What can you do?

Employer Mandate and Responsibility
Cost Care Reform
Long-Term Care
HealthContainment
Provisions

Health...
What can you do?

Employer Mandate and Responsibility
Cost Containment
Long-Term Solutions
Care
CORE Benefit
Provisions
Ta...
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Employer Mandate and Responsibility
CostHCR Quiz
Long-Term Care
Containment
Provisions
What does the Ind...
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Employer Mandate and Responsibility
Cost Containment
Long-TermOverview
Care
HCR Timeline
Provisions
2010...
What can you do?

Employer Mandate and Responsibility
Cost Containment
Long-TermOverview
Care
HCR Timeline
Provisions
2013...
What can you do?

Employer Mandate and Responsibility
Cost Containment
Long-TermOverview
Care
HCR Timeline
Provisions
2014...
Individual Mandate
2017 and beyond:
Annual adjustments

2016
Greater of $695 per person (cap of $2,085
per family) or 2.5%...
What can you do?

Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Employer Mandate
Provisions
“Applica...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Medical Loss Ratio
Provisions

Sourc...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Underwriting Changes
Provisions
For ...
What can you do?

Employer Mandate and Responsibility
Cost Containment
Long-Term of Pocket
Deductible/Out Care
Provisions
...
Metallic Levels
Product Tier Requirements in Marketplace/Exchange:
Platinum
90%
actuarial value

Gold
80%
actuarial value
...
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Employer Mandate and Responsibility
Cost Containment QHP
Long-Term Care
Individual Premiums for
Provisio...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
AffordableProvisions Coverage
Group
...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Income Eligibility
Provisions
Premiu...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Amount of Premium Tax Credit
Provisi...
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Employer Mandate and Responsibility
Long-Term Care
Silver Cost Containment
Plan Provisions Scenarios
Pri...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Employer Group Plan
Provisions
2013 ...
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Employer Mandate and Responsibility
Cost Containment
SmallLong-Term Care
Employer Tax Credit
Provisions
...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Employer Options
Provisions
What can you do?

Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Individual Mandate
Provisions
Health Care Reform
Importance of your Trusted Advisors
• Benefits

Broker

• Accountant
• Attorney
• Financial

Advisor

L...
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Questions?
Provisions
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Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Thank you for your time.
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Core hcr presentation rental association wo video

  1. 1. What can you do? Employer Mandate and Responsibility Cost Care Reform Long-Term Care HealthContainment Provisions Health Care Reform: What comes next? Presentation for GA Chapter, American Rental Association CORE Benefit Solutions, LLC Lisa Owen, President, RHU lowen@corebenefitsga.com Jennifer Gregory, Account Executive jgregory@corebenefitsga.com
  2. 2. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Solutions Care CORE Benefit Provisions Tailored employee benefit programs: CORE PRODUCTS - Medical/Rx/Dental/Vision/Life/AD&D - Disability - Long Term Care - Group Health - Wellness Programs - Self Insured Health Plans - Individual/Personal Health - Voluntary Benefits - Employee Assistance Programs (EAP) - Benefits Administration - International Plans - Human Resource Solutions - FSA, HSA, HRA OTHER PRODUCTS - Property & Casualty - EZ Enroll Kits - Worker's Compensation - General Liability - Benefits Administration - Retirement
  3. 3. What can you do? Employer Mandate and Responsibility CostHCR Quiz Long-Term Care Containment Provisions What does the Individual mandate require of all US citizens? What are employers with 49 or fewer employees required to provide employees under the ACA? Can any individual obtain a federal subsidy to help pay for health insurance? • A. Must purchase minimum essential coverage • B. Must purchase dental and vision coverage • C. Must purchase “Platinum, Gold, Silver, or Bronze Plan” • D. All of the above • A. Provide affordable and minimum value coverage or be penalized • B. Provide financial contribution to help employees purchase coverage • C. Provide Marketplace Notice to existing and new hire employees & Summary of Benefits & Coverage (SBC), if employer offers group medical plan • A. Only if employer doesn’t offer coverage • B. Only if income is between 100-400% FPL and employer does not offer affordable minimum essential coverage • C. Only if income is between 100-400% FPL • D. As long as individual is below the age of 30
  4. 4. What can you do? Employer Mandate and Responsibility Cost Containment Long-TermOverview Care HCR Timeline Provisions 2010          Dependent coverage for adult children up to age 26 Elimination of pre-existing conditions for children under 19 Preventive services covered at 100% * Patient Protection provisions * (PCP, Emergency Room) Elimination of lifetime limits, restricted annual limits on essential heath benefits Disclosure notices (Grandfathered/Non-Grandfathered, Patient Protections) Non-discrimination provisions * (enforcement delayed) Small employer tax credit Federal pre-existing condition plan available 2011  FSAs, HSAs, HRAs Changes (OTC, non-qualified H.S.A. 20% excise tax)  Medical Loss Ratio  New long-term care program (not funded) 2012  Expanded Women’s Preventive Care *  Summary of Benefits and Coverage * Does not apply to grandfathered plans
  5. 5. What can you do? Employer Mandate and Responsibility Cost Containment Long-TermOverview Care HCR Timeline Provisions 2013     Medical FSA Limit of $2,500 W-2 Reporting (250+ W-2s in 2012) Taxes and Fees (CERF, Reinsurance, Medicare, etc.) Written notice of Exchanges (new hires included) 2014            Employer Mandate: Pay or Play (50+) (Delayed until 2015) Individual Mandate State/Federal Marketplace/Exchange (1-50=2014 & 1-100=2016) Adjusted Community Rating * (1-50, 2014 & 1-100, 2016) Guaranteed issued/Guaranteed renewability * (1-50=2014 & 1-100=2016) No Pre-Existing Conditions Must cover Essential Health Benefits (EHB) * (1-50=2014 & 1-100=2016) Deductible Limits* (2-50=2014 & 2-100=2016) Out of Pocket Expenses Limits * Health plans may not establish Annual Limits on EHB * 90 Day Limit on Waiting Periods * Does not apply to grandfathered plans
  6. 6. What can you do? Employer Mandate and Responsibility Cost Containment Long-TermOverview Care HCR Timeline Provisions 2014 Continued  Automatic Enrollment (200+)  Increased Wellness Program Incentives 2016  Employer Size Redefined - (Small group = 2-100 & Large group = >100)  Community Rating (1-100) 2017  Exchange for Large Employers (>100) 2018  Cadillac Tax * Does not apply to grandfathered plans
  7. 7. Individual Mandate 2017 and beyond: Annual adjustments 2016 Greater of $695 per person (cap of $2,085 per family) or 2.5% of household income 2015 Greater of $325 per person (cap of $975 per family) or 2% of household income 2014 Greater of $95 per person (cap of $285 per family) or 1% of household income Source: BCBS Exchange Webinar
  8. 8. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Employer Mandate Provisions “Applicable Large Employers” • Employers with 50 Full-Time Equivalents (FTEs) on average • Measured by looking at entire controlled group over prior calendar year Controlled Group: 1. 2. • Parent-child= business owns, directly or indirectly, at least 80% of another business. Brother-sister= 5 or fewer owners own at least 80% of 2 or more business & combined identical ownership of the common owners in each entity is more than 50%. Transition relief in 2013: employer can measure full-time equivalents for any continuous 6-month period in 2013 to determine 2014 large employer status; remove seasonal employees working less than120 days per year What is an FTE? • • • • Common law EE who, during the applicable calendar month, was employed on average at least 30 hours of service per week Number of FTEs = all part-time EE hours (up to 120 hours per EE) for the applicable calendar month divided by 120 Only count U.S. hours Leased EE rules do not apply Source: United Health Care
  9. 9. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Medical Loss Ratio Provisions Source: BCBS Exchange Webinar ($0.05) - MLR for small groups / individual plans = 80% - MLR for large groups = 85% - Carriers provide rebates by August 1 every year - Carriers rebate individuals directly for individual plans - Carriers rebate employer directly for group plans - Employer must follow certain rebate distribution rules Commissions Taxes ($0.024) Profits ($0.036) ($0.10) Claims ($0.80) Administrative Expense The health care reform components include new minimum loss ratios (MLR):
  10. 10. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Underwriting Changes Provisions For Small Group and Individual markets: Guaranteed Issue No health status rating (also known as adjusted community rating) 3:1 age rating bands CURRENT: Guarantee Issue only required in the small group market (2-50) today. For all size markets, pre-existing condition exclusions may apply for members without creditable coverage for 63+ days. Sources: National Association of Health Underwriters (NAHU), BCBS Exchange Webinar
  11. 11. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term of Pocket Deductible/Out Care Provisions Deductible/Out-of-Pocket Limits Deductible Limit - Applies to 2-50 market - $2,000 single/$4,000 family, increased by employer contribution to FSA Out of Pocket Limit - Applies to all markets (individual, small group, large group, and self-insured) - Copays apply to out of pocket limit - $6,350 individual/$12,700 family (no more than H.S.A. limits) Sources: BCBS Exchange Webinar
  12. 12. Metallic Levels Product Tier Requirements in Marketplace/Exchange: Platinum 90% actuarial value Gold 80% actuarial value All will include Essential Health Benefits Silver 70% actuarial value * Catastrophic plan for those under 30 and those over 30 whose premium would cost more than 8% of their income Bronze 60% actuarial value Actuarial Value = Total Expected Payments by Health Plans for EHBs / Total Costs of EHBs for the Standard Population Source: BCBS Exchange Webinar
  13. 13. What can you do? Employer Mandate and Responsibility Cost Containment QHP Long-Term Care Individual Premiums for Provisions Average premium across all Affordable Care Act plans offered in Georgia, effective January 1, 2014 Metallic Levels Age 27 Age 50 FAM Single FAM Couple Child Only Bronze $231 $394 $782 $531 $565 $140 Silver $276 $472 $935 $635 $675 $168 Gold $335 $568 $1,127 $765 $813 $202 Platinum $272 $463 $919 $624 $663 $165 Catastrophic $168 $285 $566 $384 $408 $101 Source: healthcare.gov
  14. 14. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care AffordableProvisions Coverage Group Unaffordable group coverage = Employee share of premium for single coverage greater than 9.5% of the employee’s W-2 income (lowest cost plan offered) 9.5% of Salary: The Amount Employee Contributions Cannot Exceed For Single Coverage in Lowest Cost Medical Plan W-2 Salary Annual Monthly $20,000 $1,900 $158.33 $30,000 $2,850 $237.50 $40,000 $3,800 $316.67 $50,000 $4,750 $395.83 $60,000 $5,700 $475.00 Source: CIGNA
  15. 15. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Income Eligibility Provisions Premium Tax Credit Eligibility - Employees with household income between 100% and 400% of the Federal Poverty Level (non Medicaid Eligible) Household Size 1 2 3 4 Medicaid Eligible Eligible for Premium Tax Credit 100% 400% $11,490 $15,510 $19,530 $23,550 $45,960 $62,040 $78,120 $94,200 Source: Calculations by Families USA based on data from the U.S. Department of Health and Human Services
  16. 16. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Amount of Premium Tax Credit Provisions If eligible for premium tax credit, the amount of premium you pay (and your corresponding premium tax credit) is based on your FPL household income. Household Income Level Premium as Percent of Income 100% FPL 2% of Income 150% FPL 4% of Income 200% FPL 6.3% of Income 250% FPL 8.05% of Income 300% -400%FPL 9.5% of Income Source: CIGNA
  17. 17. What can you do? Employer Mandate and Responsibility Long-Term Care Silver Cost Containment Plan Provisions Scenarios Pricing ANNUAL COSTS / ADVANCED PREMIUM TAX CREDIT (Subsidy) 26 year old single person (man or woman): 1) Income: $12K (just above FPL) - individual pays $240; receives $3,000 subsidy 2) Income: $35K - no subsidy; cost of silver plan is 9.5% of income Husband is 32, wife is 30, 1 year old daughter 1) Income: $20K (just above FPL) – family pays $400; receives $8,800 subsidy 2) Income: $60K (300% FPL) – family pays $5,700; receives $3,500 subsidy Husband is 47, wife is 42, kids are 25, 20, and 16 1) Income: $28K (at FPL) - family pays $560; receives $15,500 subsidy 2) Income: $84K (300% FPL) – family pays $8,000; receives $8,000 subsidy Husband is 62, wife is 62 1) Income: $16K (at FPL) – husband/wife pay $320; receive $17,600 subsidy 2) Income: $47K (300% FPL) – husband/wife pay $4,500; receive $13,500 subsidy Source: Atlanta Journal Constitution
  18. 18. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Employer Group Plan Provisions 2013 Early Renewal Option Option for Non-grandfathered Small Group / Individual Plans: - Delay higher rates of Adjusted Community Rating and other health care reform plan design requirements (deductibles, out of pocket limits, etc.) - Keep current plan design for 11 months of 2014 - Renew December 1, 2013 with a significantly lower increase than you would otherwise see at your 2014 renewal - Early renewal option may not benefit every group or individual and your health benefits broker should be reviewing these options with you now
  19. 19. What can you do? Employer Mandate and Responsibility Cost Containment SmallLong-Term Care Employer Tax Credit Provisions 25 or fewer employees + average wage less than $50,000: - Tax credit for employers with 25 or less employees and average wages than $50K - Starting in 2014, available on the Small Employer Health Options Plan (SHOP) Exchange/Marketplace only for first two years - Credit up to 50% of employer cost - Credits decrease on a sliding scale as avg. compensation increases *tax credit started for 2010 tax year (for employers with 25 or fewer employers) and currently offers a credit up to 35% Source: BCBS Exchange Webinar
  20. 20. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Employer Options Provisions
  21. 21. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Individual Mandate Provisions
  22. 22. Health Care Reform Importance of your Trusted Advisors • Benefits Broker • Accountant • Attorney • Financial Advisor Lean on your trusted advisors to understand upcoming changes!
  23. 23. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Questions? Provisions
  24. 24. What can you do? Employer Mandate and Responsibility Cost Containment Long-Term Care Thank you for your time. Provisions Lisa Owen, President, RHU CORE Benefit Solutions, LLC 404-478-2304 lowen@corebenefitsga.com Jennifer Gregory, Account Executive CORE Benefit Solutions, LLC 404-478-2305 jgregory@corebenefitsga.com

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