The document discusses the implications of the Affordable Care Act (ACA) for self-funded health plans, emphasizing the need for compliance with ACA regulations such as shared responsibility and standard eligibility rules. It highlights the benefits for individual consumers, alongside the challenges that self-funded plans may face in adapting to these new requirements. Ultimately, the presentation advocates for compliance as a means to foster a market for comparable health products while managing individual liabilities and eligibility processes.

1. ““Obamacare” Compliance:Obamacare” Compliance:
How It Helps Self-funded PlansHow It Helps Self-funded Plans
Presented by:
Si Nahra, Ph.D., President
June 27, 2013

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About Health Decisions, Inc.
Pioneering Specialists in Group Health CarePioneering Specialists in Group Health Care
Post-Payment AdministrationPost-Payment Administration
For Over 25 YearsFor Over 25 Years
RespectRespect for Existing Proceduresfor Existing Procedures
EmphasisEmphasis on Customizationon Customization
FocusFocus on Solutionson Solutions
Customer
Philosophy:
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Health Decisions, Inc.

3. Orientation towards our topic
• Distrust of government is an American value.
• Disrespect for anything the government does is not.
• Partisan politics do not apply.
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Health Decisions, Inc.
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4. Presidents’ Policies
Presidents Health Policy Legacy
Roosevelt/Truman Social Security
Eisenhower Employment-based Benefits
Kennedy/Johnson Medicare/Medicaid
Nixon/Ford HMOs
Carter National Health Planning
Reagan Dismantle Carter program. Rely on Market Forces
Bush I Federally Qualified Health Centers
Clinton HIPAA
Bush II Medicare Part D (Rx)
Obama ACA and the Rise of the Consumer Market
Post-Obama 2016/17 may be tougher than 2014
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Health Decisions, Inc.

5. Focus Today
Affordable Care Act
(Title I, Subtitles A, C, and F)
Self-funded Group Health Plans
•Shared Responsibility AKA Pay-or-Play
•Other related requirements
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6. Gauging Intent
• No lifetime limits
• Coverage of preventive health
• Extension of dependent
coverage
• Uniform explanation of coverage
• Standard plan comparisons
• Limits on coverage costs
• Common eligibility rules
• Confirmed offer of coverage
• Limits on out-of-pocket costs
• Taxes for research and risk
Who Benefits Most?
Individual consumers
Self-funded plan role?
Implementation
A way to get to individuals
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Health Decisions, Inc.
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7. What Plan Compliance Means
1. Play by the same rules
2. Manage eligibility and enrollment
3. Pay taxes for research and risk
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Health Decisions, Inc.
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8. 1. Play by the same rules
Provision Consumer Impact Plan Consequence
Minimum Value Consumer knows what
they are getting and how it
compares
Easy to pass for most.
Out-of-pocket limits an
issue for some.
Spending accounts help.
Affordability Consumer costs for
getting coverage capped
at 9.5% of family income.
Easy to pass for most.
Issue for some low-wage
workers.
Per occurrence fine small and unlikely.
Out-of-pocket
accumulator
All consumer cost sharing
for services counts
towards limits tied to
spending accounts.
Brings order to chaos.
Many will need to re-do
cost sharing rules and
administration.
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9. 2. Manage eligibility and enrollment
Provision Consumer Impact Plan Consequence
FTE Eligibility Same eligibility rules
apply wherever you go.
New process needed.
Brings direction to most
overlooked area.
Impacts certain groups
(hourly, seasonal) more.
Offer of enrollment Presents and explains
options.
Opportunity to take
Or
Obstacle to avoid
Overall fine can be large but easy to avoid.
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Health Decisions, Inc.
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10. 3. Pay taxes
Provision Consumer Impact Plan Consequence
Research None Disturbing precedent.
See slide 3: Distrust of
government is an
American value.
Risk
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Health Decisions, Inc.
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11. Options
• Ignore
• Delay
• Fight
• Comply
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Health Decisions, Inc.
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12. Why Comply?
• The Good
– Creating a market with comparable products
– Adopting uniform plan definitions
– Standardizing how individual liability is calculated
– Defining eligibility-enrollment-entitlement processes
• Outweighs the Bad
– Changes to existing policies and procedures
– Taxes
© Copyright 2013
Health Decisions, Inc.
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Past Webinars Available
Recordings of past webinars are available upon request, including:
• Mid-June 2013 – Employer Mandate Calculations Explained
• May 2013 – Pay or Play: A Bigger Challenge for TPAs than for Plans
• April 2013 - The Most Overlooked Part of Health Reform: Enrollee Communications
• March 2013 – Why Cost Sharing is not Working
• February 2013 – Loss of Fiduciary Control
• January 2013 – Top 10 Do’s and Don'ts of Data Warehousing
• December 2012 – Union Trusts: Health Reforms Most Overlooked Winner?
• November 2012 – Year-end Renewal and Bidding: Opportunities for Control and Savings
• October 2012 – The 5 Most Important Things an Effective Dependent Audit Should Include
• September 2012 – Old Question, New Twist: Is Self-funding Right for Your Group Health Plan?
• August 2012 – Are You Ready to Manage Your Health Plan Costs?
• June 2012 - Group Health Brokers’ Future: Disintermediation or Re-intermediation
For more information, please visit www.healthdecisions.com
Copyright Health Decisions, Inc.
6/2013

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Health Decisions, Inc.
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For More Information
Contact
si@healthdecisions.com
734-451-2230
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