Introductory information on the ACA or Affordable Care Act

2.  Affordable Care Act 101
 Subsidies and Plans
 Open Enrollment Rules and Deadlines
 The Future of Healthcare
 Why Marketplace Nebraska?

3.  Clients Asking:
 Does the Affordable Care Act affect me?
 How do I get a tax subsidy?
 How do I enroll in the Marketplace?
 What are the Bronze, Silver, Gold, and
Platinum Plans?
 What are cost sharing reduction plans and
who qualifies for them?

5.  The Patient Protection and Affordable
care Act (PPACA) was signed into law on
March 23, 2010.
 Various portions of the law began being
implemented in 2010 and will continue
until 2018.
 Federal and state governments are largely
implementing these provisions.
◦ *PPACA does not affect those on Medicare, or
covered under the VA, Tricare system

6.  Covering the Uninsured & Underinsured
population
◦ Approximately 32 million more Americans
 Improving the Transparency and Ease of
Purchasing Health Insurance.
◦ The Exchange System
 Creating National Standards
◦ Essential Health Benefits (EHBs)
 Standardizing Benefit Packages
◦ Summary of Benefits
 Reducing medical and Insurance Costs

7.  Guarantee Issued. Cannot be denied coverage
 No Pre Existing Condition Limitations
 Comprehensive coverage
 Essential health benefits
 Tax Subsidies to offset premium

8. 8
PPACA regulations as of today

9. Sec. 1302(b)(1)
Services covered
include:
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including
behavioral health treatment
• Prescription drugs
• Rehabilitation and Rehabilitative services & devices
• Laboratory services
• Preventative and Wellness services and Chronic Disease
Management
• Pediatric services, including oral & vision care

10. 10
Employer Impacts Description Small Group
Fully Insured
Large Group
Fully Insured
Self-
Funded
Individual
1
Essential Health
Benefits (EHB) *
• Health Plans must provide Essential
Health Benefits for individual and
small group
Yes No No Yes
2
OOP Max * • OOP limits must comply with OOP
limits for HSA plans
• All cost sharing (including copays)
for EHB services must count toward
OOPM
Yes Yes Yes Yes
3
Deductible
Limits *
• Beginning 2014 plan design
deductibles may not exceed a $2,000
(self-only) or $4,000 (other than self-
only) annual limitation
Yes No No No
4
Metallic Levels • Four tiers of coverage for EHB
packages: Bronze, Silver, Gold, and
Platinum and catastrophic coverage
(under 30-year-olds only)
• Requirement to meet actuarial value
of one of four plans
• Requirement in and out of Exchange
Yes No No Yes
Pre-existing
Condition
Exclusion
(All Ages)
• Beginning in 2014, pre-existing
condition exclusions must be
removed for all members, not just
those under age 19
Yes Yes Yes Yes
For many 2014 provisions, we are awaiting further
guidance. Information will be updated.
* Not required for grandfathered plans

11. 90%
actuarial
value
80%
actuarial
value 60%
actuarial
value
70%
actuarial
value
11
Platinum
Plan
Gold
Plan
Bronze
Plan
Silver
Plan

12. Proprietary Information of UnitedHealth Group.
Do not distribute or reproduce without express
permission of UnitedHealth Group. 12

13. Household Size 100% 133% 150% 200%
250%
300% 400%
1 $11,670 $15,521 $17,505 $23,340
$29,175
$35,010 $46,680
2 15,730 20,921 23,595 31,460
39,325
47,190 62,920
3 19,790 26,321 29,685 39,580
49,475
59,370 79,160
4 23,850 31,721 35,775 47,700
59,625
71,550 95,400
5 27,910 37,120 41,865 55,820
69,775
83,730 111,640
6 31,970 42,520 47,955 63,940
79,925
95,910 127,880
7 36,030 47,920 54,045 72,060
90,075
108,090 144,120
8 40,090 53,320 60,135 80,180
100,225
120,270 160,360

15.  Starts November 15th 2014
 Ends February 15th 2015
 If enrolled after the 15th, the effective date is
not for the immediate month but for the nest
month out

16.  Overall, 30 percent of employers will definitely or
probably stop offering ESI in the years after 2014.
 Businesses with fewer than 50 full-time employees
most impacted by potential to seek alternative
insurance and compensation models
 At least 30 percent of employers would gain
economically from dropping coverage even if they
completely compensated employees for the change
through other benefit offerings or higher salaries.
 Move toward a more informed and engaged approach
to selecting and managing your health

17. CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations Group
May 2, 2014 (202) 690-6145 or
press@cms.hhs.gov
Administration announces proposal to clarify availability
of Health Insurance Marketplace coverage to workers eligible for
COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing
workers of their eligibility to continue health-care coverage through the Consolidated Omnibus
Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA
continuation coverage when leaving a job, they may choose to instead purchase coverage through
the Health Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of
money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of
Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in
helping workers and families maintain coverage after a job loss, and it is important that workers
know that in some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be
informed of their right to COBRA continuation coverage at the start of employment. They must also
be informed of their right to purchase COBRA coverage when separating from a job. The proposed
changes to the model notices would offer information on more affordable options available through
the Marketplace, where workers and families may be eligible for financial assistance that would not
otherwise be available for COBRA continuation coverage. In most cases, workers and their families
eligible for, but not enrolled in, COBRA continuation coverage would be able to enroll in Marketplace
coverage outside of the normal open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,”
said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight
million enrollees, we know that the Marketplace is working and is providing consumers with
additional choices and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently
asked questions related to the proposed changes to model notices. The FAQs are posted on the
Department of Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website
at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html.
In addition, HHS is publishing a clarifying bulletin regarding a special enrollment period in the
Marketplace for individuals already enrolled in COBRA continuation coverage. The bulletin is posted
on the HHS website at http://www.cms.gov/CCIIO/Resources/Regulations-and-
Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf.
The updated model notices are posted on the Department of Labor website at
http://www.dol.gov/ebsa/modelgeneralnotice.doc and
http://www.dol.gov/ebsa/modelelectionnotice.doc. A related notice of proposed rulemaking on the
COBRA notice requirements will be published in the May 7 edition of the Federal Register. The notice
of proposed rulemaking can also be viewed here at http://www.dol.gov/ebsa/pdf/cobranprm.pdf.
#
CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations Group
May 2, 2014 (202) 690-6145 or
press@cms.hhs.gov
Administration announces proposal to clarify availability
of Health Insurance Marketplace coverage to workers eligible for
COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing
workers of their eligibility to continue health-care coverage through the Consolidated Omnibus
Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA
continuation coverage when leaving a job, they may choose to instead purchase coverage through
the Health Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of
money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of
Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in
helping workers and families maintain coverage after a job loss, and it is important that workers
know that in some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be
informed of their right to COBRA continuation coverage at the start of employment. They must also
be informed of their right to purchase COBRA coverage when separating from a job. The proposed
changes to the model notices would offer information on more affordable options available through
the Marketplace, where workers and families may be eligible for financial assistance that would not
otherwise be available for COBRA continuation coverage. In most cases, workers and their families
eligible for, but not enrolled in, COBRA continuation coverage would be able to enroll in Marketplace
coverage outside of the normal open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,”
said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight
million enrollees, we know that the Marketplace is working and is providing consumers with
additional choices and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently
asked questions related to the proposed changes to model notices. The FAQs are posted on the
Department of Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website
at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html.
In addition, HHS is publishing a clarifying bulletin regarding a special enrollment period in the
Marketplace for individuals already enrolled in COBRA continuation coverage. The bulletin is posted
on the HHS website at http://www.cms.gov/CCIIO/Resources/Regulations-and-
Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf.
The updated model notices are posted on the Department of Labor website at
http://www.dol.gov/ebsa/modelgeneralnotice.doc and
http://www.dol.gov/ebsa/modelelectionnotice.doc. A related notice of proposed rulemaking on the
COBRA notice requirements will be published in the May 7 edition of the Federal Register. The notice
of proposed rulemaking can also be viewed here at http://www.dol.gov/ebsa/pdf/cobranprm.pdf.
#
CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations
Group
May 2, 2014 (202) 690-6145 or press@cms.hhs.gov
Administration announces proposal to clarify availability
of Health Insurance Marketplace coverage to workers eligible for COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing
workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget
Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation
coverage when leaving a job, they may choose to instead purchase coverage through the Health
Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of money by
instead purchasing health insurance through the Marketplace,” said Assistant Secretary of Labor for
Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in helping
workers and families maintain coverage after a job loss, and it is important that workers know that in
some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be informed
of their right to COBRA continuation coverage at the start of employment. They must also be informed of
their right to purchase COBRA coverage when separating from a job. The proposed changes to the model
notices would offer information on more affordable options available through the Marketplace, where
workers and families may be eligible for financial assistance that would not otherwise be available for
COBRA continuation coverage. In most cases, workers and their families eligible for, but not enrolled in,
COBRA continuation coverage would be able to enroll in Marketplace coverage outside of the normal
open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,”
said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight million
enrollees, we know that the Marketplace is working and is providing consumers with additional choices
and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently asked
questions related to the proposed changes to model notices. The FAQs are posted on the Department of
Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website at
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html. In

18.  GAP Plans can help cover cost of rising
deductibles
 Stand alone hospitalization, accident, and
critical illness plans can address specific
concerns
 Disability insurance helps minimize loss of
income if unable to work due to injury or
illness

19.  Experienced
 Trusted
 Licensed and insured
 Team of Licensed Professionals
 Creative solutions for a ever changing world
 Local assistance and support
Visit us at:
www.marketplacenebraska.com