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The Affordable Care Act (Obamacare): If You Do Not Have Health insurance (Uninsu

Protections Concerning Health Insurance Policies

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Dependent Coverage: The Act requires insurers to provide dependent coverage for children up to age 26 for all individual and group policies. This includes both new and existing policies.

Pre-Existing health conditions for children:

  • New plans are prohibited from including pre-existing condition exclusions for children.
  • Existing individual and group plans must eliminate pre-existing condition exclusions for children effective September 2010.

Annual Limits

  • Beginning January, 2014, new individual and group plans are prohibited from placing annual limits on the dollar value of coverage. 
  • Prior to January 2014, plans may only impose annual limits on coverage as determined by the Secretary. 

Lifetime Limits: Starting September 2010:

  • New individual and group health plans are prohibited from placing lifetime limits on the dollar value of coverage. This limitation does not apply to existing individual policies.
  • Group plans must eliminate lifetime limits on coverage.

Premium Increases: The Act requires plans to justify increases effective beginning plan year 2010.

Rescission: Insurers are prohibited from ending coverage except in cases of fraud. This limitation applies to existing individual and group plans.

Consumer Assistance: States must establish an office of health insurance consumer assistance or an ombudsman program to serve as an advocate for people with private coverage in the individual and small group markets. (Federal grants are available to assist the states beginning fiscal year 2010.)

Appeals: For new plans effective September 23, 2010 or later, appeals are standardized, including a right to an independent, external review board. The appeals process will be available even when coverage is canceled.


Limitations On Premiums That Can Be Charged: The Act requires a process for reviewing increases in health plan premiums. Insurers will be required to justify premium increases.


Minimum Health Insurance Coverage The Act creates an essential minimum health benefits package that provides a comprehensive set of services and limits the annual cost-sharing. All health benefit plans, including plans offered through the Exchanges and plans offered in the individual and small group markets outside the Exchanges, must at least meet the essential health benefits package, except for grandfathered individual and employer-sponsored plans. ("Grandfather" refers to existing policies which are allowed to remain as they are.)

Abortion coverage cannot be a required part of the essential health benefits package.

Annual Limits: Individual and Group health plans are prohibited from placing annual limits on the dollar value of coverage.

Pre-existing health conditions for adults: Existing group, individual (in the market and in the Exchange) and small group market plans must eliminate pre-existing condition exclusions for adults by 2014. No new pre-existing coverage exclusions will be allowed.

Guarantee Issue: Individual (in the market and in the Exchange) and small group market plans may not exclude coverage based on pre-existing conditions. 

Waiting periods for coverage: Plans cannot include waiting periods for coverage to start of greater than 90 days. 

Clinical trials: Costs associated with clinical trials have to be covered. Policyholder cannot be discriminated against for being part of a clinical trial. (For more information, see: 

Standardized policies: All new policies (except stand-alone dental, vision, and long-term care insurance plans), including those offered through the Exchanges and those offered outside of the Exchanges, must comply with one of the four benefit categories. Existing individual and employer-sponsored plans do not have to meet the new benefit standards.

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

Waiting Periods: Waiting periods for coverage are limited to 90 days.

Premium Rating: Individual (in the market and in the Exchanges) and small group market premiums are only allowed to vary based on:

  • Age (a maximum of 3 for older people to 1 for younger people)
  • Geographic area
  • Family composition
  • Tobacco use

Individual and small group markets: States have the option of merging these markets.

Prevention: Qualified health plans are required to provide basic preventive coverage without cost-sharing.


  • The Act establishes an internet website to help residents identify health coverage options (effective July 1, 2010)
  • The Act also requires development of a standard format for presenting information on coverage options (effective 60 days following enactment).
  • The Act requires development of standards for insurers to use in providing information on benefits and coverage. (Standards developed within 12 months following enactment; insurer must comply with standards within 24 months following enactment).
  • Details about the new pools will be available at Department of Health and Human Service's web site: offsite link

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