We continued our Celebrating 40 Years of Excellence! Fall Webinar Series with a webinar focusing on the impact of The Patient Protection and Affordable Care Act and next steps for employees, hosted by Suzanne Sentman (Human Resource Director with McKonly & Asbury) with featured guest Kent Evans (Vice President / Human Capital Consultant with Willis of Delaware, Inc).
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/.
View a full recap of this webinar at http://www.macpas.com/register-today-for-mckonly-asburys-free-the-patient-protection-and-affordable-care-act-webinar/.
Guidelines for the Colorado Health Benefit Exchange and our Federal Exchange are still up in the air. What do these various funding, administration, and oversight issues mean for employers and how will plan pricing, availability, and benefits be addressed? This presentation is designed for the Colorado business leader who needs to understand the current state of the exchanges. In this session, we’ll go over the very latest developments and how they could impact local businesses, discuss how you can create a proactive multi-year benefits strategy, and introduce resources to help you stay on top of this constantly changing landscape.
This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Affordable Care Act 101: What the Healthcare Law Means for Small BusinessSmall Business Majority
August 8, 2013. Hosted by the U.S. Small Business Administration and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Guidelines for the Colorado Health Benefit Exchange and our Federal Exchange are still up in the air. What do these various funding, administration, and oversight issues mean for employers and how will plan pricing, availability, and benefits be addressed? This presentation is designed for the Colorado business leader who needs to understand the current state of the exchanges. In this session, we’ll go over the very latest developments and how they could impact local businesses, discuss how you can create a proactive multi-year benefits strategy, and introduce resources to help you stay on top of this constantly changing landscape.
This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Affordable Care Act 101: What the Healthcare Law Means for Small BusinessSmall Business Majority
August 8, 2013. Hosted by the U.S. Small Business Administration and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
These slides were from a recent SBA webinar presented by Small Business Majority. It focused on both federal and state provisions to help local small business owners understand how the law will affect them. Topics being discussed included:
Small business tax credits (available to businesses and tax-exempt non-profits)— who’s eligible for them and how to claim them, Marketplace updates, Shared responsibility,Cost containment, Tools and resources available for small businesses interested in learning more about the law.
About Small Business Majority
Small Business Majority is a national nonprofit advocacy organization focused on solving the biggest problems facing America's 28 million small businesses. We conduct extensive opinion and economic research and work with small business owners, policy experts, and elected officials nationwide to bring nonpartisan small business voices to the public policy table.
Affordable Care Act 101: What the New Healthcare Law Means for Your Small Bus...Small Business Majority
August 15, 2013. Hosted by the U.S. Small Business Administration and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
CPA experts from the PICPA share information about important health insurance deadlines for 2016, understanding health care spending account choices, managing health insurance after job loss, changing eligibility requirements that may impact small businesses, and more.
This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses and practices like yours. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Hosted by the United States Department of Health and Human Services and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for Kentucky small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Medical Insurance Concept's By - Prof. Manoj Kumar Pandey, MBA , AIII. Associate Professor - Insurance & Marketing,
Birla Institute of Management Technology (BIMTECH), Greater Noida (NCR).
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
These slides were from a recent SBA webinar presented by Small Business Majority. It focused on both federal and state provisions to help local small business owners understand how the law will affect them. Topics being discussed included:
Small business tax credits (available to businesses and tax-exempt non-profits)— who’s eligible for them and how to claim them, Marketplace updates, Shared responsibility,Cost containment, Tools and resources available for small businesses interested in learning more about the law.
About Small Business Majority
Small Business Majority is a national nonprofit advocacy organization focused on solving the biggest problems facing America's 28 million small businesses. We conduct extensive opinion and economic research and work with small business owners, policy experts, and elected officials nationwide to bring nonpartisan small business voices to the public policy table.
Affordable Care Act 101: What the New Healthcare Law Means for Your Small Bus...Small Business Majority
August 15, 2013. Hosted by the U.S. Small Business Administration and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
CPA experts from the PICPA share information about important health insurance deadlines for 2016, understanding health care spending account choices, managing health insurance after job loss, changing eligibility requirements that may impact small businesses, and more.
This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses and practices like yours. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Hosted by the United States Department of Health and Human Services and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for Kentucky small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Medical Insurance Concept's By - Prof. Manoj Kumar Pandey, MBA , AIII. Associate Professor - Insurance & Marketing,
Birla Institute of Management Technology (BIMTECH), Greater Noida (NCR).
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
Please note: Seasonal employees ARE counted in the calculation for FTEs for the month that they work. However, if they work less than 120 days and cause the 50 FT threshold to be breached, then the employer is not considered a large employer.
Since its rocky roll out in October 2013, the Patient Protection and Affordable Care Act has been the subject of controversy and debate. But much of this has obscured the simple fact that, despite a number of changes that have been made to the law in recent months, the ACA’s major provisions still remain in force.
Connect for Colorado's Lindy Hinman's 2013 SLC presentation on health insurance marketplaces and what the Connect for Colorado organization has done to get their state insurance marketplace up and running.
Presentation by Marjorie McColl Petty, Regional Director of the Department of Health and Human Services, Region VI, at the Sept. 30, 2013 83rd Texas Post-Legislative Conference hosted by One Voice Texas, United Way of Greater Houston and the Harris County Healthcare Alliance.
Five Years Later: An Updated Look at Health Care Reform and Small Business (M...Manta
Health care reform is complex and nearly impossible for busy small business owners to keep up with. Attend the webinar, Five Years Later: An Updated Look at Health Care Reform and Small Business,” with guest experts Jeffery Ingalls and Laura Roane. Ingalls is author and president of the Stratford Financial Group and Stratford Employer Services, and Roane is and independent insurance broker.
During the webinar, they provide insight about health insurance literacy matters and the effects of “Obamacare” on your small business.
This webinar is hosted by Michael Hoffner, Partner and Leader of McKonly & Asbury’s Systems and Organization Controls (SOC) practice and Co-Director of the Assurance practice, and Janice Snyder, Partner and Co-Director of the Assurance practice.
This ethics webinar focuses on the 7 threats that could compromise a CPA’s compliance with the AICPA code of professional conduct. Many threats fall into one or more of the following seven broad categories: adverse interest, advocacy, familiarity, management participation, self-interest, self-review, and undue influence.
Ratio Analysis and Business Performance – Why Should I Care – Part 2?McKonly & Asbury, LLP
The webinar is hosted by David Blain, Partner and Director of McKonly & Asbury’s Entrepreneurial Services Group, and Eric Fischer, Benefits Advisor at American Family Life Assurance Company of Columbus (Aflac).
This webinar is a continuation of the first webinar hosted on May 30, 2019. This webinar focuses on debt covenant and leverage ratios most used and reviewed by banks and other lending institutions. The webinar also focuses on how banks and lending institutions view these ratios and how to best prepare and present your business for compliance with these ratios.
Not-For-Profit Organizations: Lessons Learned from Implementation of the New ...McKonly & Asbury, LLP
McKonly & Asbury’s July webinar entitled, “Not-For-Profit Organizations: Lessons Learned from Implementation of the New Financial Reporting Standard” took place on Thursday, July 25, 2019. The webinar was hosted by Gary Dubas, Partner and Director of McKonly & Asbury’s Nonprofit Practice, Janice Snyder, Partner and Co-Director of the Assurance Practice, and Jim Shellenberger, Principal and Leader in the Nonprofit Practice.
2019 State Taxes: Pennsylvania Update and The Multistate Tax ClimateMcKonly & Asbury, LLP
McKonly & Asbury’s June webinar entitled, “2019 State Taxes: Pennsylvania Update and the Multistate Tax Climate” is hosted by Mark Heath, Partner and Director of Tax Services at McKonly & Asbury, and Lindsey Waltemyer, Tax Supervisor. During this webinar, attendees will gain an understanding of the budget provisions and recent tax updates specific to Pennsylvania; receive updates on how various states are reacting to federal tax changes and national trends in sales tax nexus; and receive updates from Harbor Compliance on foreign entity qualification and annual report requirements.
McKonly & Asbury’s April webinar entitled, “Leasing: A New Standard is Finally Here” is hosted by Dan Sturm, Partner; Brett Bauer, Senior Manager; and Tim Showers, Supervisor. During this webinar, attendees will learn how ASC 842 differs from ASC 840; will see illustrative financial statements which highlight exactly what changes as a result of the new standard; and will gain an understanding of what they should be doing now to prepare.
Business Valuation Update & Impact of the Tax Cuts and Jobs ActMcKonly & Asbury, LLP
This webinar is hosted by McKonly & Asbury Principal and Business Valuation Leader, Eric Blocher. The webinar will focus on the following; 1) the three different approaches to valuation, 2) the importance of the Standard of Value, Level of Value, and Premise of Value, 3) the Impact of the Tax Cuts and Jobs Act on business valuation, 4) trends in the valuation industry for accounting for the Act, and 5) new topics that are affecting the business valuation industry.
This webinar will provide you with all of the information you need to know in order to understand and implement the changes made by the Tax Cut and Jobs Act, signed into law in December of 2017. McKonly & Asbury presenters, Mark Heath – Partner, and Charlie Eisenhart – Manager, will be covering corporate tax reform including rate changes, new depreciation rules, and limitations on deductions; flow-through tax reform with a special focus on the new 199A deduction; as well as the changes affecting individuals, including new rate brackets and limits on itemized deductions.
Elaine Nissley, Principal with McKonly & Asbury, will provide an overview of ethical style and perspectives. During the webinar, she will present ethics from a macro, corporate, and individual level and discuss social contracts within organizations. She will also discuss how our personal ethical perspective, the ethical perspective of others, and the organization’s ethical perspective influence social contracts and behavior in the workplace. Elaine will then look at a self-assessment tool which you can use to assess your ethical leadership style and a balanced scorecard to measure and track the corporate ethical environment, as well as some frameworks to help you to make balanced ethical decisions. The webinar will conclude with a review of the state of ethics in the workplace in 2017 and a summary of the Federal Sentencing Guidelines related to the key components of an effective ethics program to protect both the organization and their employees.
McKonly & Asbury’s October webinar is brought to you by Bridgeford Trust Company! Modern trust laws, including directed trust, trust protector, and the newly created family advisor, have revolutionized the trust industry in the United States. During this webinar, David Warren, Chairman of the Board/Co-Founder of Bridgeford Trust Company and President/CEO of Bridgeford Advisors, will highlight how these modern progressive trust laws, found only in a handful of states including South Dakota, have drastically changed how trusts are created and administered, delivering far more control and direction to settlors of trusts, beneficiaries, and their advisors than ever before.
In today’s business environment, organizations have a responsibility to their employees, clients, and customers to ensure the confidentiality, integrity and availability of the critical data that is entrusted to them. Every network is vulnerable to some form of attack. However it is not enough to simply confirm that a technical vulnerability exists and implement countermeasures; it is critical to repeatedly verify that the countermeasures are in place and working properly throughout the secured network. During this webinar, David Hammarberg, Principal, IT Director, and leader of McKonly & Asbury’s Cybersecurity Practice will be joined by Partner, Michael Hoffner and they will lead a discussion on a Cybersecurity Risk Management Program including what it is and how it can prepare your organization for the future.
Professional Ethics for CPAs - What the Rules Say and How to Interpret ThemMcKonly & Asbury, LLP
This webinar was hosted by McKonly & Asbury Partners, Janice Snyder and Michael Hoffner and reviewed the structure of the current AICPA Code of Professional Conduct as well as provided an overview of how CPAs in both Public Practice and serving in Industry should interpret the requirements therein. The presenters went through the outline of the Code, explaining where to find various components of the regulations and providing a series of examples to illustrate the application of the framework.
2018 Pennsylvania Tax Update: The State Budget, Legislation, and Multistate T...McKonly & Asbury, LLP
This webinar was hosted by McKonly & Asbury Senior Tax Manager and SALT Leader, Michael Eby, and Tax Supervisor, Lindsey Waltemyer.
It provides an overview of the enacted 2017-2018 Pennsylvania State Budget; a brief update on recently passed Pennsylvania tax legislation and court decisions of interest; and discusses how states, including Pennsylvania, are addressing these changes at the Federal level in their own respective tax structure.
Not-for-Profit Financial Reporting: How to Convert Your Financial Statements ...McKonly & Asbury, LLP
This webinar was hosted by McKonly & Asbury Partner, Janice Snyder, and Principal, Jim Shellenberger, and addressed the requirements of Accounting Standard Update 2016-14, Not-for-Profit Entities (Topic 958): Presentation of Financial Statements of Not-for-Profit Entities. The presenters reviewed the new requirements under this standard and converted a full set of not-for-profit financial statements from the previous requirements to the new requirements. This was a step-by-step, page-by-page review of not-for-profit financial statements.
This webinar was hosted by McKonly & Asbury Partner, Michael Hoffner and Senior Managers, Josh Bantz and Samuel BowerCraft.
The webinar reviewed he new Trust Services Criteria that will be effective for SOC 2 and SOC 3 reports issued after December 15, 2018. The emphasis of this webinar was on evaluating the changes to the criteria, impacts on the report, and processes and procedures for transitioning from the 2016 Criteria to the 2017 Criteria. The presenters looked in-depth at how clients should map their controls from the 2016 Trust Services Criteria to the 2017 Trust Services Criteria including challenges with the new criteria.
The webinar was hosted by McKonly & Asbury Senior Tax Manager, Mike Eby and Senior Audit Manager, Dan Kern, along with special guest, Bonnie Mark, Principal at Delta Development Group, Inc.
The presentation gave an overview of the Federal and Pennsylvania historic preservation tax credit programs for income-producing properties. Specific discussions included: 1) requirements that need to be met for a project to be eligible for the programs, 2) the application process, 3) accounting and cost certifications, 4) tax benefits of participating in the programs, 5) and recent changes to the Federal program due to Tax Reform.
Throughout the presentation, the hosts reviewed case study examples of local and national projects that they have participated in over the years. Developers, contractors, investors, and even businesses outside the real estate industry will find that there may be opportunities for them to participate in the incentives of these programs.
This webinar focused on the ins and outs of purchasing a business. The objectives of this webinar were to provide the attendees with tips and tools to use as a buy side party in a transaction. More specifically, the participants came away with a basic knowledge of how to approach and communicate with targets, how to analyze a target, the due diligence process, and what to expect at close and post-closing of a transaction.
The presenters discussed the process from start to finish with a focus on the following areas:
- What do you want to be and where do you want to go? – First step is to identify the type of business that best fits your overall business plan and strategy (culture, size, business lines, etc.).
- Preliminary process – How to identify targets, use of professionals, development of a professional, and internal advisory team.
- Transaction process – Initial discussions, development of an LOI, transaction type, and due diligence.
- Closing process – Purchase document, delivery of assets or working capital, and final adjustments.
- Post-closing – Now What?
This webinar discussed the purpose of data analytics and how it can be a light in the darkness for your organization to make better decisions for the future. The webinar covered the purpose of data analysis and its definition, the fundamental steps to take to perform data analysis to problem solve, and closed with next steps that attendees can take to further develop data analysis and business intelligence within their organizations.
During this webinar, attendees learned about the following:
- How data analytics functions to help your organization improve.
- The process for using data analytics to solve problems.
- Next steps to take to build data analysis within your organization.
As a follow up to the webinar we did in December, this webinar will dig in a little deeper into what we believe are the most impactful and relevant aspects of the Tax Cuts and Jobs Act of 2017 for both individuals and businesses. We will also identify planning opportunities for businesses to ensure that opportunities for tax minimization are realized and pitfalls are avoided.
During the webinar, participants will understand how the potential tax legislation will affect themselves individually, their families, their businesses, and how to plan for future tax liabilities.
This webinar presented a broad overview of pending tax legislation and provided details on how the current Federal tax legislation proposals will affect individuals, families, and small and large businesses. The presenters also identiied planning opportunities for businesses to ensure that opportunities for tax minimization are realized and pitfalls are avoided.
Participants will understand how the potential tax legislation will affect themselves individually, their families, their businesses, and how to plan for future tax liabilities.
Preparing to Buy or Sell? Topics and Tips for a Successful TransitionMcKonly & Asbury, LLP
This webinar was geared to those in the process of business transition. Whether looking to sell your business, transition your business to a future generation, or expand your business through acquisition, this webinar focused on key concepts from a financial and tax structure that all business owners should consider in advance of any business related transition. The webinar discussed matters of preliminary planning and preparation for transition, understanding business value, tax consequences and tax structuring matters, pitfalls to avoid, and other unintended consequences.
Remote sensing and monitoring are changing the mining industry for the better. These are providing innovative solutions to long-standing challenges. Those related to exploration, extraction, and overall environmental management by mining technology companies Odisha. These technologies make use of satellite imaging, aerial photography and sensors to collect data that might be inaccessible or from hazardous locations. With the use of this technology, mining operations are becoming increasingly efficient. Let us gain more insight into the key aspects associated with remote sensing and monitoring when it comes to mining.
Enterprise Excellence is Inclusive Excellence.pdfKaiNexus
Enterprise excellence and inclusive excellence are closely linked, and real-world challenges have shown that both are essential to the success of any organization. To achieve enterprise excellence, organizations must focus on improving their operations and processes while creating an inclusive environment that engages everyone. In this interactive session, the facilitator will highlight commonly established business practices and how they limit our ability to engage everyone every day. More importantly, though, participants will likely gain increased awareness of what we can do differently to maximize enterprise excellence through deliberate inclusion.
What is Enterprise Excellence?
Enterprise Excellence is a holistic approach that's aimed at achieving world-class performance across all aspects of the organization.
What might I learn?
A way to engage all in creating Inclusive Excellence. Lessons from the US military and their parallels to the story of Harry Potter. How belt systems and CI teams can destroy inclusive practices. How leadership language invites people to the party. There are three things leaders can do to engage everyone every day: maximizing psychological safety to create environments where folks learn, contribute, and challenge the status quo.
Who might benefit? Anyone and everyone leading folks from the shop floor to top floor.
Dr. William Harvey is a seasoned Operations Leader with extensive experience in chemical processing, manufacturing, and operations management. At Michelman, he currently oversees multiple sites, leading teams in strategic planning and coaching/practicing continuous improvement. William is set to start his eighth year of teaching at the University of Cincinnati where he teaches marketing, finance, and management. William holds various certifications in change management, quality, leadership, operational excellence, team building, and DiSC, among others.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
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India Orthopedic Devices Market: Unlocking Growth Secrets, Trends and Develop...Kumar Satyam
According to TechSci Research report, “India Orthopedic Devices Market -Industry Size, Share, Trends, Competition Forecast & Opportunities, 2030”, the India Orthopedic Devices Market stood at USD 1,280.54 Million in 2024 and is anticipated to grow with a CAGR of 7.84% in the forecast period, 2026-2030F. The India Orthopedic Devices Market is being driven by several factors. The most prominent ones include an increase in the elderly population, who are more prone to orthopedic conditions such as osteoporosis and arthritis. Moreover, the rise in sports injuries and road accidents are also contributing to the demand for orthopedic devices. Advances in technology and the introduction of innovative implants and prosthetics have further propelled the market growth. Additionally, government initiatives aimed at improving healthcare infrastructure and the increasing prevalence of lifestyle diseases have led to an upward trend in orthopedic surgeries, thereby fueling the market demand for these devices.
Affordable Stationery Printing Services in Jaipur | Navpack n PrintNavpack & Print
Looking for professional printing services in Jaipur? Navpack n Print offers high-quality and affordable stationery printing for all your business needs. Stand out with custom stationery designs and fast turnaround times. Contact us today for a quote!
Unveiling the Secrets How Does Generative AI Work.pdfSam H
At its core, generative artificial intelligence relies on the concept of generative models, which serve as engines that churn out entirely new data resembling their training data. It is like a sculptor who has studied so many forms found in nature and then uses this knowledge to create sculptures from his imagination that have never been seen before anywhere else. If taken to cyberspace, gans work almost the same way.
Business Valuation Principles for EntrepreneursBen Wann
This insightful presentation is designed to equip entrepreneurs with the essential knowledge and tools needed to accurately value their businesses. Understanding business valuation is crucial for making informed decisions, whether you're seeking investment, planning to sell, or simply want to gauge your company's worth.
[Note: This is a partial preview. To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
Sustainability has become an increasingly critical topic as the world recognizes the need to protect our planet and its resources for future generations. Sustainability means meeting our current needs without compromising the ability of future generations to meet theirs. It involves long-term planning and consideration of the consequences of our actions. The goal is to create strategies that ensure the long-term viability of People, Planet, and Profit.
Leading companies such as Nike, Toyota, and Siemens are prioritizing sustainable innovation in their business models, setting an example for others to follow. In this Sustainability training presentation, you will learn key concepts, principles, and practices of sustainability applicable across industries. This training aims to create awareness and educate employees, senior executives, consultants, and other key stakeholders, including investors, policymakers, and supply chain partners, on the importance and implementation of sustainability.
LEARNING OBJECTIVES
1. Develop a comprehensive understanding of the fundamental principles and concepts that form the foundation of sustainability within corporate environments.
2. Explore the sustainability implementation model, focusing on effective measures and reporting strategies to track and communicate sustainability efforts.
3. Identify and define best practices and critical success factors essential for achieving sustainability goals within organizations.
CONTENTS
1. Introduction and Key Concepts of Sustainability
2. Principles and Practices of Sustainability
3. Measures and Reporting in Sustainability
4. Sustainability Implementation & Best Practices
To download the complete presentation, visit: https://www.oeconsulting.com.sg/training-presentations
4. THE PATIENT PROTECTION
AND AFFORDABLE CARE ACT
FOCUS ON THE PUBLIC AND PRIVATE
EXCHANGE MARKETPLACE
SUZANNE SENTMAN
E. KENT EVANS
5. Suzanne Sentman
• HR Coordinator
• McKonly & Asubry
E. Kent Evans, CBC
• Vice President
• Human Capital Practice
• Willis of Delaware, Inc.
ABOUT US
6. DISCLOSURE
This material and any accompanying remarks are provided
for informational purposes only and nothing contained
in either should be taken as a legal opinion or as legal
advice.
7. CONFUSED? YOU ARE NOT ALONE....
“Four in ten Americans (42 percent) are unaware that the ACA is still the law of the
land, including 12 percent who believe the law has been repealed by Congress, 7
percent who believe it has been overturned by the Supreme Court and 23 percent
who don’t know whether or not the ACA remains law. And about half the public
says they do not have enough information about the health reform law to
understand how it will impact their own family….”
Source: Henry J. Kaiser Family Foundation Health Tracking Poll: April 2013
8. OBJECTIVES
This session will help you:
• Understand the Health Insurance Marketplace
• Identify who will benefit
• Define who is eligible
• Explain the enrollment process
• Define options for those with limited income
• Employer Pay or Play Tax (High Level)
• Employee Impact
9. WHAT IS AN EXCHANGE?
A technology based platform that provides greater consumer choice, reduces employer
engagement and enhances decision support.
• A broad spectrum of Exchange definitions in use today
• General Attributes:
• “Shop and Compare” quoting tool
• Technology based ‘backbone’
• Robust decision support tools
• Customer Service support
• Greater employee ownership / responsibility
• Reduced employer engagement
• Spectrum varies
• Personalized member experience
• “Point and click’ purchasing platform
• Increased employer cost predictability and budget ability (DB to DC)
10. OCTOBER 1, 2013 HEALTH INSURANCE EXCHANGE NOTICE
Employers to Provide Notice of Health Insurance Exchanges:
Beginning on March 1, 2013, employers must provide employees
written notice:
1. of the existence of the Health Insurance Exchange which will
become operative as of January 1, 2014;
2. of the employee’s potential eligibility for federal assistance if
the employer’s health plan doesn’t meet affordability and
minimum value criteria under PPACA and if employee
household income is below certain thresholds; and
3. that employees may lose the employer’s contribution to health
coverage if they purchase health insurance through the Health
Insurance Exchange.
11. Emerging Exchange
Models
• - Employer Involvement +
State / Federal Public
Exchanges
Multi carrier Exchanges
-
Individual Plans
Multi carrier
Exchanges- Group
Plans
Single carrier
Exchanges- Group
Plans
Traditional ER
sponsored Group
Plans
• Operational in 2014
• Governmental Subsidies
included
• Various attributes / types
which differ by state
model
• ER has no control
• Insured individual
products
• Ex: MA & UT
• Operational today
• Employer subsidies
possible
• Various attributes / types
which differ by third party
host capabilities
• Insured individual products
• Ex: EHealth, Extend
• Operations limited today
• Employer subsidies
possible (DC)
• Insured or self insured
• ER determined plan
offerings
• Insurers compete for
individuals
• Post enrollment risk
adjustment may be required
• Ex: Aon Hewitt (proposed),
Liazon (select markets)
• Operational today
• 3rd
party or insurer host
• Insured or self insured
• Employer subsidizes
through DB or DC
• ER determined plan
offering
• Single carrier per LOC per
employer group
• EX: Liazon, Connected,
Bloom (BCBS)
• Operational today
• High ER engagement
• Less EE choice
• Group based model
• Single or limited multi-
carrier models
Private Exchanges
- Employer Involvement +
13. SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP)
Small Business Health Options Program is a Marketplace for small businesses and their
employees
• Beginning 2014, small businesses will have more choice and control over health
insurance spending
• Choices among Qualified Health Plans to meet every budget
• Access tax credits for eligible employers
• New consumer protections
14. HOW SHOP WORKS
Small employers with fewer than 100 employees can qualify
• States may limit to those with 50 or less for first two years
• Employer will access the SHOP where its principle business office is
located
• Employer must offer coverage to all full-time employees
Sole proprietors
• May buy through the larger Marketplace rather than the SHOP Exchange
15. THE “NEW” HEALTH INSURANCE MARKETPLACE
Individuals and families can get help through the Individual Marketplace:
• Enrollment starts Oct. 1, 2013
• Coverage begins January 2014
16. HOW THE INDIVIDUAL MARKETPLACE WORKS
Coverage to fit individual needs
• May get a break on costs through a new premium tax credit
• Advance payment of the premium tax credit to the health plan to help
lower your monthly premium
Unbiased help and customer support provided
Quality health coverage that meets minimum standards
Easy to use
17. HOW THE INDIVIDUAL MARKETPLACE WORKS
One process to determine eligibility for:
• Qualified Health Plan through the Marketplace
• New tax credits to lower premiums
• Reduced cost sharing
• Medicaid
• Children’s Health Insurance Program (CHIP)
Offers choice of plans and levels of coverage
Insurance companies compete for business
18. QUALIFIED HEALTH PLANS IN THE EXCHANGE
A Qualified Health Plan:
• Is offered by an issuer that is licensed by the state and in good standing
• Covers Essential Health Benefits
• Offers at least one plan at the “silver” level and one at the “gold” level of cost-
sharing
• Agrees to charge the same premium rate whether offered directly through
Marketplace or outside the Marketplace
19. ESSENTIAL HEALTH BENEFITS
Qualified Health Plans cover Essential Health
Benefits which include at least these 10 categories
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
20. PLAN LEVELS OF COVERAGE
Levels of Coverage Plan Pays on
Average
Enrollees Pay on
Average*
(in addition to the
monthly plan premium)
Bronze 60 percent 40 percent
Silver 70 percent 30 percent
Gold 80 percent 20 percent
Platinum 90 percent 10 percent
*based on average cost of an individual under the plan and may not be the same for every enrolled person
21. THE PRIVATE EXCHANGES
• A private health insurance exchange is an exchange run by a private sector company or
nonprofit. Private exchanges combine technology and human advocacy, include online
eligibility verification, and mechanisms for allowing employers who connect their
employees or retirees with exchanges to offer subsidies. Can be group and/or
individual offerings.
• Private Exchanges will compete directly with the Public Exchanges.
• Private Exchanges will contract with insurance carriers, brokers, associations, non-
profits, or direct with employers.
• Will offer a full array of products in addition to health insurance. Example: dental, life,
or disability coverage's.
22. ELIGIBILITY AND ENROLLMENT
Marketplace eligibility requires you to:
• Live in its service area, and
• Be a U.S. citizen or national, or
• Be a non-citizen who is lawfully present in the U.S. for the entire period for which
enrollment is sought
• Not be incarcerated
23. WHEN YOU CAN ENROLL
• Marketplace Initial Open Enrollment Period Starts Oct. 1, 2013 and
ends March 31, 2014
• Annual Open Enrollment Periods after that start on October 15
and ends on December 7
• Special Enrollment Periods available in certain circumstances
during the year
24. INITIAL OPEN ENROLLMENT PERIOD
Oct. 1, 2013 – March 31, 2014
Enroll during the initial Open
Enrollment Period
Your coverage is effective*
On or before Dec. 15, 2013 Jan. 1, 2014
Between the 1st
and 15th
day of January – March First day of the following month
Between the 16th
and the last day of December
– March
First day of the second following month
*some exceptions may allow for earlier effective dates
25. SPECIAL ENROLLMENT PERIOD
May enroll or change Qualified Health Plan
• Within 60 days in individual market and 30 days in small group market from qualifying
event
Special Enrollment Period Qualifying Events
Loss of minimum essential coverage Material contract violations by Qualified
Health Plans
Gaining or becoming a dependent Gaining or losing eligibility for premium tax
credits or cost sharing reductions
Gaining lawful presence Relocation resulting in new or different
Qualified Health Plan selection
Enrollment errors of the Marketplace Exceptional circumstances
26. MARKETPLACE AFFORDABILITY
Financial help available for working families
includes:
• Tax credits to health plans to lower the monthly premiums
qualified individuals pay
• Reduced cost sharing to lower out-of-pocket spending for
health care
28. WHO IS ELIGIBLE FOR THE PREMIUM TAX SUBSIDY?
Eligibility for the new tax subsidy/credit is based on:
• Household income and family size for the year
• Income between 100% to 400% of the Federal Poverty Level (FPL) ($23,550 – $94,200 for a
family of four in 2013)
• Ineligibility for other health benefits coverage, other than the individual insurance market
Tax subsidy/credit amount depends on income as percentage of the Federal Poverty Level (FPL)
• Based on a sliding scale
• Based on the cost of the second lowest silver Qualified Health Plan, adjusted for the age and
rating area of the covered person
• Limits premium payments as a percent of income
29. WHO IS ELIGIBLE FOR COST-SHARING REDUCTION?
Eligibility for reduced cost-sharing is based on:
• Incomes at or below 250 percent of the FPL ($58,875 annually for a family of four in
2013)
• Receiving the new tax credit
• Meeting enrollment requirements
• Enrolling in a Marketplace silver-level plan
Members of federally recognized Indian Tribes
• No cost-sharing if income is <300 percent FPL
30. CATASTROPHIC PLANS
Who is eligible?
• Young adults under 30 years of age
• Those who can not afford coverage and obtain a hardship waiver from the
Marketplace
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
• Protects consumers from high out-of-pocket costs
31. MEDICAID ELIGIBILITY IN 2014
Extends option for states to expand Medicaid eligibility to
• Adults ages 19–65 with incomes up to 133% of the Federal Poverty Level (FPL)
($15,282/year for an individual, $31,322/year for a family of 4 (2013 amounts)
Ensures Medicaid coverage for all children
• With incomes up to 133% of the FPL
Shifts to simplified way of calculating income to determine Medicaid/CHIP eligibility
• Known as Modified Adjusted Gross Income (MAGI)
32. SIMPLIFYING MEDICAID AND CHIP
Modernized rules to rely on electronic data
• Reduce need for paper documentation
Apply online, by phone, by mail or in person
12-month eligibility period for
• Adults
• Parents
• Children
Simplified process for renewing coverage
33. ENROLLMENT ASSISTANCE
Help available in each Marketplace
• Toll-free call center
• Website
• Navigator program
• Enrollment counselors
• In-person Assistors
• Community-based organizations
• Agents and brokers (state’s decision)
35. EMPLOYERS – PAY OR PLAY TAX IN 2015
• Applies to employers with 50 or more employees who DOES NOT offer health coverage.
• Employer requirement to offer health coverage to full-time employees or pay a penalty.
• When determining whether an employer has 50 employees, it is those working 30 or more hours/week and full time
equivalent employees (total monthly part time hours/120).
• This does not mean that part-time employees must be covered
• Fine for noncompliance is $2,000 per full-time employee annually, but first 30 employees
not counted (i.e., if the employer has 51 employees and doesn’t provide coverage, the
employer pays the fine for 21 full-time employees. Part-time employees are counted in
determining employer size but do not count them in calculating the penalty amount.)
36. EMPLOYERS – PAY OR PLAY TAX IN 2015
• An employer with 50 or more employees that DOES OFFER coverage but has at least
one full-time employee receiving a tax credit in the Exchange will pay the lesser of
$3,000 for each of those employees receiving a tax credit or $2,000 for each of their
full-time employees (FTE).
• An individual with family income up to 400% of FPL is eligible for a tax credit instead of
employer coverage if:
• The actuarial value of the employer’s coverage is less than the minimum standard (does not cover at least 60%
or costs); or
• The employer requires the employee to contribute more than 9.5% of the employee’s household AGI income
toward the cost of coverage but penalty would be assessed on a FTE basis.
• Waiting periods in excess of 90 days are prohibited.
37. EMPLOYEE IMPACT IN 2014
In 2014, U.S. citizens and residents are required (with limited exceptions) to have
qualifying health coverage or “minimum essential health coverage” for themselves
and their dependents.
Exceptions to Individual Mandate:
• Religious objectors
• Individuals not lawfully present
• Incarcerated individuals
• Taxpayers with income under 100% of poverty and those who have a hardship waiver
• Members of Indian tribes
• Those who were not covered for a period of less than three months during the year
• People with no income tax liability
38. EMPLOYEE IMPACT IN 2014
Year Flat Dollar
Penalty
Family
Maximum
Percentage of
Income
2014 $95 $285 1.0%
2015 $325 $675 2.0%
2016 $695 $2,085 2.5%
Individuals who do not have qualifying health coverage will be subject to a tax penalty. This
penalty is also called a “shared responsibility payment”. The penalty will be the greater of:
A specified flat dollar amount per taxpayer, up to a maximum of three times the specified amount per family; or
A percentage of household income over the threshold amount of income required for income tax return filing
Following 2016, the
penalty will be
indexed for inflation.
39. APPROVED IRS PLAY OR PAY GUIDANCE
Proposed Regulations due March, 18 and public hearings for draft on April, 23
Proposals:
• Exclude hours worked overseas, not common law employees (leased workers, partners, sole proprietors, and true
independent contractors.)
• Employers near 50 employee threshold can choose any 6 consecutive month period in 2013 to get employee count
vs. entire 2013 period.
• If controlled group, apply mandate to each company in the group separately for penalty but not the calculation.
• Minimum Essential Coverage for all full time and dependents to mean 95% or the employees and dependents. A
5% margin for error.
• Dependent Coverage to exclude “Spouses”.
40. EXCHANGE STRATEGIES
• Defined Contribution vs. Defined Benefit?
• Is there a difference between Your Enrollment Platform and an Exchange?
• Is your Exchange Intuitive?
• Timing?
• Communications?
• Does your Exchange contain Health Outcomes/Wellness?
• ROI and can it be measured?
41. Suzanne Sentman
• ssentman@macpas.com
• 717-972-5761
• HR Coordinator
• McKonly & Asubry
E. Kent Evans, CBC
• Vice President
• Human Capital Practice
• Willis of Delaware, Inc.
• 302-397-0171
• kent.evans@willis.com
CONTACT US
SPEAKER NOTES: The Health Insurance Marketplace is a new way to find and buy health insurance and apply for Medicaid (discussed later). The Marketplace is designed to help you find health insurance that fits your budget, with less hassle. Eligible individuals and small businesses can shop for affordable, private coverage from Qualified Health Plans. Qualified Health Plans in the new Marketplace will be sold and run by private companies, and every Qualified Health Plan will cover a core set of benefits called Essential Health Benefits. You’ll be able to compare your options based on price, benefits, quality, and other important features. New and expanded programs will be directly linked in, and more people than ever before will get a break on costs. You will have guaranteed coverage and renewability, regardless of a pre-existing condition (like cancer or diabetes), sex, age, etc. When you shop at the Marketplace, information about prices and benefits is written in simple terms you can understand, so you don’t have to guess about your costs. You get a clear picture of what you’re paying and what you’re getting before you make a choice. Choose a plan from the comfort of your home, or anywhere you can access the Web, and sign up right online. Beginning October 2013, through one application, at one time, you and your family can explore every Qualified Health Plan in your area. You may even be eligible for an advance payment tax credit that lowers your monthly premium right away.
SPEAKER NOTES: Today, small employers have a tough time finding and affording coverage that meets the needs of their employees. Starting in 2014, they’ll have more choice and control over health insurance spending through the Small Business Health Options Program (SHOP). Eligible employers can choose the level of coverage they offer, define how much they’ll contribute toward their employees’ coverage, have exclusive access to a small business tax credit, and benefit from new protections that help them get real value for your premium dollars.
SPEAKER NOTES: Small employers must have fewer than 100 employees to be eligible to participate in a SHOP, although states may define a small employer eligible to participate in the SHOP as one with 50 or fewer employees until 2016. § 155.710 Eligibility standards for SHOP. (b) Employer eligibility requirements. An employer is a qualified employer eligible to purchase coverage through a SHOP if such employer— (1) Is a small employer; (2) Elects to offer, at a minimum, all full-time employees coverage in a QHP through a SHOP; and (3) Either— (i) Has its principal business address in the Marketplace (Exchange) service area and offers coverage to all its full-time employees through that SHOP; or (ii) Offers coverage to each eligible employee through the SHOP serving that employee’s primary worksite. (c) Participating in multiple SHOPs. If an employer meets the criteria in paragraph (b) of this section and makes the election described in (b)(3)(ii) of this section, a SHOP shall allow the employer to offer coverage to those employees whose primary worksite is in the SHOP’s service area. Those who are sole proprietors are considered individuals and may buy through the Marketplace, but not through a SHOP.
SPEAKER NOTES: The Marketplace (also known as an Exchange) is for individuals and small employers to directly compare certain competitive private health insurance options, known as Qualified Health Plans, on the basis of price, quality and other factors. The Marketplace, which will become fully operational by Jan. 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses similar options as large businesses. When key parts of the health care law take effect, there’ll be a new way to buy health insurance: the Health Insurance Marketplace. Enrollment starts Oct. 1, 2013 Coverage begins January 2014 When you shop at the Health Insurance Marketplace, information about prices and benefits is written in simple terms you can understand, so you don’t have to guess about your costs. You get a clear picture of what you’re paying and what you’re getting before you make a choice.
SPEAKER NOTES: The Marketplace will make it easier to find insurance coverage that fits your needs by: Increasing affordability. Find out if you are eligible for advance payment of the premium tax credits, cost-sharing reductions, or public insurance programs to make coverage more affordable. Offering personalized help. The Marketplace can help you consider your coverage choices and answer your questions. Help will be available through a website, a call center and community groups or individuals specifically designated as “navigators” to help consumers. Depending on the state, insurance agents and brokers may also be able to help consumers and small employers find coverage options in the Marketplace (if they meet criteria discussed later). Ensuring quality. The Marketplace will ensure that all Qualified Health Plans in the Marketplace meet basic standards, including quality standards, consumer protections, and access to an adequate range of doctors and clinicians. Making costs clear. When you shop at the Marketplace, information about prices and benefits is written in simple terms you can understand, so you don’t have to guess about your costs. You get a clear picture of what you’re paying and what you’re getting before you make a choice. Increasing transparency. The Marketplace will post clear and detailed information about health plan prices, benefits and quality so that you can make meaningful comparisons between plans.
SPEAKER NOTES: Through the Marketplace, you’ll be able to find out if you’re eligible for the new tax credits (which you can use right away to lower what you pay for your monthly health plan premium); cost-sharing reductions; or other health insurance programs, like Medicaid (a Federal/State program which covers certain people with low income and resources) and the Children’s Health Insurance Program (CHIP) (which covers certain children; and enroll promptly and easily in the appropriate program. One Marketplace application, one time, and you’ll see all the programs you qualify for. The Marketplace offers competition, choice, and clout. Insurance companies will compete for business on a level and transparent playing field, driving down costs.
SPEAKER NOTES: Section 1301 of the Health Care Law defines Qualified Health Plans as follows: (a) QUALIFIED HEALTH PLAN.—In this title: (1) IN GENERAL.—The term ‘‘Qualified Health Plan’’ means a health plan that— (A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in section 1311(c) issued or recognized by each Marketplace through which such plan is offered; (B) provides the Essential Health Benefits package described in section 1302(a); and (C) is offered by a health insurance issuer that— (i) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title; H. R. 3590—45 (ii) agrees to offer at least one Qualified Health Plan in the silver level and at least one plan in the gold level in each such Marketplace (see slide 11); (iii) agrees to charge the same premium rate for each Qualified Health Plan of the issuer without regard to whether the plan is offered through an Marketplace or whether the plan is offered directly from the issuer or through an agent; and (iv) complies with the regulations developed by the Secretary under section 1311(d) and such other requirements as an applicable Marketplace may establish. The Marketplace can only offer Qualified Health Plans, including stand-alone dental Qualified Health Plans that cover pediatric dental benefits.
SPEAKER NOTES: The Health Care Law provides for the establishment of an Essential Health Benefit (EHB) package that includes coverage of EHBs (as defined by the Secretary of the Department of Health and Human Services (the Secretary)). The law directs that EHBs be equal in scope to the benefits covered by a typical employer plan and cover at least the 10 general categories listed above.
SPEAKER NOTES: Actuarial value, or AV, is a measure of the percentage of expected health care costs a health plan will cover and can be considered a general summary measure of health plan generosity. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy. While premiums are not taken into account to calculate the actuarial value, generally plans with a higher actuarial value and more generous cost-sharing tend to have higher premiums. The Health Care Law requires that plans meet certain levels of coverage called “metal tiers.” Each of these levels of coverage is associated with an actuarial value, which the statute requires be calculated based on the provision of the Essential Health Benefits to a standard population (and without regard to the population the plan may actually provide benefits to). The levels of coverage are as follows: Bronze level - is a health plan that has an AV of 60 percent. Silver level - is a health plan that has an AV of 70 percent. The Silver plan is used for figuring the reductions in cost sharing and premium tax credits for eligible individuals. Gold level - is a health plan that has an AV of 80 percent. Platinum level - is a health plan that has an AV of 90 percent
SPEAKER NOTES: The Marketplace must determine an applicant eligible for enrollment in a Qualified Health Plan (QHP) through the Marketplace if he or she meets the following requirements: Meets the applicable residence standard—lives in the state served by the Marketplace, or if different, the service area of the Marketplace. Citizenship, status as a national, or lawful presence. Is a citizen or national of the United States, or is a noncitizen who is lawfully present in the United States, and is reasonably expected to be a citizen, national, or a non-citizen who is lawfully present for the entire period for which enrollment is sought. Is not incarcerated, other than incarceration pending the disposition of charges. NOTE: If you meet the eligibility requirements you are considered a “Qualified Individual.”
SPEAKER NOTES: The Marketplace may only permit a qualified individual to enroll in a Qualified Health Plan (QHP) or an enrollee to change QHPs during the Initial Open Enrollment Period, the Annual Open Enrollment Period, or a Special Enrollment Period for which the qualified individual has been determined eligible. NOTE: Later in the presentation we will discuss Medicaid and the Children’s Health Insurance Program (CHIP). You can apply for these programs at anytime. Annual Open Enrollment Period For the 2015 benefit period and beyond, the Annual Open Enrollment Period begins October 15 and extends through December 7 of the preceding calendar year. For example, on October 15, 2014, qualified individuals can begin enrolling in coverage that will start on January 1, 2015. Automatic enrollment The Marketplace may automatically enroll qualified individuals, at such time and in such manner as HHS may specify, and subject to the Marketplace demonstrating to HHS that it has good cause to perform such automatic enrollments. Notice of Annual Open Enrollment Period Starting in 2014, the Marketplace must provide a written Annual Open Enrollment notification to each enrollee no earlier than Sept. 1, and no later than Sept. 30.
SPEAKER NOTES: The Initial Open Enrollment Period begins Oct. 1, 2013 and extends through March 31, 2014. If the Marketplace receives a Qualified Health Plan (QHP) selection from a qualified individual-- From Oct. 1 to Dec. 15, 2013, the Marketplace must ensure an effective date of coverage of Jan. 1, 2014. Between the first and fifteenth day of any subsequent month during the Initial Open Enrollment Period, the Marketplace must ensure an effective date of coverage of the first day of the following month. Between the sixteenth and last day of the month for any month between December 2013 and March 31, 2014, the Marketplace must ensure an effective date of coverage of the first day of the second following month. The Marketplace has an option to allow for earlier effective dates. Subject to the Marketplace demonstrating to HHS that all of its participating QHP issuers agree to effectuate coverage in a timeframe shorter than mentioned above, the Marketplace may do one or both of the following for all applicable individuals: For a QHP selection received from a qualified individual the Marketplace may provide an earlier effective date, provided that either— (A) The qualified individual has not been determined eligible for advance payments of the new tax credit or cost-sharing reductions; or (B) The qualified individual pays the entire premium for the first partial month of coverage as well as all cost sharing. For a QHP selection received by the Marketplace from a qualified individual on a date set by the Marketplace after the fifteenth of the month for any month between December 2013 and March 31, 2014, the Marketplace may provide an effective date of coverage of the first of the following month.
SPEAKER NOTES: The Initial Open Enrollment Period begins Oct. 1, 2013 and extends through March 31, 2014. If the Marketplace receives a Qualified Health Plan (QHP) selection from a qualified individual-- From October 1 to December 15, 2013, the Marketplace must ensure an effective date of coverage of Jan. 1, 2014. Between the first and fifteenth day of any subsequent month during the Initial Open Enrollment Period, the Marketplace must ensure an effective date of coverage of the first day of the following month. Between the sixteenth and last day of the month for any month between December 2013 and March 31, 2014, the Marketplace must ensure an effective date of coverage of the first day of the second following month. The Marketplace has an option to allow for earlier effective dates. Subject to the Marketplace demonstrating to HHS that all of its participating QHP issuers agree to effectuate coverage in a timeframe shorter than mentioned above, the Marketplace may do one or both of the following for all applicable individuals: For a QHP selection received from a qualified individual the Marketplace may provide an earlier effective date, provided that either— (A) The qualified individual has not been determined eligible for advance payments of the new tax credit or cost-sharing reductions; or (B) The qualified individual pays the entire premium for the first partial month of coverage as well as all cost sharing. For a QHP selection received by the Marketplace from a qualified individual on a date set by the Marketplace after the fifteenth of the month for any month between December 2013 and March 31, 2014, the Marketplace may provide an effective date of coverage of the first of the following month.
SPEAKER NOTES: Coverage will be more affordable for some consumers through the new tax credits (also called Advance Premium Tax Credits) and reduced cost sharing. This financial assistance will help low income consumers who are not eligible for other insurance coverage buy insurance coverage.
SPEAKER NOTES: With most tax credits, you have to wait until you file your taxes to get the credit. But the new premium tax credit available through the Marketplace lets you reduce your costs right away. People who qualify can take the tax credit in the form of advance payments to lower their monthly health plan premiums starting in 2014, which can help make insurance more affordable. The premium tax credit is generally available to individuals and families with incomes between 100% and 400% of the Federal Poverty Level ($23,550 – $94,200 for a family of four in 2013) who do not have access to certain other types of minimum essential coverage, which will make coverage much more affordable for the middle class. The Congressional Budget Office estimates that when the Affordable Care Act is fully phased in, the premium tax credit will help 20 million Americans afford health insurance. The tax credit will be applied when you sign up for QHP coverage through the Marketplace and the payment will go directly to the insurance company. When you apply, you will provide your household income, identification to show that you are in the U.S. legally and other information. The Marketplace will determine what benefits you are eligible to receive (Medicaid, Child Health Plan Plus, tax credits). You will compare the Qualified Health Plans that are offered, each with a clear description of benefits and cost. You will buy the plan and the tax credit will be applied at that time to lower your cost. You will save more money if you choose a less expensive plan. Age-based increases in premiums are included when the premium tax credit is calculated. The advance payment of premium tax credits is reconciled at the end of the tax year. It limits the premium payments as a percent of income.
SPEAKER NOTES: Cost-sharing reductions are available to consumers to help them afford the insurance coverage they bought through the Marketplace. To be eligible for cost-sharing reductions, a consumer must have a household income that is less than or equal to 250% of the Federal Poverty Level (FPL) which is $58,875 annually for a family of four in 2013; meet the requirements to enroll in a health plan through the Marketplace and receive the new tax credit; and enroll in a silver-level plan through the Marketplace. A consumer who is a member of a Federally-recognized Indian tribe may also be eligible for special cost-sharing rules. Certain American Indians and Alaska Natives who purchase health insurance through the Marketplace do not have to pay copays or other cost-sharing if their income is under 300 percent of the Federal poverty level, which is roughly $70,650 for a family of four in 2013 ($88,320 in Alaska).
SPEAKER NOTES: Catastrophic plans will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost-sharing—providing affordable individual coverage options for young adults and people for whom coverage would otherwise be unaffordable. The tax penalty will be explained in more detail in future materials.
SPEAKER NOTES: The Health Care Law fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country. Beginning in January 2014, individuals under 65 years of age with incomes up to 133 percent of the Federal poverty level (FPL) will be eligible for Medicaid in those states that proceed with the Medicaid expansion. In addition, all children with incomes up to 133% of the FPL will be eligible for Medicaid. Those states that previously covered these children through the CHIP program will continue to receive the enhanced CHIP matching rate. In addition, the rules for counting income for purposes of determining Medicaid and CHIP eligibility will be much simpler and easier for families to understand. The Health Care Law makes coverage accessible to millions who would have otherwise remained uninsured.
SPEAKER NOTES: The new rule simplifies the Medicaid and CHIP eligibility, enrollment and renewal process in the following ways: Modernizes eligibility verification procedures to rely primarily on electronic data sources while providing states flexibility to determine the usefulness of available data before requesting additional information from applicants, and simplifying verification procedures for states through the operation of a Federal data services “Hub” that will link states with Federal data sources (e.g. Social Security and Homeland Security). Codifies current Medicaid policy so that eligibility is renewed by first evaluating the information available through existing data sources and limits renewals for the people enrolled through the simplified, income-based rules to once every 12 months unless the individual reports a change or the agency has information to prompt a reassessment of eligibility.
SPEAKER NOTES: If you have questions or need help applying, there are several resources that will be available, including a toll-free call center and website with plan comparison tools. There are also several programs to help you through the process of enrolling and using health insurance, including the Navigator program. Community-based organizations, agents and brokers, and other third-party assistors will also play a large role in helping people apply for health insurance coverage. The final rule lays out ways for agents and brokers to help consumers and small businesses enroll through the Marketplace if the state so chooses. It is important to note that some of the assistance resources (Marketplace call centers and websites, and Navigators) will be unbiased and impartial, while others (agents and brokers, and issuer web sites and call centers), will not. For information about enrolling in Medicaid or the Children’s Health Insurance Program (CHIP), check with your State Medical Assistance (Medicaid). Call 1-800-MEDICARE (1-800-633-4227) to get their phone number. TTY users should call 1-877-486-2048. Or, visit www.medicare.gov/contacts and search for your state Medicaid office’s contact information.
SPEAKER NOTES: The Insurance Finder on www.HealthCare.gov is a tool that can help you identify both private and public health coverage options available in your area. The Finder sorts through available options to help identify the ones that may be right for you.