The Patient Protection and Affordable Care Act — signed into law on March 23, 2010 – has been fraught with unpredictability, challenges and opportunities. Whether it’s Supreme Court rulings, elections, regulatory activity or attempts to repeal the law itself, there has always been some level of uncertainty surrounding the law despite its ongoing implementation. Join us for this webinar and learn how Cigna, a global health service company, has approached the act in support of its clients and customers. Early assessment and analysis led Cigna to where it is today, but the conversation is still far from over. Through this case study discussion, you’ll learn how Cigna built market-differentiating resources from the ground up and how it works to position its key stakeholders for success under the law today and into the future. Attendees will learn: Major impacts of PPACA on employers and employees. How analysis and insight guided the creation of Cigna's PPACA communication resources. Cigna's ongoing approach for supporting clients across industries in this highly regulated environment.

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Taking on PPACA: Five Years and
Counting

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Speakers: Kari Stevens, Esq.
Managing Counsel
Cigna Health Care Reform Consulting and
Communication
Kathy Vaccaro
Executive Consultant
Cigna Health Care Reform Consulting and
Communication
Moderator: Ladan Nikravan
Senior Editor
Workforce magazine
Taking on PPACA: Five Years
and Counting

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Ladan Nikravan
Senior Editor
Workforce magazine
Taking on PPACA: Five Years
and Counting

9. #WFwebinar
Kari Stevens, Esq
Managing Counsel
Cigna Health Care
Reform Consulting and
Communications
Taking on PPACA: Five Years
and Counting
Kathy Vaccaro
Executive Consultant
Cigna Health Care
Reform Consulting and
Communications

10. TAKING ON PPACA:
FIVE YEARS AND
COUNTING
Cigna Health Care Reform Consulting and Communications
March 4, 2015
Kari Stevens and
Kathy Vaccaro

11. Agenda
11Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
Legislation and impacts: Establishing a
leadership position
Evolving and differentiating in a highly regulated
environment: Cigna’s Health Care Reform
Consulting and Communications Team
Q&A

12. Establishing a Leadership Position
LEGISLATION AND IMPACTS
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

13. 13
March 23, 2010
Patient Protection and Affordable Care Act (PPACA)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

14. Challenges, Delays and Breakdowns:
Uncertainty Amid Implementation
14Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

15. 2010 - 2013 2014 2015 +
Focus on definition,
communication, interpretation,
and execution of immediate
requirements and preparing for
longer-term shifts
Navigate significant market
disruption with the launch of
exchanges, and other major
reforms
Capitalize on opportunities
created by major market
shake-out and a new market
reality
Early Groundwork New Status QuoMarket Transition
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna 15
PPACA Roadmap: Early Analysis

16. Cigna’s Collaborative Approach
16Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
Legal &
Government
Affairs
Healthcare
Business
Teams
Technology
Solution
Group
Shared
Responsibility

17. 2010
Provision Timeline
17Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna
201120122013201420152016AND
BEYOND
55 PPACA provisions already implemented with 12+ in progress or on the horizon
Large employer reporting
requirements
Employer
Mandate
Minimum essential
coverage reporting
Cadillac
tax
Small group
definition change
Public exchanges may
open to large employers
Summary of Benefits
and Coverage
Comparative Effectiveness
Research Fee
No pre-existing
conditions for all ages
Essential
health benefits
Health Insurance
Marketplaces/Exchanges
Individual
mandate
Clinical
trials
Wellness programs
and incentives
Waiting
periods
Guaranteed
availability/renewability
No annual
dollar limits
Health insurance
industry fee
Reinsurance
fee
HSAs
Medical
loss ratio
Eliminating the Medicare
Part D “Donut Hole”
OTC drug
limits
Medicare Part A tax on wages
and investment income
FSA
limits
Grandfathered
plans
Early retiree
reinsurance program
Appeals and
external review
Dependent
coverage to age 26
Doctor
choice
Phasing out
annual limits
No lifetime
limits
Prohibition in favor of highly
compensated individuals
No unreasonable
premium increases
Temporary
high-risk pools
100 %
preventive care
No pre-existing conditions
for under age 19

18. Established Program Management Office,
Developed Guiding Tenets
18Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
• Position clients and
customers for long-
term success
• Effect real ‘reform’
together
• 100% compliant
• Dedicated
implementation
resources
• “Go-to” resource
for clients and
brokers
• Award-winning
website and web
meeting series
• Dedicated
communications
team
• Advocate for
sustainable,
market-based
reform
• Preferred partner;
maximum
influence; early
insight
AdvocacyCommunicationsComplianceStrategy

19. Fees & Taxes: A Closer Look at ‘CERF’
Implementation and Communication
19Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
• Impact on
employer and
insurer costs
• Impact on rates
• Pass the cost onto
employees or not
• Administrative
support or not
• Cross functional
team, including
o Finance
o Underwriting
o IT
o Service
o Product
• Budgetary impacts
• Multi-year
implementation with
tight timeframes
• Detailed alerts
identifying key
elements and
requirements
• Internal and
external
communication plan
• Training for clients,
brokers and sales
teams
• Toolkit for clients
and brokers
• Feedback through
regulatory process
• Industry meeting
and feedback
session
participation
• Ensure regulators
understood the
impacts of the
decision
• Impact and difficulty
for employers
AdvocacyCommunicationsComplianceStrategy

20. “Informed on Reform” Branding:
Establishing Flagship Communications
20Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
InformedOnReform.com
25,000 monthly visits
Web Meeting Series
57,000 participants
94% average satisfaction rate
Breaking News Alerts
93 and counting
InformedOnReform.com
25,000 monthly visits
Web Meeting Series
57,000 participants
94% average satisfaction rate
Breaking News Alerts
93 and counting

21. Cigna’s Health Care Reform Consulting and Communications Team
EVOLVING AND DIFFERENTIATING
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

22. • Team of communications and legal
professionals dedicated to health
care reform
– Communication and educational
resources about the law and its
impacts
– Speak, engage, strategize and
provide consulting services
• Closely aligned with legal partners in
Washington, D.C. and the states that
help influence key aspects of the law
Health Care Reform Consulting and Communications Team:
‘You don’t have to go it alone!’
22Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
COMMUNICATIONS
AND SALES
SUPPORT
CONSULTING
SERVICES

23. Key Strategic Alignment: An Enterprise View
23Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna
Total health
and network
Enrollment
and retention
Implementation
Government
affairs
Sales/ Sales
Effectiveness
Product
Corporate
communications
Cigna U
Service
operations
Cigna creative
communications
Customer
experience
Brand

24. • Legal and
business impact
• Compliance focused
Strategy
Today’s Guiding Tenets: Expanded Consultation Focus
24Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna
• Foster client and
customer success
• Deliver best-in-class
solutions
Consultation
• Enterprise training
and resources
• Award-winning
website and web
meetings
Education
• Dedicated team
• Enterprise view
Communication

25. Spotlight on communications and education
Cigna’s industry-leading tools and resources include:
25Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
• InformedOnReform.com
• Informed On Reform web meeting series
• Health Care Reform for you infographic
tool (HCRforYOU.com)
• Breaking news alerts
• Partnership with Groom Law Group
• Internal Training and Development

26. Spotlight on consulting and events
Cigna’s Health Care Reform Consulting and Communications team serves as a
resource for benefits professionals.
Our communication and
legal experts are available for:
• Presentations, panels and
speaking opportunities
• Strategy sessions
• Web meetings
• Roadshows
• Roundtables
• Educational events
26Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

27. What’s Next?
Leading in a Highly Regulated Environment
27Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
New standards and potential penalties
New reporting requirements: First report due in 2016 on coverage offered in 2015EMPLOYER
MANDATE
IMPACTS
New Congress has identified full-time definition as a priority (40 hours vs. current 30)
2015 U.S. Supreme Court ruling on public exchange subsidies
2016 Small group expansion from 50 to 100 full-time employees
2017 Public exchanges may open to large employers
2018 Cadillac taxOTHER
REGULATORY
TOPICS

28. Cigna Health Care Reform Resources
28Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
Visit our website
www.InformedonReform.com
• Optimized for desktop,
tablet or mobile devices
• News alerts, fact sheets,
timeline, FAQs and more
• Try our Health Care for You
infographic tool

29. Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company.
“Cigna” and the “Tree of Life” logo are registered service marks, and “Together, all the way.” is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna
Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Connecticut General Life Insurance
Company and Cigna Health and Life Insurance Company, and not by Cigna Corporation. All models are used for illustrative purposes only.
000000 04/15 © 2015 Cigna. Some content provided under license.

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