Reform for Providers:

The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA), or simply health care reform, was signed into law on March 23, 2010.

It includes a variety of provisions that will affect members, employers, and health care providers over the next several years. 

The ACA includes mandates that will expand coverage to many more Americans:

• Large employers (50 or more employees) will be required to offer coverage to their employees.
• Small employers will be encouraged, but not required, to offer coverage.
• Individuals will be required to obtain coverage, and will be offered premium subsidies to help make that coverage more affordable.

ACA also includes a variety of insurance reforms, including:

• The elimination of pre-existing condition exclusions.
• The guaranteed issue of health insurance.
• The elimination of lifetime dollar limits and restricted annual limits.
• A requirement that health insurance companies meet a minimum loss ratio; the proportion of premium dollars used to pay health care providers for services received by its members.

Wellmark’s Response to the ACA:

Wellmark continues an intensive review of the ACA legislation, and we are working collaboratively with our stakeholders to ensure that coverage remains accessible and affordable. Please check this page often for the most up-to-date information.

Information for Providers:

For  information of specific interest to providers, see the Information by Topic section under the Information and Resources section below. 

Guides, Timelines and Overviews:

• Wellmark's Guide to Health Care Reform, 2010 
• Blue Cross Blue Shield Association Health Care Reform Guide, July 2010 
• Health Care Reform Bill Timeline 
• Detailed Implementation Timeline – from the Kaiser Family Foundation.

Information by Topic:

• Preventive Care Coverage Expanded with Additional Services for Women 

• ICD-10 Crosswalk FAQ, 6/21/2010 
• Preventive Care, 10/2010 

Feedback:

Your feedback is important to us!

• Give feedback on this site  

Timelines: 

• Timeline: What’s Changing and When  A quick look at the ACA implementation.
• Detailed Implementation Timeline – from the Kaiser Family Foundation.

Tools & Video: 

•  “Health Reform Hits Main Street” ; a video from the Kaiser Family Foundation.
  
• AskBlue Healthcare Reform for Iowa^SM  or the AskBlue Healthcare Reform for South Dakota^SM ; a personalized interactive tool for consumers and businesses from the Blue Cross Blue Shield Association.

Related Websites:

• The Patient Protection and Affordable Care Act - HR 3590  ^{(906 page PDF)} 
• The Reconciliation Amendment - HR 4872  ^{(150 page PDF)}    
• Blue Cross and Blue Shield Association 
  
• Department of Health and Human Services (HHS) 
  
• Centers for Disease Control and Prevention (CDC) 
  
• U.S. Dept of Labor (DOL)
  
• Agency for Healthcare Research & Quality (AHRQ) 
  
• Internal Revenue Service (IRS) 
  
• Iowa Insurance Division 
• South Dakota Division of Insurance 

^{Wellmark is not providing any legal advice with regard to compliance with the requirements of the Affordable Care Act ("ACA") and Mental Health Parity and Addiction Equity Act ("MHPAEA"). Regulations and guidance on specific provisions of the ACA and MHPAEA have been and will continue to be provided by the U.S. Department of Health and Human Services ("HHS") and/or other agencies. The information provided reflects Wellmark's understanding of the most current information and is subject to change without further notice. Please note that plan benefits, rates, renewal rate adjustments, and rating impact calculations are subject to change and may be revised during a plan’s rating period based on guidance and regulations issued by HHS or other agencies. Wellmark makes no representation as to the impact of plan changes on a plan's grandfathered status or interpretation or implementation of any other provisions of ACA or MHPAEA. Any questions about Wellmark's approach to the ACA or MHPAEA may be referred to your Wellmark account representative. Wellmark will not determine whether coverage is discriminatory or otherwise in violation of Internal Revenue Code Section 105(h). Wellmark also will not provide any testing for compliance with Internal Revenue Code Section 105(h). Wellmark will not be held liable for any penalties or other losses resulting from any employer offering coverage in violation of section 105(h). Wellmark will not determine whether any change in an Employer Administered Funding Arrangement affects a health plan’s grandfathered health plan status under ACA or otherwise complies with ACA. Wellmark will not be held liable for any penalties or other losses resulting from any Employer Administered Funding Arrangement. For purposes of this paragraph, an “Employer Administered Funding Arrangement” is an arrangement administered by an employer in which the employer contributes toward the member’s share of benefit costs (such as the member’s deductible, coinsurance, or copayments) in the absence of which the member would be financially responsible. An Employer Administered Funding Arrangement does not include the employer’s contribution to health insurance premiums or rates.}