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Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
Affordable care act exchange 101
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Affordable care act exchange 101

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  • Not attorney, Not accountant We know the WHAT HCR is trying to achieve, it is the HOW that in many instances is still unknown As of June 11 th , 2013 changing almost weekly with guidance issued from HHS, DOL and IRS
  • Please be sure to ask a question if you have one, mostly likely someone in the room has the same question. That is exactly why we set up the break out session format – to encourage open dialog
  • Individual mandate is the foundation for the success or rather the stability of the Exchange Question is are the penalties enough to persuade or encourage enrollment especially for a young health individual Exempt from penalty: Religiously opposed Undocumented immigrant Incarcerated Member of Indian tribe Family income is below threshold for filing tax return
  • Rebranded by govt Marketplace. Promotes customer friendly platform to purchase insurance, customer experience
  • Individual mandate is the foundation for the success or rather the stability of the Exchange Question is are the penalties enough to persuade or encourage enrollment especially for a young health individual Exempt from penalty: Religiously opposed Undocumented immigrant Incarcerated Member of Indian tribe Family income is below threshold for filing tax return
  • Individual mandate is the foundation for the success or rather the stability of the Exchange Question is are the penalties enough to persuade or encourage enrollment especially for a young health individual Exempt from penalty: Religiously opposed Undocumented immigrant Incarcerated Member of Indian tribe Family income is below threshold for filing tax return
  • Marketplace = a new place to shop for and by health insurance Expedia -> Turbo Tax
  • Exchange = a new place to shop for and by health insurance Expedia -> Turbo Tax Rebranded by govt Marketplace
  • Exchange = a new place to shop for and by health insurance Expedia -> Turbo Tax Rebranded by govt Marketplace
  • Exchange = a new place to shop for and by health insurance Expedia -> Turbo Tax Rebranded by govt Marketplace
  • Exchange = a new place to shop for and by health insurance Expedia -> Turbo Tax Rebranded by govt Marketplace
  • Exchange = a new place to shop for and by health insurance Expedia -> Turbo Tax Rebranded by govt Marketplace
  • Exchange = a new place to shop for and by health insurance Expedia -> Turbo Tax Rebranded by govt Marketplace
  • Bronze plans will have the lowest monthly premium, but cost shares will be more when health care services are provided. Platinum plans will have the highest monthly premium, but cost shares will be less. Platinum = 90% -> Bronze = 60% Ambulatory, RX, maternity, mental health, preventive, etc Tax credit applies to assist with premium cost. Subsidies assist with out of pocket coverage cost (deductible, coinsurance)
  • Bronze plans will have the lowest monthly premium, but cost shares will be more when health care services are provided. Platinum plans will have the highest monthly premium, but cost shares will be less. Platinum = 90% -> Bronze = 60% Ambulatory, RX, maternity, mental health, preventive, etc Tax credit applies to assist with premium cost. Subsidies assist with out of pocket coverage cost (deductible, coinsurance)
  • Bronze plans will have the lowest monthly premium, but cost shares will be more when health care services are provided. Platinum plans will have the highest monthly premium, but cost shares will be less. Platinum = 90% -> Bronze = 60% Ambulatory, RX, maternity, mental health, preventive, etc Tax credit applies to assist with premium cost. Subsidies assist with out of pocket coverage cost (deductible, coinsurance)
  • Transcript

    • 1. People helping people…it’s what we do best. Health Insurance Exchange and Defined Contributions Health Planswww.kapnick.com
    • 2. Solutions for a Superior Workplace | Disclaimer The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reforms on individuals should be interpreted and applied. The impact of these reforms on individual situations may vary. The overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should no be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code. 2
    • 3. Solutions for a Superior Workplace | Agenda  Individual Mandate  What is an Exchange? Public vs. Private?  When will the Exchange be available?  How will Exchanges differ?  What is the estimated cost of coverage on the Exchange?  Employer Responsibility  Defined Contributions Health Plans  Q&A3
    • 4. Solutions for a Superior Workplace | Individual Mandate  Supreme Court issued its decision on June 28, 2012  5:4 ruling  The individual mandate is constitutional  Jan. 1, 2014: Individuals must enroll in coverage or pay a penalty  Penalty amount: Greater of $ amount or a % of income  2014 = $95 or 1%  2015 = $325 or 2%  2016 = $695 or 2.5%
    • 5. Solutions for a Superior Workplace | Health Insurance Marketplace Exchange  Marketplace
    • 6. Solutions for a Superior Workplace | Public vs. Private Marketplaces Difference between two types of Marketplaces:  Public  Private
    • 7. Solutions for a Superior Workplace | Public Marketplaces  Two Types of Public Marketplaces:  The public Health Insurance Marketplace is a state- or federal- run platform where individuals can obtain health insurance coverage. They will also be able to compare and choose health plans offered by private companies and find out if they are eligible for financial assistance  The Marketplaces will also operate a Small Business Health Options Program (SHOP). There, small employers can purchase a variety of plans, and then may choose to allow its employees to choose from plans it selects or one plan. HHS delayed multi-plan availability until 2015
    • 8. Solutions for a Superior Workplace | Marketplace Availability First Open Enrollment: October 1, 2013 - March 31, 2014 Coverage starts: January 1, 2014 for plan selections made by December 15, 2013 Annual Open Enrollment (after first year): October 15th - December 7th Coverage begins January 1 of the next year
    • 9. Solutions for a Superior Workplace | Public Marketplace Each State can choose to:  Create and run its own Marketplace – State-Based Marketplace  Partner with the federal government to run some Marketplace functions – Partnership Marketplace  Have a Marketplace that’s operated by the federal government - Federally-facilitated Marketplace Market Saturation • 52 million uninsured Americans • About half will explore the new Marketplace • About 19 million will be eligible for a premium subsidy
    • 10. Solutions for a Superior Workplace | States Marketplace Decisions Partnership Marketplace (7 states)State-based Marketplace (16 states and DC) Federally-facilitated Marketplace (27 states) WA OR WY UT* TX SD OK ND NM NV NE MT LA KS ID HI CO CA ARAZ AK WI WV VA TN SC OH NC MO MS MN MI KY IA INIL GA FL AL VT PA NY NJ NH MA ME CT DE RI MD DC * In Utah, the federal government will run the marketplace for individuals while the state will run the small business, or SHOP, marketplace. As of May 10, 2013
    • 11. Solutions for a Superior Workplace | Public Marketplaces – Online Application
    • 12. Solutions for a Superior Workplace | Public Marketplaces – Paper Application
    • 13. Solutions for a Superior Workplace | Marketplace Reform Mandates Health plans must comply with new market reforms: Fair Premiums: Health status and gender not used to set premiums; limits on age rating Guaranteed Renewability: Coverage must be renewed for all policyholders with limited exceptions Single Risk Pool: Issuers cannot use separate risk pools to charge certain customers’ higher rates Guaranteed Availability: Coverage must be offered to all comers, with limited exceptions
    • 14. Solutions for a Superior Workplace | Marketplace Reform Mandates The only factors that can be used to vary the premium rate for a plan in the individual or small group market are: Age | Family Status | Tobacco use | Geography Health plans cannot change premium rates based on: Health Status | Claims Experience | Gender
    • 15. Solutions for a Superior Workplace | Marketplace Reform Mandates  Health plans must be certified to be offered in a Marketplace, and must include 10 required Essential Health Benefits:  Ambulatory Patient Services  Emergency Services  Hospitalization  Maternity and Newborn Care  Mental Health and Substance Abuse  Prescription Drugs  Rehabilitative and Habilitative Services  Laboratory Services  Preventive and Wellness Services and Chronic Disease Management  Pediatric Services including oral and vision care
    • 16. Solutions for a Superior Workplace | Marketplace Reform Mandates All plans must provide at least 60% actuarial value minimum Actuarial Value is calculated as the percentage of total average costs that a subscriber will pay for covered services (e.g. copays, deductible, coinsurance, etc. Excludes premiums) Four levels of coverage on the exchanges: Bronze: Plans cover 60% of the costs Silver: Plans cover 70% of the costs Gold: Plans cover 80% of the costs Platinum: Plans cover 90% of the costs
    • 17. Solutions for a Superior Workplace | Marketplace Costs What might unsubsidized Marketplace plans cost? MI 25.8% Increase
    • 18. Solutions for a Superior Workplace | Marketplace Tax Credits and Subsidies Individuals might be eligible for tax credits or subsidies Who will be eligible?  Individuals at 100% - 400% Federal Poverty Level without access to affordable, minimum essential coverage that enroll in coverage through the Public Marketplace Who won’t be eligible?  Employees offered small or large employer plans that provide affordable, minimum value coverage  Individuals eligible for government-sponsored health care
    • 19. Solutions for a Superior Workplace | Notice of Exchange Employers must notify new and current employees of Marketplace information  Originally effective March 1, 2013 – Delayed  Temporary Guidance: no later than October 1, 2013 Virtually all employers must provide to full-time and part-time employees - subject to Fair Labor Standards Act (FLSA) – regardless if they offer coverage Department of Labor Model Notices available
    • 20. Solutions for a Superior Workplace | Notice of Exchange
    • 21. Solutions for a Superior Workplace | Defined Contribution Health Plans
    • 22. Solutions for a Superior Workplace | Defined Contribution Health Plans What is a Defined Contribution Health Plan? Why might Defined Contribution Plans be appropriate now? How does it work? Benefits to Employers and Employees
    • 23. Solutions for a Superior Workplace | Defined Contribution Health Plans What is a Defined Contribution Health Plan?  Employer gives employees a fixed contribution to purchase Health Coverage  Employee uses the funds to buy or help pay for an insurance plan they select themselves
    • 24. Solutions for a Superior Workplace | Defined Contribution Health Plans Why now?  Marketplace is electronic platform that allows and requires insurance carriers to provide multiple options  Continued cost increases from medical inflation and ACA mandates
    • 25. Solutions for a Superior Workplace | Defined Contribution Health Plans How does it work?
    • 26. Solutions for a Superior Workplace | Defined Contribution Health Plans Example A – One Carrier
    • 27. Solutions for a Superior Workplace | Defined Contribution Health Plans Sample Menu Choices for Employer PPO HMO $1000 Ded 80/20 $100 Ded 80/20 $1250 Ded HSA 80/20 $1300 Ded HSA 80/20 $2500 Ded HSA 80/20 $1500 Ded HSA 80/20 $3000 Ded HSA 80/20 $3000 Ded 80/20 $4000 Ded 70/30 $4000 Ded 70/30 PPO HMO $1000 Ded 80/20 $100 Ded 80/20 $1250 Ded HSA 80/20 $1300 Ded HSA 80/20 $2500 Ded HSA 80/20 $1500 Ded HSA 80/20 $3000 Ded HSA 80/20 $3000 Ded 80/20 $4000 Ded 70/30 $4000 Ded 70/30 Option A Option B
    • 28. Solutions for a Superior Workplace | Defined Contribution Health Plans Example B – Multi-carrier
    • 29. Solutions for a Superior Workplace | Defined Contribution Health Plans Benefits  Allows the employer to fix cost based on budget, not insurance rate increase  Allows an employee to select coverage that best fits their need and budget

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