Health Care Reform Matrix: A Tool for Understanding the ImpactCBIZ, Inc.
Our Health Care Reform Matrix is a comprehensive tool to help you understand all of the impacts of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.
Health Care Reform Matrix: A Tool for Understanding the ImpactCBIZ, Inc.
Our Health Care Reform Matrix is a comprehensive tool to help you understand all of the impacts of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.
20th Annual Legal & Accounting Institute - Healthcare Reform - Joshua A. Sutinsaafdn
Joshua A. Sutin, Attorney at Law with Cox | Smith presents "Healthcare Reform: Where do Employers Go From Here" for the San Antonio Area Foundation's 20th Annual Legal & Accounting Institute on December 6, 2012.
View this powerpoint delivered by Rita Landgraf, secretary of the Division of Health and Social Services for the State of Delaware about the Health Care Reform Legislation. This presentation was given on June 2, 2010 at the Delaware State Chamber of Commerce's End-of-Session Legislative Brunch at Dover Downs.
In less than one year, major provisions of the Patient Protection and Affordable Care Act are taking effect at state and federal levels, and many of those new provisions will directly impact businesses around the country. At this event, we’ll present fact-based, non-partisan information that’s important to Colorado business leaders: the timeline of the law and important dates.
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.
Health Care Reform Legislative Brief
2013 Compliance Checklist
In light of the Supreme Court's June 28, 2012, decision to uphold the health care reform law, or Affordable Care Act (ACA), employers must continue to comply with ACA mandates that are currently in effect.
Staffscapes, Inc. is a Human Resources Outsourcing firm that specializes in HR, Payroll & Benefits. We recently presented this slide show to a group of Colorado Small Business Owners and Managers and are sharing it with the general public today.
Are you ready for the upcoming 2014 provisions of the new healthcare reform act? Do you know what the implications are to you as a small or midsize company?
Our webinar will help you become familiar with upcoming requirements under the Patient Protection and Affordable Care Act.
Expect to learn the following and more:
What is the Patient Protection and Affordable Care Act
How does an organization determine their 2014 cost to comply?
What should organizations be doing now to prepare?
With the landmark healthcare reform legislation now in place, we're sure that you have questions about how it impacts your organization and your employees. At a Pearson Partners International HR Roundtable presentation, Buck Consultants helped decipher the legislation—so you understand, in practical terms, what it means and what you need to do. Presentation includes:
Market Reform:
timeline and play-or-pay penalties
Individual Responsibility:
deadlines, definitions and numbers
Insurance Exchanges:
explanation and eligibility
Financing:
funding, taxes and surcharges
Employer Responsibility:
compliance, reporting and communication
20th Annual Legal & Accounting Institute - Healthcare Reform - Joshua A. Sutinsaafdn
Joshua A. Sutin, Attorney at Law with Cox | Smith presents "Healthcare Reform: Where do Employers Go From Here" for the San Antonio Area Foundation's 20th Annual Legal & Accounting Institute on December 6, 2012.
View this powerpoint delivered by Rita Landgraf, secretary of the Division of Health and Social Services for the State of Delaware about the Health Care Reform Legislation. This presentation was given on June 2, 2010 at the Delaware State Chamber of Commerce's End-of-Session Legislative Brunch at Dover Downs.
In less than one year, major provisions of the Patient Protection and Affordable Care Act are taking effect at state and federal levels, and many of those new provisions will directly impact businesses around the country. At this event, we’ll present fact-based, non-partisan information that’s important to Colorado business leaders: the timeline of the law and important dates.
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.
Health Care Reform Legislative Brief
2013 Compliance Checklist
In light of the Supreme Court's June 28, 2012, decision to uphold the health care reform law, or Affordable Care Act (ACA), employers must continue to comply with ACA mandates that are currently in effect.
Staffscapes, Inc. is a Human Resources Outsourcing firm that specializes in HR, Payroll & Benefits. We recently presented this slide show to a group of Colorado Small Business Owners and Managers and are sharing it with the general public today.
Are you ready for the upcoming 2014 provisions of the new healthcare reform act? Do you know what the implications are to you as a small or midsize company?
Our webinar will help you become familiar with upcoming requirements under the Patient Protection and Affordable Care Act.
Expect to learn the following and more:
What is the Patient Protection and Affordable Care Act
How does an organization determine their 2014 cost to comply?
What should organizations be doing now to prepare?
With the landmark healthcare reform legislation now in place, we're sure that you have questions about how it impacts your organization and your employees. At a Pearson Partners International HR Roundtable presentation, Buck Consultants helped decipher the legislation—so you understand, in practical terms, what it means and what you need to do. Presentation includes:
Market Reform:
timeline and play-or-pay penalties
Individual Responsibility:
deadlines, definitions and numbers
Insurance Exchanges:
explanation and eligibility
Financing:
funding, taxes and surcharges
Employer Responsibility:
compliance, reporting and communication
Health Reform Bulletin: Implementation Guidance & ACA UpdatesCBIZ MHM, LLC
1) Distribution of Marketplace Notice to Employees; 2) 90-day Waiting Period; 3) Individual Shared Responsibility- Final Regulations; 4) Employer Appeals in Marketplace Eligibility Determinations; 5) Small Business Tax Credit; 6) Preventive Care - Health Saving Accounts; and 7) Internal Claims, Appeals and External Review: Providing Culturally and Linguistically Appropriate Notices
Change is constant as employers and employees navigate
through the twists and turns of health benefits coverage. This infographic provides and overview of health care reform compliance deadlines.
This presentation highlights the changes required of small businesses to maintain compliance with Health Care Reform regulations. Cathy Harbison, director of operations for employee benefits at Neace Lukens, served as the expert speaker to explain upcoming changes for 2011 – 2014, and the implications for businesses with less than 50 employees.
CBIZ Matrix & Health Reform Bulletin 40 ACA Updates: CLASS Act Suspended, Inc...CBIZ, Inc.
CBIZ HEALTH REFORM MATRIX
A TOOL FOR UNDERSTANDING THE IMPACT OF HEALTH CARE REFORM
Patient Protection and Affordable Care Act (Public Law 111-148, Enacted March 23, 2010) and the
Health Care and Education Reconciliation Act (Public Law 111-152, enacted March 30, 2010)
For more information, visit http://www.cbiz.com/benefits/
Employers Healthcare Reform Overview and TimelineThe comprehensive nature of this recently passed reform includes benefit re-design, increased administrative compliance costs, eligibility rule restructuring, increased taxes and health insurance exchange management. Employers need to streamline their operations to meet ...compliance requirements set by the legislation and their employer\’s workforce size.
To prepare for open enrollment, health plan sponsors should become familiar with the legal changes affecting plans for the 2014 plan year. In addition, health plan sponsors should make sure that open enrollment packages include certain participant notices.
Successful Exhibiting at the LeadingAge Annual MeetingLeadingAge
Need to know information to prepare your sales team for the 2016 LeadingAge Annual Meeting and EXPO, one of the Largest Aging Services EXPOs in America.
Understand your options with respect to various social media platforms and which ones are likely to enhance your fundraising campaigns and philanthropy program in general.
Philanthropy Planned Giving Primer 04-15-15LeadingAge
Learn from respected fundraising consultants and LeadingAge Business Associate, Richner & Richner, LLC about the basic elements of a planned giving campaign.
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
May 20 AAHSA Town Hall: Health Reform and Employers
1. Health Care Reform Town Hall
Update
What Does It Mean For You As An Employer?
Thursday, May 20
2:00 – 3:00 p.m. ET
1
2. Speakers
Barbara Gay, Director of Advocacy Information,
AAHSA
Dave Sanders, National Tax & Erisa Practice, Aon
Consulting
Thora Johnson, Partner, Employee Benefits and
Executive Compensation, Venable, LLP
2
3. Structure of Today’s Program
Introduction: Barbara Gay
Key Employer Provisions Overview: Dave Sanders
Timeline Implementation: Thora Johnson
Questions and Closing: Barbara Gay
3
4. Implementation of Health Reform
Implementation Challenges
Complex and challenging law to implement
2,400 pages plus 153 page reconciliation bill
HHS (Health and Human Services) on point for
implementation
Date of enactment was 3/23/10, with 6 month effective date
for some provisions (9/23/2010)
Plans in existence on 3/23/10 are exempt from many rules,
if remain unchanged ("grandfathered" plan)
4
5. Key Employer Issues – Market Reforms
Dependent Coverage Annual and Lifetime Maximums
Coverage of adult children up to No lifetime maximums permitted
age 26, regardless of marital or for overall benefits (annual/
student status lifetime limits on specific benefits
permitted)
– If not eligible for other group plan
(this condition expires 12/31/13) – Effective 6 months after
– Applies even if the child is not a enactment (1/1/11 for CY plans)
tax dependent Complete elimination of annual
Effective 6 months after limits beginning January 1, 2014
enactment (1/1/11 for CY plans) Restrictions on annual limits prior
to 2014 TBD by regulation
– Effective 6 months after
enactment (1/1/11 for CY plans)
5
6. Key Employer Issues – Market Reforms
Pre-existing Conditions Exclusions Waiting Periods
Not permitted for children under Waiting periods greater than 90 days
age 19 are not permitted
– Effective 6 months after Effective 1/1/2014
enactment (1/1/11 for CY plans)
Not permitted for all plan enrollees
– Effective 1/1/2014
Preventive Benefits
Must provide first dollar coverage for
evidence based preventative care
Effective 6 months after enactment
(1/1/11 for CY plans)
Grandfathered plans exempt
6
7. Key Employer Issues – Impactful Provisions
Free Rider Provision Employee Voucher
Applies to employees working 30+ Applies to employees working 30+
hours/week hours per week
Employer pays $3,000 for each Employers would convert health
EE with coverage <60% of coverage subsidy to cash for any
allowed costs or if EE pays >9.5% employees who would pay
of their household income for between 8% and 9.8% of their
health coverage household income for health
coverage and opts out of
Employers not offering health employer sponsored coverage for
coverage pay $2,000 per EE coverage in an Exchange based
First 30 employees not included in plan
calculation of assessment Effective 1/1/2014
Effective 1/1/2014
7
8. Key Employer Issues
Auto Enrollment Health Accounts
Applies to new hires OTC drugs no longer
Employees can opt-out reimbursable under FSA,
HRA or HSA, unless prescribed by
Employer can choose plan for physician
auto enrollment
– Effective 1/1/2011
Effective 1/1/11 or issuance of
regulations by DOL, if later Penalty on withdrawal of HSA
funds for non-medical expenses
Employee Notification increased to 20%
Employers must notify employees – Effective 1/1/2011
at time of hire of the availability of Annual contributions to health
Exchanges and their potential FSAs limited to $2,500 annually
eligibility for a subsidy
– Effective 1/1/2013
Effective 3/1/2013
– Indexed to CPI as of 1/1/2014
No requirement to offer same
coverage as Exchange plans
8
9. Key Employer Issues
W-2 Reporting Uniform Explanation of Coverage
Employers required to report the Annual distribution of summary of
“value” of health benefits provided benefits and coverage
to each employee
– Not to exceed 4 pages
– Value defined as COBRA cost
Uniform Explanation is in addition
Effective 1/1/2011 to the SPD required by ERISA
Effective 3/23/2012
Transparency Requirements
Same HHS transparency Small Employer Tax Credit
requirements as Exchange based
plans Employers with <25 employees
Claims payment policies and data earning < $50,000 each are eligible
for tax credit
Information on cost sharing and
payment for OON Applies to employer contributions
Information on rating policies toward cost of health insurance
Effective 1/1/2014 Available for 2010-13 tax years
9
10. Key Employer Issues
Wellness Incentives Appeals Process
Employers permitted to increase Employer plans must have HHS
employee reward for participation in approved external review process
wellness programs to 30% of total
plan cost Effective 1/1/2011
– HHS may increase to 50% Grandfathered plans exempt
Effective 1/1/2014
Grandfathered plans exempt Cost Sharing Limitations
Nondiscrimination Out of pocket expense cannot
exceed HSA related coverage
Insured plans are subject to same Deductibles cannot exceed $2,000
nondiscrimination rules as self- single & $4,000 family as indexed
funded plans
Effective 1/1/2011
Effective 1/1/2014
Grandfathered plans exempt Grandfathered plans exempt
10
11. Key Employer Issues
CLASS Act
Voluntary federal LTC insurance program
EEs can purchase via payroll deductions
All auto enrolled EEs can opt-out
Lifetime benefit payments
5-year vesting period
Eligible for benefit if at least 2 ADLs for 90 days
Estimated revenue: $71 billion
Effective 1/1/2011
11
12. Other Key Provisions
2010 Adoption assistance plan dollar limit
increased from $12,170 to $13,170
Nursing mothers entitled to unpaid breaks
and private lactation room
2014 Medicaid expansion to 133% of FPL
Individual Mandate begins with penalties in
2015
State-based Insurance Exchanges are
operational
2017 Employer plans of any size can participate
in Exchanges (state approval)
2018 High cost excise tax with revised thresholds
of $10,200/individual and $27,500/family
12
13. Other Key Provisions
New Taxes on High Income Individuals
Adjusted gross income >$200k for individuals
and >$250k for couples
Additional Medicare payroll tax on wages of
0.9% (employee-share only)
New surtax on investment income of 3.8%
New taxes on higher income individuals
replaces lost revenue from delayed enactment
of high cost plan excise tax (estimated $210
billion)
Effective 1/1/2013
13
14. Impact on Post-Retirement Health Plans
Taxation of Medicare Part D retiree drug subsidy
Temporary reinsurance program for pre-Medicare retirees (at least age 55)
– Re-insurance for claims covering 80% of costs between $15,000-
$90,000 for pre-65 retirees
– Only funded up to $5 billion
Cutbacks to Medicare FFS providers and Medicare Advantage plan funding
Closure of Medicare Part D “donut hole”
14
15. Timeline for Next Steps
Applies to
Effective Grandfathered
Date Action Items Plans?
Now If you have 25 or fewer FTEs, work with your
Finance Department to evaluate whether you are
eligible for the small employer tax credit and if so,
apply for credit
If you offer retiree coverage and apply for the
Medicare Part D subsidy, work with your Finance
Department and auditors to evaluate the current
impact on your financial statements under the
FASB rules because the Medicare Part D subsidy
will effectively become taxable in 2013
6/23/2010 If you offer retiree coverage for retirees ages
55-65 who are not eligible for Medicare, apply
for the retiree reinsurance program, work with your
Finance Department and obtain claims data from
your insurance company/TPA and consider
appropriate plan design changes
14
16. Applies to
Effective Grandfathered
Date Action Items Plans?
1/1/2011 Evaluate what plans you are going to offer, and
for determine whether any plans need to be
calendar
restructured
year plans
• Determine what grandfathered plans you have
• Determine whether you have any dental and
vision coverage that you want to convert to
“stand-alone” plans so that they are exempt from
the new rules on annual and lifetime limits
• Determine whether you have any fully-insured
plans that need to be restructured to comply with
the nondiscrimination coverage rules, such as
executive-only plans
• CLASS Act (voluntary long-term care program)
• New wellness programs (grants available for
small employers).
15
17. Applies to
Effective Grandfathered
Date Action Items Plans?
1/1/2011 Amend medical plan documents
for
calendar
year plans
• Remove lifetime maximum limits for essential
health benefits (and define what those are)
• Revise annual limits for essential health benefits
to reflect HHS standards
• Remove pre-existing condition limits for children
under age 19
• Limit right to rescind coverage only to fraud or
intentional misrepresentation of a material fact
• Expand dependent eligibility to cover adult
children up to age 26 (applicable to grandfathered
plans only if the dependents are not eligible for
coverage under another employment-based plan)
• Remove cost sharing, and implement first-dollar
coverage, for preventive care (deductibles,
copays, and co-insurance can't apply)
• Permit designation of any participating primary
care provider
• Remove restrictions on emergency care
• Update internal and external appeals procedures
16
18. Applies to
Effective Grandfathered
Date Action Items
Plans?
1/1/2011 for Amend medical plan documents (cont’d)
calendar
year plans • Any additional design changes that may be
made to offset some of the anticipated
increases in costs due to limits on annual and
lifetime maximums, removal of pre-existing
conditions, etc.
Amend medical FSA plan documents
• Eliminate reimbursement for OTC drugs
• If small employer, consider establishing
“Simple” cafeteria plan
Provide notice of changes to participants (by
11/1/2010)
• Give at least 60 days’ advance notice of
changes (SMMs or new SPDs)
Negotiate insurance costs or stop-loss
coverage, as applicable
• Removal of annual, lifetime, and pre-existing
condition limits, and cost sharing, the addition
of other restrictions, and expansion of
dependent eligibility could create more expense
to employers, in terms of premiums for fully-
insured plans and stop-loss
17
19. Applies to
Effective Grandfathered
Date Action Items Plans?
1/1/2011 for Update contracts with TPAs/claims
calendar administrators
year plans
• Compliance with new internal and external
claims processes
● Determine who will prepare HHS reporting on
medical loss ratios
● Determine who will handle transparency
disclosures to HHS (and public)
Implement auto enrollment (depending on
effective date)
Work with payroll to implement changes
● Payroll withholding to implement any “Simple”
employer cafeteria plan; voluntary CLASS Act
plan
● W-2 reporting of employer-provided health
coverage
18
20. Applies to
Effective Date Grandfathered
Action Items Plans?
1/1/2011 for Provide required notices to HHS
calendar year
plans
● Reporting to HHS on medical loss ratios
• Reporting to HHS (and public) to comply
with transparency provisions
Apply for available grants for small
employer wellness program
1/1/2012 for Amend medical plan documents
calendar year
plans
• Coordination with Medicare
Provide new required (uniform) plan
summaries
Update contracts with TPAs/claims
administrators
• Put systems in place to enable quality of
care reports to HHS
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21. Applies to
Effective Date Grandfathered
Action Items Plans?
1/1/2013 for Amend Medical FSA plan documents
calendar year
plans
• Impose cap on contributions
Work with payroll to implement
changes
• Medical FSA caps
• Increased Medicare taxes on earned
income
Work with Finance
• Taxation of Medicare Part D subsidy
• Payment of per-participant fee
(premium tax)
Provide required notices by 3/1/2013 to
employees regarding availability of
insurance exchanges
20
22. Applies to
Effective Grandfathered
Date Action Items Plans?
1/1/2014 for Evaluate what plans you are going to offer
calendar
year plans
• Small employers have access to state
insurance exchanges
• Large employers are subject to play or pay
penalties, opt-out penalties, and “free
choice” vouchers
• Permitted increase in employee reward to
30% for participation in wellness program
Amend medical plan documents
• Grandfathered plans must expand
dependent eligibility for adult children, even
if eligible for other employer-provided
coverage
21
23. Applies to
Effective Date Grandfathered
Action Items Plans?
1/1/2014 for Amend medical plan documents
calendar year (cont’d)
plans
• Remove waiting periods exceeding 90
days
• Remove all annual limits on essential
benefits
• Remove all pre-existing conditions (can
no longer impose on individuals age 19
and over)
Mandated cost-sharing limits
• Add coverage for clinical trials for cancer
or life threatening diseases
• Any additional design changes that may
be made to offset some of the
anticipated increases in costs due to
changes on annual limits, removal of
pre-existing conditions, and limits on
cost-sharing
Negotiate insurance costs or stop-loss
coverage, as applicable
• Removal of annual and pre-existing
condition limits, cost sharing and other
restrictions, and expansion of dependent
eligibility could create more expense to
employers, in terms of premiums for
fully-insured plan and stop-loss
Reporting to IRS on employer-provided
coverage 22
24. Applies to
Effective Date Grandfathered
Action Items Plans?
1/1/2014 for Provide required notices regarding
calendar year employer-provided coverage and
plans wellness programs
1/1/2017 for Evaluate what plans you are going to
calendar year offer
plans
• Large employers have access to state
insurance exchanges
1/1/2018 for Evaluate what plans you are going to
calendar year offer
plans
• Work with Finance and with insurance
company or actuarial firm to determine if
you offer a "Cadillac" plan subject to
penalty tax, or whether you can
restructure your plans to minimize or
avoid penalty
24
25. Questions?
Questions will be addressed by emailing:
townhall@aahsa.org.
If we cannot get to your question we will
respond via email or by providing
information on the AAHSA Health Reform
Hub located on aahsa.org:
http://www.aahsa.org/healthreform
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26. Resources
AAHSA Health Reform Information Hub
www.aahsa.org/healthreform
AON Consulting Microsite
www.aon.com/healthcarereform
Venable, LLP
www.venable.com
26
27. Speaker Contact Information
Barbara Gay, Advocacy, AAHSA
(202) 508-9489
bgay@aahsa.org
Dave Sanders, National Tax & Erisa Practice, AON
Consulting
(410) 547-5989
dave.sanders@aon.com
Thora Johnson, Employee Benefits and Executive
Compensation, Venable, LLP
(410) 244-7747
tajohnson@venable.com
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