Despite changes to the health care system that took effect in September and more to come in the next two years, full implementation of the massive health reform law could look different by 2018 when all current provisions take hold, an official with the state’s top insurer said Tuesday in Vicksburg.

“I can say with certainty it won’t be implemented as written,” said Doug Henley, a sales director with BlueCross BlueShield of Mississippi during a health care lunch-and-learn assembly of the Vicksburg-Warren County Chamber of Commerce. “I can also say with 100 percent certainty it won’t be repealed.”

Parts of the Patient Protection and Affordable Care Act now effective involve several new requirements and limits for private insurers. Unmarried adult children younger than 26 may now remain on their parents’ insurance plan, and pre-existing medical conditions may not be excluded on new policies for people younger than 19. Effective Jan. 1, 2012, employers must report the value of benefits they provide for each employee on the employees’ W-2. Also, insurers must spend 80 to 85 percent of premiums on quality-of-care improvements or rebate it to customers. By 2014, mandates on having health insurance become effective for individuals and businesses with more than 50 employees.

Some provisions, such as excise taxes on expensive “Cadillac” insurance plans, were pushed back to 2018. According to published reports this month, one-year waivers were issued by the Obama administration for large companies such as McDonalds and large insurers such as Aetna so certain plans with low annual limits could be continued without having to raise the max coverage offered to employees.

Riley Nelson of the Vicksburg-based accounting firm May & Company advised over-the-counter medications won’t be reimbursed through cafeteria plans in 2011.

“As you begin to make your cafeteria elections for 2011, you’ll need to look at that and know that those over-the-counter medicines no longer qualify,” Nelson said.

Deductions for medical and dental expenses, which must exceed 7.5 percent of adjusted gross income when individuals and married couples itemize, must surpass 10 percent by 2013.

“It’s really moving where if you don’t have any significant medical expenses, and nursing care, things like that, you’re hardly going to be able to take medical expenses anymore,” Nelson said.

Tax credits will phase in by 2014 for small businesses to afford health insurance through the government-run exchange. Other provisions mandate the caloric intake of all food at chain restaurants be displayed on most menus and vending machines. A service tax on indoor tanning salons took effect this year.