.

Creates a temporary re!insurance program (until the Exchanges are available) to help offset the costs

of expensive premiums for employers and retirees for health benefits for retirees age 55!64. Effective

90 days after enactment.

Bans insurance companies from dropping people from coverage when they get sick. Effective 6

months after enactment.

6.  NO DISCRIMINATION AGAINST CHILDREN WITH PRE!EXISTING CONDITIONS

Prohibits new health plans in all markets plus grandfathered group health plans from denying

coverage to children with pre!existing conditions. Effective 6 months after enactment. (Beginning in

2014, this prohibition would apply to all persons.)

Prohibits health insurance companies from placing lifetime caps on coverage. Effective 6 months

after enactment.

Tightly restricts the use of annual limits to ensure access to needed care in all new plans and

grandfathered group health plans. These tight restrictions will be defined by HHS. Effective 6 months

after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all new plans

and grandfathered group health plans.)

Requires new private plans to cover preventive services with no co!payments and with preventive

services being exempt from deductibles. Effective 6 months after enactment.

10.  NEW, INDEPENDENT APPEALS PROCESS

Ensures consumers in new plans have access to an effective internal and external appeals process to

appeal decisions by their health insurance plan. Effective 6 months after enactment.

Requires plans in the individual and small group market to spend 80 percent of premium dollars on

medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet

these thresholds must provide rebates to policyholders. Effective on January 1, 2011.

(INTERIM HIGH!RISK POOL)

Provides immediate access to affordable insurance for Americans who are uninsured because of a

pre!existing condition ! through a temporary subsidized high!risk pool. Effective 90 days after

enactment.

PARENTS' INSURANCE

Requires new health plans and certain grandfathered plans to allow young people up to their 26th

birthday to remain on their parents' insurance policy, at the parents' choice. Effective 6 months after

enactment.

Increases funding for Community Health Centers to allow for nearly a doubling of the number of

patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2010.

Provides new investment in training programs to increase the number of primary care doctors,

nurses, and public health professionals. Effective beginning in fiscal year 2010.

Prohibits group health plans from establishing any eligibility rules for health care coverage that have

the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.

Provides aid to states in establishing offices of health insurance consumer assistance in order to help

individuals with the filing of complaints and appeals. Effective beginning in FY 2010.

18.  CREATES NEW, VOLUNTARY, PUBLIC LONG!TERM CARE INSURANCE PROGRAM

Creates a long!term care insurance program to be financed by voluntary payroll deductions to

provide home and community-based services to adults who become functionally disabled. Effective

on January 1, 2011.