Allow states the option of merging the individual and small group markets. (Effective January 1, 2014)

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Permit states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.

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Require the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

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Create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan.

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Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits.

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Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:

  • 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);
  • 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);
  • 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).
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Create state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage.

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Assess employers with 50 or more employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment.  Employers with 50 or more employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees from the assessment.  Require employers with more than 200 emp

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Require U.S. citizens and legal residents to have qualifying health coverage (phase-in tax penalty for those without coverage).

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