Presentation on the Affordable Care Act given by J.P. Wieski, Legislative Liaison/Public Information Officer from the Office of the Commissioner of Insurance, State of Wisconsin to De Pere Area Chamber of Commerce on 9/11/13.
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
Learn how you can successfully navigate the Affordable Care Act, "Obama Care".
This easy to read outline will benefit your family and business.
Call (816-224-9466) for more information today.
Understanding the ObamaCare North Carolina Health Insurance Plans
As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with an effective date January 1, 2014 or after:Individuals cannot be declined for health insurance or charged more due to their health status or gender.
Insurance premiums are based on age, your zip code and tobacco usage.
Coverage limitations or exclusions based on pre-existing conditions are not allowed.
Elimination of annual and lifetime coverage limits.
Prohibition of declining an individual for coverage based on their participation in an approved clinical trial.
Maternity and mental health are included on all policies.
Preventative dental is covered with a $25 copay for members up to age 19. There is also some vision coverage for this age group.
Whether or not your children are students they can stay on your policy until age 26.
Introduction of the Medical Loss Ratio (MLR) which ensures that 80% of the premium dollars paid to the health insurance issuer are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders
http://www.hisonc.com/obamacare-north-carolina
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
The Patient Protection and Affordable Care Act (Obama Care) provides opportunities for individuals and very small businesses to obtain affordable health insurance. More people will be covered in states like California which are expanding Medicaid (Medi-Cal) coverage. It is a complicated law but we hope that this presentation can give a suitable overview for the way the law is being implemented in the State of California.
Health-Care Reform: Replacing Myths with FactsDolf Dunn
Emotions and financial decisions rarely ever go well together, so it is critical to understand how (if any) the new health care program will affect you and your family.
Annual report presented on 3/8/2012 at the Chairman\'s Gala for the De Pere Area Chamber of Commerce. Features highlights of organization\'s formation 125 years ago
De Pere Area Chamber, Lori Compas, Wisconsin Business Alliance, ACA 9-11-13Cheryl Detrick
Presentation on the Affordable Care Act given by Lori Compas, Executive Director of the Wisconsin Business Alliance and its sister foundation to De Pere Area Chamber of Commerce on 9/11/13.
De Pere Area Chamber Affordable Care Act Presentation, David Grunke, Manager ...Cheryl Detrick
Presentation on the Affordable Care Act given by David Grunke, Manager Strategic Accounts, WPS Health Insurance/Arise Health Plan to De Pere Area Chamber of Commerce on 9/11/13.
Learn how you can successfully navigate the Affordable Care Act, "Obama Care".
This easy to read outline will benefit your family and business.
Call (816-224-9466) for more information today.
Understanding the ObamaCare North Carolina Health Insurance Plans
As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with an effective date January 1, 2014 or after:Individuals cannot be declined for health insurance or charged more due to their health status or gender.
Insurance premiums are based on age, your zip code and tobacco usage.
Coverage limitations or exclusions based on pre-existing conditions are not allowed.
Elimination of annual and lifetime coverage limits.
Prohibition of declining an individual for coverage based on their participation in an approved clinical trial.
Maternity and mental health are included on all policies.
Preventative dental is covered with a $25 copay for members up to age 19. There is also some vision coverage for this age group.
Whether or not your children are students they can stay on your policy until age 26.
Introduction of the Medical Loss Ratio (MLR) which ensures that 80% of the premium dollars paid to the health insurance issuer are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders
http://www.hisonc.com/obamacare-north-carolina
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
The Patient Protection and Affordable Care Act (Obama Care) provides opportunities for individuals and very small businesses to obtain affordable health insurance. More people will be covered in states like California which are expanding Medicaid (Medi-Cal) coverage. It is a complicated law but we hope that this presentation can give a suitable overview for the way the law is being implemented in the State of California.
Health-Care Reform: Replacing Myths with FactsDolf Dunn
Emotions and financial decisions rarely ever go well together, so it is critical to understand how (if any) the new health care program will affect you and your family.
Annual report presented on 3/8/2012 at the Chairman\'s Gala for the De Pere Area Chamber of Commerce. Features highlights of organization\'s formation 125 years ago
De Pere Area Chamber, Lori Compas, Wisconsin Business Alliance, ACA 9-11-13Cheryl Detrick
Presentation on the Affordable Care Act given by Lori Compas, Executive Director of the Wisconsin Business Alliance and its sister foundation to De Pere Area Chamber of Commerce on 9/11/13.
De Pere Area Chamber Affordable Care Act Presentation, David Grunke, Manager ...Cheryl Detrick
Presentation on the Affordable Care Act given by David Grunke, Manager Strategic Accounts, WPS Health Insurance/Arise Health Plan to De Pere Area Chamber of Commerce on 9/11/13.
Debra Verstegen, Dickenshied Cravillion Insurance Services, presentation to De Pere Area Chamber of Commerce February 13th, 2013 De Pere at Dawn. "Financial Fitness" panel
De Pere Area Chamber Affordable Care Act Presentation, Daren Allen, Common Gr...Cheryl Detrick
Presentation on the Affordable Care Act given by Daren Allen, Vice President of Sales & Business Development for the Common Ground Healthcare Cooperative to De Pere Area Chamber of Commerce on 9/11/13.
Kaitlin Gilles from Green Bay Packaging gave this great presentation at our De Pere at Dawn in September 2014. We all know about recycling, but what else can businesses and individuals do to be more sustainable.
Fraser Trebilcock teamed up with Lansing Regional Chamber of Commerce to present a free seminar to help employers keep up with changes related to Health Care Reform. This is the fourth presentation in the Business Education Series, titled "Navigating the ACA Marketplace: Guidance for Small Businesses and Individuals". Michael James, Senior Health Care and Business Attorney from Fraser Trebilcock, presented the keynote presentation.
Get ready for the Affordable Care Act. The light you see is the oncoming train!
Lot's of things happening, not too many answers and it will take a few years to flesh it all out.
Health Reform Alert - Implementation Guidance FAQsCBIZ, Inc.
The ACA’s governing agencies (Labor, HHS and IRS) have issued their 18th set of implementation FAQs, further defining certain aspects of the Affordable Care Act, as well as how the law coordinates with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Following are highlights of this guidance.
Learn more at www.cbiz.com
Presentation from INTEGRATED's Chuck Gooder, senior advisor, and Blake Sternard, the business analyst. The presentation focuses on the ways to identify the major changes of healthcare, with specific attention to the potential challenges posed to enrollees, physicians, hospitals, and healthcare organizations associated with the implementation of Obamacare.
Similar to De Pere Area Chamber Affordable Care Act Presentation, JP Wieski, Wisconsin OCI (20)
At De Pere at Dawn on 3/14 for "Healthy Living for Spring," lead physical therapist for Aurora BayCare Sport Medicine, Corey Kunzer, presented on the new trend of running barefoot. Fascinating!!
From 3/14 De Pere at Dawn, Healthy Living for Spring, Prevea dietician Deb Guenterberg presented on "Super Foods" -- how many do you include in your diet?
Benefits Of X De Pere At Dawn 3 12 By Xo FitnessCheryl Detrick
At our March 14th De Pere at Dawn, Ryan Jennings with xo fitness, presented the benefits of e(x)ercise and how to get started & keep going. Entertaining and informative!
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
3. Effective September 23, 2010
No lifetime dollar limits on coverage/limitations on annual dollar
limits
Dependent coverage to age 26
◦ WI law in place prior to PPACA
Coverage of preventive services without cost sharing
◦ Most WI insurers had in place prior to PPACA
Insurers are limited in the amount of administrative expenses
they can fund with premium dollars
No preexisting condition exclusions for children under age 19
5. Guaranteed Issue
Insurers must sell a health insurance policy to any person who applies
for coverage except in cases of fraud.
Individuals cannot be denied a policy due to a preexisting health
condition.
Insurers cannot exclude or limit coverage for a preexisting condition.
The Health Insurance Risk-Sharing Plan (HIRSP) currently provides
coverage to individuals who cannot obtain health insurance.
HIRSP ends December 31, 2013, because all consumers, regardless of
their health, have access to coverage in the private market.
6. Individual and small group plans must cover
essential health benefits (EHBs).
Ambulatory patient services Prescription drugs
Emergency services Rehabilitative and habilitative
services and devices
Hospitalization Laboratory services
Maternity and newborn care Preventive and wellness services
and chronic disease management
Mental health and substance use
disorder services, including
behavioral health treatment
Pediatric services, including oral
and vision care
7. Insurers in the individual and small group
markets may only take the following into
account when pricing their products:
Individual or family coverage;
The area of the state the policy is sold;
Age; and
Tobacco Use
8. Limited Access to Catastrophic Plans
What is catastrophic coverage?
◦ Plans with high deductibles and lower premiums.
◦ Includes coverage of 3 primary care visits and preventive
services with no out-of-pocket costs.
Who is eligible?
◦ Young adults under 30 years of age.
◦ Those who obtain a hardship waiver from the federal
exchange.
9. Individual and small group plans will be
categorized into 1 of 4 different metal tiers.
The tiers represent the average portion of
expected costs a plan will cover for an average
population.
Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
10. All plans will limit in-network, out-of-pocket
expenses to $6,350 for self only coverage and
$12,700 for family coverage.
Out-of-network services do not count toward
these limits.
For 2014, out-of-pocket expenses tied to
prescription drugs will not count toward these
out-of-pocket maximums if the prescription
drug plan is separate from the medical plan.
11. Generally, plans in the small group market cannot
have deductibles that exceed $2,000 for individual
coverage or $4,000 for family coverage.
A small group plan may exceed those limits if,
for example, an employer’s contribution to a
health savings account is available to offset
increases in excess of the $2,000/$4,000 limits.
12. What are the impacts of these
changes on plans and
consumers?
13. Health insurance premiums will increase, on
average, for the majority of people.
Many consumers in the individual market will
be required to “buy up.”
Younger, healthier people will pay more and
older individuals with greater health care needs
will pay less.
14. Few opportunities for consumers to keep their
current health insurance plans.
Insurers selling in certain areas of the state
today will change their service areas in 2014,
meaning their plans will not be available in
the same areas of the state as they are today.
15. Most consumers in the individual market will have one opportunity
a year to purchase coverage, unless a special enrollment period is
triggered.
The initial open enrollment period begins on October 1, 2013,
and ends March 31, 2014.
Open enrollment is defined as the time when you can sign up for
coverage, not when it is effective.
If you want coverage effective on January 1, 2014, you must
purchase health insurance by December 15, 2013.
If you wait until you are sick to purchase coverage and the open
enrollment period has ended, you will not be able to purchase a
plan until open enrollment in the fall.
16. Employers continue to be able to purchase
health insurance at anytime during the year.
Employers unable to meet contribution or
participation requirements may need to wait
to purchase coverage until a special
enrollment period is available from
November 15th through December 15th.
17. Is there a requirement to
purchase health insurance?
18. Beginning January 1, 2014, federal law requires
most individuals to have health insurance or
pay a penalty.
Those who do not have health insurance
coverage, or fit within an exemption, will pay
a federal tax penalty beginning in 2014.
19. Year Penalty
2014 Greater of $95 per adult, or 1% of taxable
income.
2015 Greater of $325 per adult, or 2% of taxable
income.
2016 Greater of $695 per adult, or 2.5% of taxable
income.
Post
2016
Penalty increases annually based on a cost-
of-living adjustment.
21. If an employer offers coverage to its full-time
employees, it must offer coverage to
employees working at least 30 hours per week
or face a penalty of $100 per day per member.
22. Employers with fewer than 50 full-time
equivalent employees are not required to offer
health insurance coverage to their employees.
23. PPACA creates Employer Shared Responsibility
requirements effective January 1, 2014.
The federal government delayed the
requirements and associated penalties, without
statutory authority, until 2015.
24. In 2015, federal law requires employers with 50 or
more employees who work the equivalent of 30 or
more hours per week to offer affordable health
insurance.
Penalty:
Employers who do not offer their employees
health insurance coverage face a penalty of
$2,000 per employee (the employer can
exempt the first 30 employees).
25. In 2015, employers with 50 or more employees who
offer coverage to their employees must offer
affordable coverage.
Penalty:
Employers offering coverage that is not affordable
face a penalty of $3,000 for each employee accessing
subsidized coverage through the exchange.
The total penalty for not offering affordable coverage
cannot exceed the penalty for not offering insurance
coverage at all.
26. Is there a notice employers are
required to send employees
about PPACA?
27. Federal law requires all employers subject to the
Fair Labor Standards Act to provide a notice to
employees about PPACA by October 1, 2013.
The federal Department of Labor has released
model notices on their Web site.
http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.
pdf
http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf
29. The federal exchange is a federal Web site that will allow
consumers to:
Check their eligibility for government assistance programs,
including subsidies and premium tax credits available to help
pay for private health insurance;
Compare individual and small group health insurance plans; and
Link consumers to insurers for the purchase of health insurance
after they choose a plan they are interested in
The initial and annual enrollment periods are the same for the
federal exchange as they are for the outside market (off
exchange).
30. Throughout this presentation, reference to “on
exchange” means plans available for purchase
through the federal exchange.
Reference to “off exchange” refers to the
private health insurance market offering plans
outside of the federal exchange that
individuals or employers can purchase.
31. Consumers have the right to purchase coverage
either on exchange or from the market outside
of the exchange (off exchange).
There are no penalties tied to where coverage is
purchased.
Consumers are encouraged to research options
off the exchange before committing to a
purchase on the exchange.
32. What is the federal Health
Insurance Premium Tax Credit?
33. The PTC is a public assistance provision in the law that artificially
reduces the actual premium charged by insurers.
It does not reduce the premium. Rather, through tax dollars, it
provides public assistance to offset the premium you will pay.
Eligibility:
Income between 100% and 400% of the Federal Poverty Level (FPL)
◦ $23,550 - $94,200 for a family of four in 2013.
Must purchase a Qualified Health Plan (QHP) on the exchange.
◦ All plans offered on the exchange are QHPs.
Must be ineligible for government-sponsored coverage or affordable
employer-sponsored insurance.
34. The PTC can be taken in advance or in the form
of a refund at the end of the year.
If taking the tax credit in advance, there is a
risk of having to re-pay any overpayments
made to you.
35. Advanced PTC Example:
Monthly Premium $300
Monthly Tax Credit -240
New Monthly Cost $ 60
Refundable PTC Example:
Yearly Tax Credit $2,880 (240 a month x 12)
Tax Due - 900
IRS Refund $1,980
37. Federal Cost-Sharing Subsidies are a form of public
assistance that artificially reduce the actual cost-
sharing charged by insurers.
The subsidies do not reduce the out-of-pocket
expenses required by the plan. Rather, through tax
dollars, they provide public assistance to offset your
out-of-pocket expenses, such as deductibles,
copays and coinsurance.
Eligibility:
Individuals must have income below 250% FPL; and
Must purchase a silver level plan on exchange.
39. Like the federal exchange available to
individuals, the Small Business Health Options
Program (SHOP) is a federal Web site that will
allow employers and employees to compare
health insurance plans.
Employers with between 2 and 50 full-time
employees are eligible to purchase coverage
on the SHOP.
40. Nothing requires employers to purchase
coverage on the SHOP and insurers are not
required to sell on the SHOP.
Employers should compare plans on and off
the SHOP.
Insurers must charge the same for similar
plans whether they are sold on or off the SHOP.
41. Employer Choice:
In 2014, a small employer choosing to
purchase coverage on the SHOP will compare
plans and choose a plan that meets their
needs.
The small employer will offer the plan to its
employees, like it does today.
42. Employee Choice:
PPACA requires an employee choice option
for 2014, but the federal government has
delayed its availability until 2015.
Employee choice allows employees to
compare and select a plan in the metal tier
authorized by their employer.
43. Employers interested in purchasing coverage
on the SHOP will need to meet a 70%
participation rate.
In 2016, the definition of small employer
includes employers with over 50 employees
but fewer than 100.
44. Are the Small Business Health
Care Tax Credits still available?
45. Beginning in 2014, the small business health care tax credit
available today is limited to employers purchasing coverage
on the SHOP.
In 2014, the tax credit will increase from a maximum of 35%
of an employer’s qualified health expenses to a maximum of
50%.
Employers with under 10 employees making less than
$25,000 a year will reap most of the benefit from these
tax credits.
Employers are only eligible for the tax credit for 2 years.
46. To qualify:
The employer must have fewer than 25 full-
time employees;
The average annual wages of employees must
be less than $50,000; and
The employer must pay at least half of the
insurance premiums.
48. Navigators:
Are funded by the federal government to help
individuals apply for public assistance programs
and compare health insurance plans sold on the
exchange.
They will also conduct consumer education and
outreach activities.
49. Navigators:
Cannot legally provide advice to consumers
about which health insurance plan to choose and
are not permitted to sell insurance.
Are to ensure consumers know there are plans
available off exchange but are prohibited from
helping consumers compare plans off exchange.
Must be certified by the federal exchange and be
licensed by the state.
50. Federal grants awarded to six WI organizations totaling
approximately $1.0 million.
Partners for Community Development, Inc.
Northwest WI Concentrated Employment Program, Inc.
Legal Action of WI, Inc./SeniorLAW
National Council of Urban Indian Health
National Healthy Start Association
R&B Receivables Management Corporation
51. Certified Application Counselors:
Help individuals apply for public assistance programs and
compare health insurance plans sold on the exchange.
Are not responsible for outreach and education activities.
Are not federally funded.
Will work in settings such as hospitals, local health
departments, provider offices, etc.
Must be affiliated with a CAC organization approved by the
exchange and must be registered with the state.
52. If you have any doubt or question about whether the
person you are working with is a licensed navigator or
registered CAC or you know they are but question their
conduct, you should contact OCI.
To verify a navigator license, visit:
https://ociaccess.oci.wi.gov/ProducerInfo/PrdInfo.oci
To inquire about a CAC or report concerns about
navigator or CAC conduct, e-mail OCI at:
ociagentlicensing@wisconsin.gov
54. Licensed health insurance agents will
be available in 2014 to assist
individuals and employers, like they do
today.
Unlike navigators and CACs, licensed agents
are permitted to provide advice in helping
individuals assess which health plan best
suits their needs.
56. OCI was created in 1871 to ensure that the insurance
industry responsibly and adequately met the
insurance needs of Wisconsin citizens.
Even after the passage of PPACA, OCI’s mission
remains the same and OCI continues to be the
primary regulator of the insurance industry in
Wisconsin.
Consumers should continue to view OCI as a resource
on any issue related to the WI insurance market.