A multi-year rollout. A year-by-year timeline.

The Patient Protection and Affordable Care Act (PPACA) was first passed in 2010 with its various regulations rolling out over the next few years.  See our timeline of key changes for employers.


  • High cost coverage tax


  • Employer Shared Responsibility for employers with 50 to 99 full-time and full-time equivalent employees


  • Employer Shared Responsibility for employers with 100 or more full-time and full-time equivalent employees

  • Health insurance reporting coverage

  • First payment of Transitional Reinsurance Fee is due

  • First payment of Health Insurance Providers Fee is due


  • Exchanges

  • Transparency in coverage (QHP) reporting―reporting begins after QHPs have been in place one calendar year

  • Fair health insurance premiums

  • Guaranteed availability of insurance coverage

  • Guaranteed renewability of coverage

  • Preexisting Condition Exclusion prohibition (for all enrollees)

  • Nondiscrimination based on health status

  • Nondiscrimination against healthcare providers

  • Comprehensive health insurance coverage

  • Cost-sharing limitations

  • Prohibition on excessive waiting periods

  • Coverage for clinical trials

  • Annual/lifetime limits prohibited on essential benefits

  • Increase in small business healthcare tax credit

  • Provision of additional information (Quality Reporting)―reporting required no earlier than reporting required for QHPs (see above)

  • Individual mandate


  • HIPAA electronic transaction standards

  • Health FSA cap

  • Loss of tax exclusion of Medicare Part D drug subsidy

  • Increase in Code § 213 medical deduction

  • New Medicare hospital insurance tax of 0.9 percent on high-income individuals*

  • New 3.8 percent Medicare payroll tax on unearned income for high-income individuals*

  • First payment of Patient Centered Outcomes Research Institute Fee is due. Fee increases from $1 per participant to $2 per participant for plan years beginning on or after November 1, 2012.

  • Notices to employees about exchanges and subsidies

  • Co-ops

  • *$200,000 individual, $250,000 joint


  • New, voluntary options for long-term care insurance (postponed indefinitely)

  • Distribution of four-page Summary of Benefits and Coverage and Uniform Glossary

  • Quality of care reporting―delayed pending regulations

  • W-2 reporting (mandatory for 2012 tax year)


  • Expansion of preventive services under Medicare

  • OTC drug limits

  • Simple cafeteria plans

  • HSA/Archer MSA penalty tax increase

  • W-2 reporting (voluntary for 2011 tax year)

  • Bringing down cost of coverage (reporting and rebates)―minimum loss ratios

  • Small business grants to provide wellness programs


  • Grandfathered plan requirements

  • Early retiree reinsurance

  • Temporary high-risk pool

  • HHS consumer web portal

  • Preexisting Condition Exclusion prohibition for those under age 19

  • Annual/lifetime limits prohibited on essential benefits (some annual limits may apply until 2014)

  • Rescission prohibition

  • Preventive health services

  • Dependent coverage for children under age 26

  • Nondiscrimination for insured plans application/enforcement―delayed pending additional guidance. Agencies have indicated that employers are not required to comply with this requirement until regulations are issued.

  • Appeals process

  • Patient protections (primary care provider designations, ER services, etc.)

  • Ensuring that consumers get value for their dollars (rate review)

  • Automatic enrollment―no specific effective date. In sub-regulatory guidance, the DOL has indicated that employers are not required to comply with this requirement until regulations are issued.

  • Small business healthcare tax credit

  • Tax-free coverage to children under age 27 (see above regarding coverage mandate to age 26)