ARA of GA

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. What can you do?
Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Employer Options
Provisions

21. What can you do?
Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Individual Mandate
Provisions

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. What can you do?
Employer Mandate and Responsibility
Cost Containment
Long-Term Care
Questions?
Provisions

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