SlideShare a Scribd company logo
1 of 14
““Obamacare” Compliance:Obamacare” Compliance:
How It Helps Self-funded PlansHow It Helps Self-funded Plans
Presented by:
Si Nahra, Ph.D., President
June 27, 2013
2
About Health Decisions, Inc.
Pioneering Specialists in Group Health CarePioneering Specialists in Group Health Care
Post-Payment AdministrationPost-Payment Administration
For Over 25 YearsFor Over 25 Years
RespectRespect for Existing Proceduresfor Existing Procedures
EmphasisEmphasis on Customizationon Customization
FocusFocus on Solutionson Solutions
Customer
Philosophy:
© Copyright 2013
Health Decisions, Inc.
Orientation towards our topic
• Distrust of government is an American value.
• Disrespect for anything the government does is not.
• Partisan politics do not apply.
© Copyright 2013
Health Decisions, Inc.
3
Presidents’ Policies
Presidents Health Policy Legacy
Roosevelt/Truman Social Security
Eisenhower Employment-based Benefits
Kennedy/Johnson Medicare/Medicaid
Nixon/Ford HMOs
Carter National Health Planning
Reagan Dismantle Carter program. Rely on Market Forces
Bush I Federally Qualified Health Centers
Clinton HIPAA
Bush II Medicare Part D (Rx)
Obama ACA and the Rise of the Consumer Market
Post-Obama 2016/17 may be tougher than 2014
4© Copyright 2013
Health Decisions, Inc.
Focus Today
Affordable Care Act
(Title I, Subtitles A, C, and F)
Self-funded Group Health Plans
•Shared Responsibility AKA Pay-or-Play
•Other related requirements
© Copyright 2013
Health Decisions, Inc.
5
Gauging Intent
• No lifetime limits
• Coverage of preventive health
• Extension of dependent
coverage
• Uniform explanation of coverage
• Standard plan comparisons
• Limits on coverage costs
• Common eligibility rules
• Confirmed offer of coverage
• Limits on out-of-pocket costs
• Taxes for research and risk
Who Benefits Most?
Individual consumers
Self-funded plan role?
Implementation
A way to get to individuals
© Copyright 2013
Health Decisions, Inc.
6
What Plan Compliance Means
1. Play by the same rules
2. Manage eligibility and enrollment
3. Pay taxes for research and risk
© Copyright 2013
Health Decisions, Inc.
7
1. Play by the same rules
Provision Consumer Impact Plan Consequence
Minimum Value Consumer knows what
they are getting and how it
compares
Easy to pass for most.
Out-of-pocket limits an
issue for some.
Spending accounts help.
Affordability Consumer costs for
getting coverage capped
at 9.5% of family income.
Easy to pass for most.
Issue for some low-wage
workers.
Per occurrence fine small and unlikely.
Out-of-pocket
accumulator
All consumer cost sharing
for services counts
towards limits tied to
spending accounts.
Brings order to chaos.
Many will need to re-do
cost sharing rules and
administration.
© Copyright 2013
Health Decisions, Inc.
8
2. Manage eligibility and enrollment
Provision Consumer Impact Plan Consequence
FTE Eligibility Same eligibility rules
apply wherever you go.
New process needed.
Brings direction to most
overlooked area.
Impacts certain groups
(hourly, seasonal) more.
Offer of enrollment Presents and explains
options.
Opportunity to take
Or
Obstacle to avoid
Overall fine can be large but easy to avoid.
© Copyright 2013
Health Decisions, Inc.
9
3. Pay taxes
Provision Consumer Impact Plan Consequence
Research None Disturbing precedent.
See slide 3: Distrust of
government is an
American value.
Risk
© Copyright 2013
Health Decisions, Inc.
10
Options
• Ignore
• Delay
• Fight
• Comply
© Copyright 2013
Health Decisions, Inc.
11
Why Comply?
• The Good
– Creating a market with comparable products
– Adopting uniform plan definitions
– Standardizing how individual liability is calculated
– Defining eligibility-enrollment-entitlement processes
• Outweighs the Bad
– Changes to existing policies and procedures
– Taxes
© Copyright 2013
Health Decisions, Inc.
12
131313
Past Webinars Available
Recordings of past webinars are available upon request, including:
• Mid-June 2013 – Employer Mandate Calculations Explained
• May 2013 – Pay or Play: A Bigger Challenge for TPAs than for Plans
• April 2013 - The Most Overlooked Part of Health Reform: Enrollee Communications
• March 2013 – Why Cost Sharing is not Working
• February 2013 – Loss of Fiduciary Control
• January 2013 – Top 10 Do’s and Don'ts of Data Warehousing
• December 2012 – Union Trusts: Health Reforms Most Overlooked Winner?
• November 2012 – Year-end Renewal and Bidding: Opportunities for Control and Savings
• October 2012 – The 5 Most Important Things an Effective Dependent Audit Should Include
• September 2012 – Old Question, New Twist: Is Self-funding Right for Your Group Health Plan?
• August 2012 – Are You Ready to Manage Your Health Plan Costs?
• June 2012 - Group Health Brokers’ Future: Disintermediation or Re-intermediation
For more information, please visit www.healthdecisions.com
Copyright Health Decisions, Inc.
6/2013
© Copyright 2013
Health Decisions, Inc.
14
For More Information
Contact
si@healthdecisions.com
734-451-2230
Connect with me on LinkedIn
Add me to your circles on Google+
Follow us on Twitter: @hlthdecisions
Like us on FaceBook

More Related Content

What's hot

North Chamber Hcr 20110630 Slideshare
North Chamber Hcr 20110630 SlideshareNorth Chamber Hcr 20110630 Slideshare
North Chamber Hcr 20110630 Slideshare
stevenhookstra
 
Sarah Gordon, CFSI
Sarah Gordon, CFSISarah Gordon, CFSI
Sarah Gordon, CFSI
Mad*Pow
 
Pulse - Allen Davis
Pulse - Allen DavisPulse - Allen Davis
Pulse - Allen Davis
WRONG PERSON
 
Jennifer Lee, BCBS MA Foundation
Jennifer Lee, BCBS MA FoundationJennifer Lee, BCBS MA Foundation
Jennifer Lee, BCBS MA Foundation
Mad*Pow
 
Wellness Powerpoint
Wellness PowerpointWellness Powerpoint
Wellness Powerpoint
OTR
 
Rolling HIP Presentation
Rolling HIP PresentationRolling HIP Presentation
Rolling HIP Presentation
HIP-ZA
 
Stratum Benefit Solutions Presentation
Stratum Benefit Solutions PresentationStratum Benefit Solutions Presentation
Stratum Benefit Solutions Presentation
guest1ae7db
 

What's hot (19)

North Chamber Hcr 20110630 Slideshare
North Chamber Hcr 20110630 SlideshareNorth Chamber Hcr 20110630 Slideshare
North Chamber Hcr 20110630 Slideshare
 
Synergies at Work: Realizing the Full Value of Health Investments
Synergies at Work: Realizing the Full Value of Health InvestmentsSynergies at Work: Realizing the Full Value of Health Investments
Synergies at Work: Realizing the Full Value of Health Investments
 
Sarah Gordon, CFSI
Sarah Gordon, CFSISarah Gordon, CFSI
Sarah Gordon, CFSI
 
Innovative Use of Data Mining/Warehousing for Employee Activation
Innovative Use of Data Mining/Warehousing for Employee ActivationInnovative Use of Data Mining/Warehousing for Employee Activation
Innovative Use of Data Mining/Warehousing for Employee Activation
 
HM312 Week 3
HM312 Week 3HM312 Week 3
HM312 Week 3
 
Pulse - Allen Davis
Pulse - Allen DavisPulse - Allen Davis
Pulse - Allen Davis
 
Primary Care Spend: A Chapter Focus
Primary Care Spend: A Chapter FocusPrimary Care Spend: A Chapter Focus
Primary Care Spend: A Chapter Focus
 
Fall 2009 Hod Presentation Ebp And Health Reform
Fall 2009 Hod Presentation  Ebp And Health ReformFall 2009 Hod Presentation  Ebp And Health Reform
Fall 2009 Hod Presentation Ebp And Health Reform
 
Risk Stratification in Mental Health using Big Data
Risk Stratification in Mental Health using Big DataRisk Stratification in Mental Health using Big Data
Risk Stratification in Mental Health using Big Data
 
Health Reform, Past and Present
Health Reform, Past and PresentHealth Reform, Past and Present
Health Reform, Past and Present
 
The Health Plan Board’s Role in Managing Risk
The Health Plan Board’s Role in Managing RiskThe Health Plan Board’s Role in Managing Risk
The Health Plan Board’s Role in Managing Risk
 
Challenges Facing Healthcare Delivery Systems
Challenges Facing Healthcare Delivery SystemsChallenges Facing Healthcare Delivery Systems
Challenges Facing Healthcare Delivery Systems
 
Jennifer Lee, BCBS MA Foundation
Jennifer Lee, BCBS MA FoundationJennifer Lee, BCBS MA Foundation
Jennifer Lee, BCBS MA Foundation
 
Post-Election Analysis of Health Care Legislative & Regulatory Trends
Post-Election Analysis of Health Care Legislative & Regulatory TrendsPost-Election Analysis of Health Care Legislative & Regulatory Trends
Post-Election Analysis of Health Care Legislative & Regulatory Trends
 
Wellness Powerpoint
Wellness PowerpointWellness Powerpoint
Wellness Powerpoint
 
A Charitable Life
A Charitable LifeA Charitable Life
A Charitable Life
 
Rolling HIP Presentation
Rolling HIP PresentationRolling HIP Presentation
Rolling HIP Presentation
 
Investments in Behavioral Health: Drivers and Outlook - Behavioral Health Cra...
Investments in Behavioral Health: Drivers and Outlook - Behavioral Health Cra...Investments in Behavioral Health: Drivers and Outlook - Behavioral Health Cra...
Investments in Behavioral Health: Drivers and Outlook - Behavioral Health Cra...
 
Stratum Benefit Solutions Presentation
Stratum Benefit Solutions PresentationStratum Benefit Solutions Presentation
Stratum Benefit Solutions Presentation
 

Viewers also liked (9)

205 canoa po-opuscoloriduzione vulnerabilità
205   canoa po-opuscoloriduzione vulnerabilità205   canoa po-opuscoloriduzione vulnerabilità
205 canoa po-opuscoloriduzione vulnerabilità
 
189 persone disabili come gestire l’antincendio e le emergenze
189   persone disabili come gestire l’antincendio e le emergenze189   persone disabili come gestire l’antincendio e le emergenze
189 persone disabili come gestire l’antincendio e le emergenze
 
381 somministrazione lavoro valurazione rischi
381   somministrazione lavoro valurazione rischi381   somministrazione lavoro valurazione rischi
381 somministrazione lavoro valurazione rischi
 
41 la tutela della salute e sicurezza dei volontari
41 la tutela della salute e sicurezza dei volontari41 la tutela della salute e sicurezza dei volontari
41 la tutela della salute e sicurezza dei volontari
 
12 misure lavoro-all_dic12_michele_scozzai_def
12   misure lavoro-all_dic12_michele_scozzai_def12   misure lavoro-all_dic12_michele_scozzai_def
12 misure lavoro-all_dic12_michele_scozzai_def
 
229 2015 attività di movimentazione di un copri tombino di cemento e int...
229   2015    attività di movimentazione di un copri tombino di cemento e int...229   2015    attività di movimentazione di un copri tombino di cemento e int...
229 2015 attività di movimentazione di un copri tombino di cemento e int...
 
282 cpt-rivista-anno6_n°01
282    cpt-rivista-anno6_n°01282    cpt-rivista-anno6_n°01
282 cpt-rivista-anno6_n°01
 
07 2016 sicurezza-agricoltura_gatti
07   2016   sicurezza-agricoltura_gatti07   2016   sicurezza-agricoltura_gatti
07 2016 sicurezza-agricoltura_gatti
 
Abaka 15 06-2015
Abaka 15 06-2015Abaka 15 06-2015
Abaka 15 06-2015
 

Similar to Health Decisions Webinar: Obamacare Compliance: How it Helps Self-funded Plans

Health Decisions Webinar: May 2013 obama care compliance 1 of 3
Health Decisions Webinar: May 2013 obama care compliance 1 of 3Health Decisions Webinar: May 2013 obama care compliance 1 of 3
Health Decisions Webinar: May 2013 obama care compliance 1 of 3
Si Nahra
 
10 minuteguidetohealthreform 10 minute guide
10 minuteguidetohealthreform 10 minute guide10 minuteguidetohealthreform 10 minute guide
10 minuteguidetohealthreform 10 minute guide
Chris K. Leslie
 
Stratum Benefit Solutions Presentation
Stratum Benefit Solutions PresentationStratum Benefit Solutions Presentation
Stratum Benefit Solutions Presentation
Patriciatucker
 
VistaNational Resource Library
VistaNational Resource LibraryVistaNational Resource Library
VistaNational Resource Library
rrobatzek
 
Strategic Plaaning Presentation - MGMA Nashville 2/11/2014
Strategic Plaaning Presentation - MGMA Nashville  2/11/2014Strategic Plaaning Presentation - MGMA Nashville  2/11/2014
Strategic Plaaning Presentation - MGMA Nashville 2/11/2014
William Cockrell
 
Benefits In The…T Workplace
Benefits In The…T WorkplaceBenefits In The…T Workplace
Benefits In The…T Workplace
nrmc
 
How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...
How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...
How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...
WEX Health Trends and Insights
 
The Business Case for QualityDecision making in todays health car.docx
The Business Case for QualityDecision making in todays health car.docxThe Business Case for QualityDecision making in todays health car.docx
The Business Case for QualityDecision making in todays health car.docx
anhcrowley
 

Similar to Health Decisions Webinar: Obamacare Compliance: How it Helps Self-funded Plans (20)

Tpa vs as os
Tpa vs as osTpa vs as os
Tpa vs as os
 
Health Decisions Webinar: May 2013 obama care compliance 1 of 3
Health Decisions Webinar: May 2013 obama care compliance 1 of 3Health Decisions Webinar: May 2013 obama care compliance 1 of 3
Health Decisions Webinar: May 2013 obama care compliance 1 of 3
 
Health Decisions Webinar: Employer Mandate Calculations Explained
Health Decisions Webinar: Employer Mandate Calculations ExplainedHealth Decisions Webinar: Employer Mandate Calculations Explained
Health Decisions Webinar: Employer Mandate Calculations Explained
 
10 minuteguidetohealthreform 10 minute guide
10 minuteguidetohealthreform 10 minute guide10 minuteguidetohealthreform 10 minute guide
10 minuteguidetohealthreform 10 minute guide
 
Stratum Benefit Solutions Presentation
Stratum Benefit Solutions PresentationStratum Benefit Solutions Presentation
Stratum Benefit Solutions Presentation
 
How Wellness Can Transform Your Benefits Solutions. Handout.
How Wellness Can Transform Your Benefits Solutions. Handout.How Wellness Can Transform Your Benefits Solutions. Handout.
How Wellness Can Transform Your Benefits Solutions. Handout.
 
Health Care Reform Preparedness: Strategies for Making Your Health Care More ...
Health Care Reform Preparedness: Strategies for Making Your Health Care More ...Health Care Reform Preparedness: Strategies for Making Your Health Care More ...
Health Care Reform Preparedness: Strategies for Making Your Health Care More ...
 
VistaNational Resource Library
VistaNational Resource LibraryVistaNational Resource Library
VistaNational Resource Library
 
Strategic Plaaning Presentation - MGMA Nashville 2/11/2014
Strategic Plaaning Presentation - MGMA Nashville  2/11/2014Strategic Plaaning Presentation - MGMA Nashville  2/11/2014
Strategic Plaaning Presentation - MGMA Nashville 2/11/2014
 
Find out the best medicare plans 2023 from best to worst.pdf
Find out the best medicare plans 2023 from best to worst.pdfFind out the best medicare plans 2023 from best to worst.pdf
Find out the best medicare plans 2023 from best to worst.pdf
 
Benefits In The…T Workplace
Benefits In The…T WorkplaceBenefits In The…T Workplace
Benefits In The…T Workplace
 
9 18 web presentation
9 18 web presentation9 18 web presentation
9 18 web presentation
 
How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...
How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...
How Health Plans Can Thrive in Today's Post-Reform Consumer Marketplace [Prev...
 
Health Decisions Webinar: December 2012 union trusts
Health Decisions Webinar: December 2012 union trustsHealth Decisions Webinar: December 2012 union trusts
Health Decisions Webinar: December 2012 union trusts
 
The Business Case for QualityDecision making in todays health car.docx
The Business Case for QualityDecision making in todays health car.docxThe Business Case for QualityDecision making in todays health car.docx
The Business Case for QualityDecision making in todays health car.docx
 
The Future of Personalizing Care Management & the Patient Experience
The Future of Personalizing Care Management & the Patient ExperienceThe Future of Personalizing Care Management & the Patient Experience
The Future of Personalizing Care Management & the Patient Experience
 
Hcr rotary version
Hcr rotary versionHcr rotary version
Hcr rotary version
 
Health Care Reform: What to Expect
Health Care Reform: What to Expect Health Care Reform: What to Expect
Health Care Reform: What to Expect
 
The Future of Employer Health Insurance
The Future of Employer Health InsuranceThe Future of Employer Health Insurance
The Future of Employer Health Insurance
 
Health reform webinair
Health reform webinairHealth reform webinair
Health reform webinair
 

More from Si Nahra

Health Decisions Webinar: Getting the Most out of Your Audit
Health Decisions Webinar: Getting the Most out of Your AuditHealth Decisions Webinar: Getting the Most out of Your Audit
Health Decisions Webinar: Getting the Most out of Your Audit
Si Nahra
 
Health Decisions Webinar: Your ACA Plan
Health Decisions Webinar: Your ACA PlanHealth Decisions Webinar: Your ACA Plan
Health Decisions Webinar: Your ACA Plan
Si Nahra
 

More from Si Nahra (15)

Health Decisions Webinar: ACA IRS Reporting -- Who Reports What?
Health Decisions Webinar: ACA IRS Reporting -- Who Reports What?Health Decisions Webinar: ACA IRS Reporting -- Who Reports What?
Health Decisions Webinar: ACA IRS Reporting -- Who Reports What?
 
Health Decisions Webinar: Getting the Most out of Your Audit
Health Decisions Webinar: Getting the Most out of Your AuditHealth Decisions Webinar: Getting the Most out of Your Audit
Health Decisions Webinar: Getting the Most out of Your Audit
 
Health Decisions Webinar: ACA Compliance Checklist - Are You Ready for 2015?
Health Decisions Webinar: ACA Compliance Checklist - Are You Ready for 2015?Health Decisions Webinar: ACA Compliance Checklist - Are You Ready for 2015?
Health Decisions Webinar: ACA Compliance Checklist - Are You Ready for 2015?
 
Health Decisions Webinar: The Status of ACA Compliance
Health Decisions Webinar: The Status of ACA ComplianceHealth Decisions Webinar: The Status of ACA Compliance
Health Decisions Webinar: The Status of ACA Compliance
 
Health Decisions Webinar: ACA Communication Requirements - An Employee Relati...
Health Decisions Webinar: ACA Communication Requirements - An Employee Relati...Health Decisions Webinar: ACA Communication Requirements - An Employee Relati...
Health Decisions Webinar: ACA Communication Requirements - An Employee Relati...
 
Health Decisions Webinar: April 2014 ACA Cost Sharing
Health Decisions Webinar: April 2014 ACA Cost SharingHealth Decisions Webinar: April 2014 ACA Cost Sharing
Health Decisions Webinar: April 2014 ACA Cost Sharing
 
Health Decisions Webinar: Your ACA Plan
Health Decisions Webinar: Your ACA PlanHealth Decisions Webinar: Your ACA Plan
Health Decisions Webinar: Your ACA Plan
 
Health Decisions Webinar: The Future of ACA and Benefit Communication
Health Decisions Webinar: The Future of ACA and Benefit CommunicationHealth Decisions Webinar: The Future of ACA and Benefit Communication
Health Decisions Webinar: The Future of ACA and Benefit Communication
 
Health Decisions Webinar: Secret Provider Agreements -- Where They Came From....
Health Decisions Webinar: Secret Provider Agreements -- Where They Came From....Health Decisions Webinar: Secret Provider Agreements -- Where They Came From....
Health Decisions Webinar: Secret Provider Agreements -- Where They Came From....
 
Health Decisions Webinar: July 2013 auditing pbm oversight
Health Decisions Webinar: July 2013 auditing   pbm oversightHealth Decisions Webinar: July 2013 auditing   pbm oversight
Health Decisions Webinar: July 2013 auditing pbm oversight
 
Health Decisions Webinar: January 2013 data warehouses
Health Decisions Webinar: January 2013 data warehousesHealth Decisions Webinar: January 2013 data warehouses
Health Decisions Webinar: January 2013 data warehouses
 
Health Decisions Webinar: October 2012 Things an Effective DEA Should Include
Health Decisions Webinar: October 2012 Things an Effective DEA Should IncludeHealth Decisions Webinar: October 2012 Things an Effective DEA Should Include
Health Decisions Webinar: October 2012 Things an Effective DEA Should Include
 
Health Decisions Webinar: The Five Levers of Management Control for Your Heal...
Health Decisions Webinar: The Five Levers of Management Control for Your Heal...Health Decisions Webinar: The Five Levers of Management Control for Your Heal...
Health Decisions Webinar: The Five Levers of Management Control for Your Heal...
 
Health Decisions Webinar: Health Data: Plan Control Starts Here
Health Decisions Webinar: Health Data: Plan Control Starts HereHealth Decisions Webinar: Health Data: Plan Control Starts Here
Health Decisions Webinar: Health Data: Plan Control Starts Here
 
Health Decisions Webinar: Health Reform: A Contrarian's Perspective
Health Decisions Webinar: Health Reform: A Contrarian's PerspectiveHealth Decisions Webinar: Health Reform: A Contrarian's Perspective
Health Decisions Webinar: Health Reform: A Contrarian's Perspective
 

Recently uploaded

Recently uploaded (20)

FEXLE- Salesforce Field Service Lightning
FEXLE- Salesforce Field Service LightningFEXLE- Salesforce Field Service Lightning
FEXLE- Salesforce Field Service Lightning
 
Revolutionizing Industries: The Power of Carbon Components
Revolutionizing Industries: The Power of Carbon ComponentsRevolutionizing Industries: The Power of Carbon Components
Revolutionizing Industries: The Power of Carbon Components
 
How Do Venture Capitalists Make Decisions?
How Do Venture Capitalists Make Decisions?How Do Venture Capitalists Make Decisions?
How Do Venture Capitalists Make Decisions?
 
Raising Seed Capital by Steve Schlafman at RRE Ventures
Raising Seed Capital by Steve Schlafman at RRE VenturesRaising Seed Capital by Steve Schlafman at RRE Ventures
Raising Seed Capital by Steve Schlafman at RRE Ventures
 
Vendors of country report usefull datass
Vendors of country report usefull datassVendors of country report usefull datass
Vendors of country report usefull datass
 
Special Purpose Vehicle (Purpose, Formation & examples)
Special Purpose Vehicle (Purpose, Formation & examples)Special Purpose Vehicle (Purpose, Formation & examples)
Special Purpose Vehicle (Purpose, Formation & examples)
 
Unlock Your TikTok Potential: Free TikTok Likes with InstBlast
Unlock Your TikTok Potential: Free TikTok Likes with InstBlastUnlock Your TikTok Potential: Free TikTok Likes with InstBlast
Unlock Your TikTok Potential: Free TikTok Likes with InstBlast
 
How to refresh to be fit for the future world
How to refresh to be fit for the future worldHow to refresh to be fit for the future world
How to refresh to be fit for the future world
 
Cracking the Change Management Code Main New.pptx
Cracking the Change Management Code Main New.pptxCracking the Change Management Code Main New.pptx
Cracking the Change Management Code Main New.pptx
 
TriStar Gold Corporate Presentation May 2024
TriStar Gold Corporate Presentation May 2024TriStar Gold Corporate Presentation May 2024
TriStar Gold Corporate Presentation May 2024
 
Shoe Deodorizer Manufacturing Plant Project Report.pptx
Shoe Deodorizer Manufacturing Plant Project Report.pptxShoe Deodorizer Manufacturing Plant Project Report.pptx
Shoe Deodorizer Manufacturing Plant Project Report.pptx
 
Potato Flakes Manufacturing Plant Project Report.pdf
Potato Flakes Manufacturing Plant Project Report.pdfPotato Flakes Manufacturing Plant Project Report.pdf
Potato Flakes Manufacturing Plant Project Report.pdf
 
HAL Financial Performance Analysis and Future Prospects
HAL Financial Performance Analysis and Future ProspectsHAL Financial Performance Analysis and Future Prospects
HAL Financial Performance Analysis and Future Prospects
 
Using Generative AI for Content Marketing
Using Generative AI for Content MarketingUsing Generative AI for Content Marketing
Using Generative AI for Content Marketing
 
Innomantra Viewpoint - Building Moonshots : May-Jun 2024.pdf
Innomantra Viewpoint - Building Moonshots : May-Jun 2024.pdfInnomantra Viewpoint - Building Moonshots : May-Jun 2024.pdf
Innomantra Viewpoint - Building Moonshots : May-Jun 2024.pdf
 
A Brief Introduction About Jacob Badgett
A Brief Introduction About Jacob BadgettA Brief Introduction About Jacob Badgett
A Brief Introduction About Jacob Badgett
 
LinkedIn Masterclass Techweek 2024 v4.1.pptx
LinkedIn Masterclass Techweek 2024 v4.1.pptxLinkedIn Masterclass Techweek 2024 v4.1.pptx
LinkedIn Masterclass Techweek 2024 v4.1.pptx
 
Event Report - IBM Think 2024 - It is all about AI and hybrid
Event Report - IBM Think 2024 - It is all about AI and hybridEvent Report - IBM Think 2024 - It is all about AI and hybrid
Event Report - IBM Think 2024 - It is all about AI and hybrid
 
Meaningful Technology for Humans: How Strategy Helps to Deliver Real Value fo...
Meaningful Technology for Humans: How Strategy Helps to Deliver Real Value fo...Meaningful Technology for Humans: How Strategy Helps to Deliver Real Value fo...
Meaningful Technology for Humans: How Strategy Helps to Deliver Real Value fo...
 
Equinox Gold Corporate Deck May 24th 2024
Equinox Gold Corporate Deck May 24th 2024Equinox Gold Corporate Deck May 24th 2024
Equinox Gold Corporate Deck May 24th 2024
 

Health Decisions Webinar: Obamacare Compliance: How it Helps Self-funded Plans

  • 1. ““Obamacare” Compliance:Obamacare” Compliance: How It Helps Self-funded PlansHow It Helps Self-funded Plans Presented by: Si Nahra, Ph.D., President June 27, 2013
  • 2. 2 About Health Decisions, Inc. Pioneering Specialists in Group Health CarePioneering Specialists in Group Health Care Post-Payment AdministrationPost-Payment Administration For Over 25 YearsFor Over 25 Years RespectRespect for Existing Proceduresfor Existing Procedures EmphasisEmphasis on Customizationon Customization FocusFocus on Solutionson Solutions Customer Philosophy: © Copyright 2013 Health Decisions, Inc.
  • 3. Orientation towards our topic • Distrust of government is an American value. • Disrespect for anything the government does is not. • Partisan politics do not apply. © Copyright 2013 Health Decisions, Inc. 3
  • 4. Presidents’ Policies Presidents Health Policy Legacy Roosevelt/Truman Social Security Eisenhower Employment-based Benefits Kennedy/Johnson Medicare/Medicaid Nixon/Ford HMOs Carter National Health Planning Reagan Dismantle Carter program. Rely on Market Forces Bush I Federally Qualified Health Centers Clinton HIPAA Bush II Medicare Part D (Rx) Obama ACA and the Rise of the Consumer Market Post-Obama 2016/17 may be tougher than 2014 4© Copyright 2013 Health Decisions, Inc.
  • 5. Focus Today Affordable Care Act (Title I, Subtitles A, C, and F) Self-funded Group Health Plans •Shared Responsibility AKA Pay-or-Play •Other related requirements © Copyright 2013 Health Decisions, Inc. 5
  • 6. Gauging Intent • No lifetime limits • Coverage of preventive health • Extension of dependent coverage • Uniform explanation of coverage • Standard plan comparisons • Limits on coverage costs • Common eligibility rules • Confirmed offer of coverage • Limits on out-of-pocket costs • Taxes for research and risk Who Benefits Most? Individual consumers Self-funded plan role? Implementation A way to get to individuals © Copyright 2013 Health Decisions, Inc. 6
  • 7. What Plan Compliance Means 1. Play by the same rules 2. Manage eligibility and enrollment 3. Pay taxes for research and risk © Copyright 2013 Health Decisions, Inc. 7
  • 8. 1. Play by the same rules Provision Consumer Impact Plan Consequence Minimum Value Consumer knows what they are getting and how it compares Easy to pass for most. Out-of-pocket limits an issue for some. Spending accounts help. Affordability Consumer costs for getting coverage capped at 9.5% of family income. Easy to pass for most. Issue for some low-wage workers. Per occurrence fine small and unlikely. Out-of-pocket accumulator All consumer cost sharing for services counts towards limits tied to spending accounts. Brings order to chaos. Many will need to re-do cost sharing rules and administration. © Copyright 2013 Health Decisions, Inc. 8
  • 9. 2. Manage eligibility and enrollment Provision Consumer Impact Plan Consequence FTE Eligibility Same eligibility rules apply wherever you go. New process needed. Brings direction to most overlooked area. Impacts certain groups (hourly, seasonal) more. Offer of enrollment Presents and explains options. Opportunity to take Or Obstacle to avoid Overall fine can be large but easy to avoid. © Copyright 2013 Health Decisions, Inc. 9
  • 10. 3. Pay taxes Provision Consumer Impact Plan Consequence Research None Disturbing precedent. See slide 3: Distrust of government is an American value. Risk © Copyright 2013 Health Decisions, Inc. 10
  • 11. Options • Ignore • Delay • Fight • Comply © Copyright 2013 Health Decisions, Inc. 11
  • 12. Why Comply? • The Good – Creating a market with comparable products – Adopting uniform plan definitions – Standardizing how individual liability is calculated – Defining eligibility-enrollment-entitlement processes • Outweighs the Bad – Changes to existing policies and procedures – Taxes © Copyright 2013 Health Decisions, Inc. 12
  • 13. 131313 Past Webinars Available Recordings of past webinars are available upon request, including: • Mid-June 2013 – Employer Mandate Calculations Explained • May 2013 – Pay or Play: A Bigger Challenge for TPAs than for Plans • April 2013 - The Most Overlooked Part of Health Reform: Enrollee Communications • March 2013 – Why Cost Sharing is not Working • February 2013 – Loss of Fiduciary Control • January 2013 – Top 10 Do’s and Don'ts of Data Warehousing • December 2012 – Union Trusts: Health Reforms Most Overlooked Winner? • November 2012 – Year-end Renewal and Bidding: Opportunities for Control and Savings • October 2012 – The 5 Most Important Things an Effective Dependent Audit Should Include • September 2012 – Old Question, New Twist: Is Self-funding Right for Your Group Health Plan? • August 2012 – Are You Ready to Manage Your Health Plan Costs? • June 2012 - Group Health Brokers’ Future: Disintermediation or Re-intermediation For more information, please visit www.healthdecisions.com Copyright Health Decisions, Inc. 6/2013
  • 14. © Copyright 2013 Health Decisions, Inc. 14 For More Information Contact si@healthdecisions.com 734-451-2230 Connect with me on LinkedIn Add me to your circles on Google+ Follow us on Twitter: @hlthdecisions Like us on FaceBook

Editor's Notes

  1. We want to pose initial questions to participants at this point: Are you a self-funded plan (choose one) __fiduciary __manager __advisor __administrator What is the approximate number of active employees in the self-funded plan you represent? __under 100 __100-1000 __1000 to 5000 __over 5000 What is the approximate number of retirees in the self-funded plan you represent? __ none __under 100 __100-1000 __1000 to 5000 __over 5000