A new report, "Health Care Reform and Walmart: What the Senate Health Care Reform Bill Means to the Country’s Largest Employer," outlines how that the Senate Health Care Bill, as written, fails to hold Walmart responsible for the health care costs of its 1.4 million employees.
This document provides a timeline and overview of key provisions in the Patient Protection and Affordable Care Act (ACA). It outlines the legislative timeline from when the House and Senate passed versions of health care reform in 2009-2010 to when President Obama signed the bill into law. It then summarizes major ACA provisions being implemented from 2010 through 2018 and beyond, including requirements for insurance plans, the establishment of health insurance exchanges, Medicaid expansion, and individual/employer mandates. The document concludes by discussing how the ACA is paid for through various new taxes and fees and its projected impact on the private health insurance marketplace.
The Patient Protection and Affordable Care Act (PPACA) timeline outlines key provisions and their implementation dates between 2010-2018. Major provisions include prohibiting pre-existing condition exclusions (2010), expanding dependent coverage to age 26 (2010), establishing state-based health insurance exchanges (2014), an individual mandate to purchase insurance (2014), an employer mandate for firms with 50+ employees (2015), and a tax on high-cost "Cadillac" plans (2018). The timeline provides an overview of how PPACA rolls out major health insurance reforms over an 8 year period.
Taking a closer look at what your company needs to know about moving from a fully-insured to a self-funded health benefits environment. Originally presented by Greg Bass, Senior Consultant/Benefits Division Manager for The Starr Group, this presentation shares the "secret formula" for health insurance programs that successfully work WITH ObamaCare!
This document defines various key terms related to health insurance:
1. It describes an actuary as an insurance professional responsible for determining premiums based on claims paid versus premiums collected to ensure profits.
2. It provides brief definitions for terms like admitting privilege, affordable care act, agent, beneficiary, benefit, brand name drug, broker, carrier, case management, certificate of insurance, claim, and COBRA.
3. It explains concepts such as coinsurance, copayment, credit for prior coverage, deductible, denial of claim, dependent, effective date, exclusion, explanation of benefits, fee for service, generic drug, group health insurance, and guaranteed issue.
The document provides an overview of key provisions of the Affordable Care Act (ACA) for employers, including requirements for large employers to offer affordable minimum essential health coverage. It defines terms like full-time employees, dependents, minimum essential coverage, affordability, minimum value, and outlines penalties for noncompliance. It advises employers to assess their status as a large employer based on employee headcount, identify which employees must be offered coverage, ensure coverage meets affordability and minimum value standards, and consider actions needed like amending cafeteria plans to prepare for 2014 requirements.
Health care reform_timeline_chart_1-28-13Eric Stern
The timeline summarizes important dates in the implementation of the Affordable Care Act between 2010 and 2018. Key provisions include:
- 2010-2011: Dependent coverage must be offered until age 26 and pre-existing conditions can be covered through high-risk pools.
- 2011-2013: Medical loss ratio and electronic transactions rules apply, health care exchanges are established.
- 2014: Most individuals must have coverage or pay a penalty and health insurance market reforms take effect.
- 2015-2018: Additional taxes and fees are imposed on health plans, and remaining ACA provisions are implemented.
Stop loss insurance protects companies that self-fund their health care plans. It reimburses employers for medical claims that exceed predetermined deductibles, shielding them from catastrophic losses. Employers may choose to self-fund to realize savings over conventional insurance and customize benefits for their employees. Stop loss coverage kicks in to reimburse employers after individual or total claims for the group reach specified deductible levels set in the insurance contract.
This document provides a timeline and overview of key provisions in the Patient Protection and Affordable Care Act (ACA). It outlines the legislative timeline from when the House and Senate passed versions of health care reform in 2009-2010 to when President Obama signed the bill into law. It then summarizes major ACA provisions being implemented from 2010 through 2018 and beyond, including requirements for insurance plans, the establishment of health insurance exchanges, Medicaid expansion, and individual/employer mandates. The document concludes by discussing how the ACA is paid for through various new taxes and fees and its projected impact on the private health insurance marketplace.
The Patient Protection and Affordable Care Act (PPACA) timeline outlines key provisions and their implementation dates between 2010-2018. Major provisions include prohibiting pre-existing condition exclusions (2010), expanding dependent coverage to age 26 (2010), establishing state-based health insurance exchanges (2014), an individual mandate to purchase insurance (2014), an employer mandate for firms with 50+ employees (2015), and a tax on high-cost "Cadillac" plans (2018). The timeline provides an overview of how PPACA rolls out major health insurance reforms over an 8 year period.
Taking a closer look at what your company needs to know about moving from a fully-insured to a self-funded health benefits environment. Originally presented by Greg Bass, Senior Consultant/Benefits Division Manager for The Starr Group, this presentation shares the "secret formula" for health insurance programs that successfully work WITH ObamaCare!
This document defines various key terms related to health insurance:
1. It describes an actuary as an insurance professional responsible for determining premiums based on claims paid versus premiums collected to ensure profits.
2. It provides brief definitions for terms like admitting privilege, affordable care act, agent, beneficiary, benefit, brand name drug, broker, carrier, case management, certificate of insurance, claim, and COBRA.
3. It explains concepts such as coinsurance, copayment, credit for prior coverage, deductible, denial of claim, dependent, effective date, exclusion, explanation of benefits, fee for service, generic drug, group health insurance, and guaranteed issue.
The document provides an overview of key provisions of the Affordable Care Act (ACA) for employers, including requirements for large employers to offer affordable minimum essential health coverage. It defines terms like full-time employees, dependents, minimum essential coverage, affordability, minimum value, and outlines penalties for noncompliance. It advises employers to assess their status as a large employer based on employee headcount, identify which employees must be offered coverage, ensure coverage meets affordability and minimum value standards, and consider actions needed like amending cafeteria plans to prepare for 2014 requirements.
Health care reform_timeline_chart_1-28-13Eric Stern
The timeline summarizes important dates in the implementation of the Affordable Care Act between 2010 and 2018. Key provisions include:
- 2010-2011: Dependent coverage must be offered until age 26 and pre-existing conditions can be covered through high-risk pools.
- 2011-2013: Medical loss ratio and electronic transactions rules apply, health care exchanges are established.
- 2014: Most individuals must have coverage or pay a penalty and health insurance market reforms take effect.
- 2015-2018: Additional taxes and fees are imposed on health plans, and remaining ACA provisions are implemented.
Stop loss insurance protects companies that self-fund their health care plans. It reimburses employers for medical claims that exceed predetermined deductibles, shielding them from catastrophic losses. Employers may choose to self-fund to realize savings over conventional insurance and customize benefits for their employees. Stop loss coverage kicks in to reimburse employers after individual or total claims for the group reach specified deductible levels set in the insurance contract.
This document summarizes a presentation about self-insurance under the Affordable Care Act. The presentation discusses what self-insurance is, the impact of the ACA on self-insured plans, advantages and disadvantages of self-insurance, and updates about ACA requirements. It provides an overview of stop loss insurance, cost-sharing limits, reinsurance fees, employer penalties, and reporting requirements under the ACA. The presentation aims to educate companies on health care reform and compliance obligations for self-insured plans.
The Pros and Cons of Self-Insured vs. Fully Insuredbenefitexpress
This webinar reviews which factors and employer should consider in self-insuring and full benefits. It will discuss the legal, administrative, and ee issues.
Note: If this publication all links are dead, but you need to download files from this publication, please send me a private message and I'll try to help you or emai to info@presslounge.vn for supporting
Disclaimer: We do not encourage illegal activity. References to a content protected by the copyright law, are given exclusively in the fact-finding purposes. If you liked the program, music or the book – buy it.
This presentation is designed to provide the information needed to understand self-funding, assist you in explaining the solution to clients and then determine whether it is right for their company by comparing and contrasting it to a fully insured solution.
Get ready for the Affordable Care Act. The light you see is the oncoming train!
Lot's of things happening, not too many answers and it will take a few years to flesh it all out.
Health Care Reform: The Franchise Operator's Guide 10-26-12Franchise Workforce
The document summarizes key provisions of the Affordable Care Act that take effect in 2014, including:
1) The Supreme Court upheld the individual mandate and entire Affordable Care Act.
2) State health insurance exchanges will offer plans to individuals and small businesses.
3) Most individuals will be required to have minimum essential health coverage or pay a penalty. Low-income individuals can receive subsidies.
4) Employers with 50+ full-time employees that do not offer affordable coverage may pay penalties.
5) Nondiscrimination rules are expanded to prevent fully insured group health plans from favoring highly-compensated employees.
Voluntary insurance policies provided by employers can help address rising health care costs and benefits challenges. As health care premiums increase faster than wages, employers are forced to reduce coverage while employees face higher deductibles and out-of-pocket costs. This places financial strain on both employers and employees. Voluntary insurance supplements existing health plans by providing additional benefits to help cover expenses with no added costs to employers. It enhances employee benefits packages and satisfaction while helping attract and retain talent. Over half of large employers offer voluntary insurance as an affordable solution to complex health care issues.
- Employers who receive the Retiree Drug Subsidy (RDS) will lose the tax deduction for retiree drug expenses starting in 2013 due to healthcare reform regulations. This will significantly increase costs for companies with retiree prescription drug coverage.
- Self-funded Employer Group Waiver Plans (EGWPs) are emerging as an alternative to the RDS. EGWPs allow employers to contract with a prescription drug plan sponsor to provide retiree drug benefits while passing on government subsidies to reduce costs.
- EGWPs offer employers benefits like reducing costs, satisfying existing retiree benefit commitments, increasing efficiency, reducing administrative burden, and improving cash flow compared to the RDS. Employers should
Group insurance provides coverage to a large number of individuals under a single master policy between the insurer and a representative body. It offers benefits like life, health, and accident insurance to groups of people associated with an employer or organization. Grouping individuals allows insurers to offer lower rates due to the large volume of policies.
In this presentation I discuss the best types of insurance for business owners. Our firm provides all of these services and more. Audio will soon be added.
This document provides a glossary of terms related to individual health insurance. It defines terms like agent, annual deductible, coinsurance, network providers, pre-existing conditions, and premiums. It also provides contact information for Celtic Insurance Company, an individual health insurance provider. Celtic aims to offer consumers affordable and easy-to-understand insurance plans. The glossary helps explain insurance concepts and Celtic's services.
Affordable Care Act and Employer Shared ResponsibilityJenny Villier
The document discusses the Employer Shared Responsibility provision under the Affordable Care Act that requires applicable employers to either offer affordable health insurance to employees or pay a penalty. It applies to employers with 50 or more full-time equivalent employees as of 2016, or 100 or more in 2015. Employers must offer coverage to 70% of employees in 2015 or 95% in 2016. If an employer does not comply and an employee receives a premium tax credit, the employer must pay $2,084-$3,126 per full-time employee beyond the thresholds. The penalties are meant to incentivize employers to provide coverage and lower insurance costs.
The document discusses employee benefits trends in India. It notes that India has a large and diverse population. Mandatory benefits include provident fund, gratuity, and personal accident insurance. Voluntary benefits include mediclaim, life insurance, and superannuation. Insurance companies offer various products for retirement benefits like defined contribution plans and defined benefit plans. Common retirement benefits provided by employers include leave encashment, gratuity, and superannuation. Trends show life insurance participation and defined contribution plans increasing among employers and employees in India.
This document discusses Symetra Financial and Crowne Group's partnership in providing stop loss insurance solutions. It highlights Symetra's financial strength and experience. Crowne leverages its long relationship with Symetra to obtain competitive pricing and claims terms for clients. The document also outlines Crowne's services, including proposals, reporting, renewals, and claims assistance. Case studies show how Crowne has intervened to reduce clients' claims costs and rates. In the end, the document emphasizes Symetra and Crowne's commitment to partnering with agents and providing extensive service and leverage for favorable stop loss terms.
The document discusses how the Affordable Care Act (ACA) will affect small businesses and their employees. It notes that smaller businesses are less likely than larger ones to offer health insurance. It explains that under the ACA, small businesses can keep existing "grandfathered" plans, but new requirements will apply to other plans. New plans purchased by small businesses must guarantee coverage regardless of health status, cover essential benefits, and meet other standards. The ACA also creates insurance exchanges for small businesses to purchase coverage more easily and provides tax credits to help cover costs. However, some small employers may face penalties if they do not offer affordable coverage.
Stop loss coverage is a form of excess risk insurance that protects self-funded employer health plans. It helps manage costs for very large medical claims by having the insurance carrier pay for claims above a certain threshold amount.
The plan fiduciary is responsible for the administration and management of an employee benefit plan. For a self-funded employer health plan, the employer is generally considered the plan fiduciary since they are responsible for purchasing administrative services, such as from a third party administrator (TPA). The TPA then provides various services on behalf of the employer plan.
A company must formulate a sound compensation policy that determines the nature, administration, and review of cash compensation, near-cash compensation, and benefits in a strategic manner. An effective compensation policy pays employees based on performance, is competitive with the market, engages employees in the company's success, and communicates a link to corporate performance. Compensation includes guaranteed cash like salary, variable pay like bonuses and commissions, benefits like health insurance and retirement plans, and other elements like allowances and recognition programs. The document also discusses Social Security System benefits provided in the Philippines like sickness, maternity, disability, retirement and death benefits.
R. Scott Baxter has provided graphic design, marketing, and creative services for various clients. His portfolio highlights projects including marketing campaigns, brochures, websites, packaging, signage, and publications. For each project, he utilized design, photography, and production skills to effectively communicate clients' messages and achieve their goals.
The document discusses a study conducted by Burson-Marsteller examining social media use among Fortune 100 companies. The study found that 76% of Fortune 100 companies have official Twitter accounts, while 14% have Facebook pages and 10% have corporate blogs. 21% of companies use just one channel, most commonly Twitter, while 22% use two channels and 17% use all three channels. The technology industry is the most active on social media. The document provides examples of how Fortune 100 companies use Twitter for news/updates, customer service, promotions and other purposes.
This document summarizes a presentation about self-insurance under the Affordable Care Act. The presentation discusses what self-insurance is, the impact of the ACA on self-insured plans, advantages and disadvantages of self-insurance, and updates about ACA requirements. It provides an overview of stop loss insurance, cost-sharing limits, reinsurance fees, employer penalties, and reporting requirements under the ACA. The presentation aims to educate companies on health care reform and compliance obligations for self-insured plans.
The Pros and Cons of Self-Insured vs. Fully Insuredbenefitexpress
This webinar reviews which factors and employer should consider in self-insuring and full benefits. It will discuss the legal, administrative, and ee issues.
Note: If this publication all links are dead, but you need to download files from this publication, please send me a private message and I'll try to help you or emai to info@presslounge.vn for supporting
Disclaimer: We do not encourage illegal activity. References to a content protected by the copyright law, are given exclusively in the fact-finding purposes. If you liked the program, music or the book – buy it.
This presentation is designed to provide the information needed to understand self-funding, assist you in explaining the solution to clients and then determine whether it is right for their company by comparing and contrasting it to a fully insured solution.
Get ready for the Affordable Care Act. The light you see is the oncoming train!
Lot's of things happening, not too many answers and it will take a few years to flesh it all out.
Health Care Reform: The Franchise Operator's Guide 10-26-12Franchise Workforce
The document summarizes key provisions of the Affordable Care Act that take effect in 2014, including:
1) The Supreme Court upheld the individual mandate and entire Affordable Care Act.
2) State health insurance exchanges will offer plans to individuals and small businesses.
3) Most individuals will be required to have minimum essential health coverage or pay a penalty. Low-income individuals can receive subsidies.
4) Employers with 50+ full-time employees that do not offer affordable coverage may pay penalties.
5) Nondiscrimination rules are expanded to prevent fully insured group health plans from favoring highly-compensated employees.
Voluntary insurance policies provided by employers can help address rising health care costs and benefits challenges. As health care premiums increase faster than wages, employers are forced to reduce coverage while employees face higher deductibles and out-of-pocket costs. This places financial strain on both employers and employees. Voluntary insurance supplements existing health plans by providing additional benefits to help cover expenses with no added costs to employers. It enhances employee benefits packages and satisfaction while helping attract and retain talent. Over half of large employers offer voluntary insurance as an affordable solution to complex health care issues.
- Employers who receive the Retiree Drug Subsidy (RDS) will lose the tax deduction for retiree drug expenses starting in 2013 due to healthcare reform regulations. This will significantly increase costs for companies with retiree prescription drug coverage.
- Self-funded Employer Group Waiver Plans (EGWPs) are emerging as an alternative to the RDS. EGWPs allow employers to contract with a prescription drug plan sponsor to provide retiree drug benefits while passing on government subsidies to reduce costs.
- EGWPs offer employers benefits like reducing costs, satisfying existing retiree benefit commitments, increasing efficiency, reducing administrative burden, and improving cash flow compared to the RDS. Employers should
Group insurance provides coverage to a large number of individuals under a single master policy between the insurer and a representative body. It offers benefits like life, health, and accident insurance to groups of people associated with an employer or organization. Grouping individuals allows insurers to offer lower rates due to the large volume of policies.
In this presentation I discuss the best types of insurance for business owners. Our firm provides all of these services and more. Audio will soon be added.
This document provides a glossary of terms related to individual health insurance. It defines terms like agent, annual deductible, coinsurance, network providers, pre-existing conditions, and premiums. It also provides contact information for Celtic Insurance Company, an individual health insurance provider. Celtic aims to offer consumers affordable and easy-to-understand insurance plans. The glossary helps explain insurance concepts and Celtic's services.
Affordable Care Act and Employer Shared ResponsibilityJenny Villier
The document discusses the Employer Shared Responsibility provision under the Affordable Care Act that requires applicable employers to either offer affordable health insurance to employees or pay a penalty. It applies to employers with 50 or more full-time equivalent employees as of 2016, or 100 or more in 2015. Employers must offer coverage to 70% of employees in 2015 or 95% in 2016. If an employer does not comply and an employee receives a premium tax credit, the employer must pay $2,084-$3,126 per full-time employee beyond the thresholds. The penalties are meant to incentivize employers to provide coverage and lower insurance costs.
The document discusses employee benefits trends in India. It notes that India has a large and diverse population. Mandatory benefits include provident fund, gratuity, and personal accident insurance. Voluntary benefits include mediclaim, life insurance, and superannuation. Insurance companies offer various products for retirement benefits like defined contribution plans and defined benefit plans. Common retirement benefits provided by employers include leave encashment, gratuity, and superannuation. Trends show life insurance participation and defined contribution plans increasing among employers and employees in India.
This document discusses Symetra Financial and Crowne Group's partnership in providing stop loss insurance solutions. It highlights Symetra's financial strength and experience. Crowne leverages its long relationship with Symetra to obtain competitive pricing and claims terms for clients. The document also outlines Crowne's services, including proposals, reporting, renewals, and claims assistance. Case studies show how Crowne has intervened to reduce clients' claims costs and rates. In the end, the document emphasizes Symetra and Crowne's commitment to partnering with agents and providing extensive service and leverage for favorable stop loss terms.
The document discusses how the Affordable Care Act (ACA) will affect small businesses and their employees. It notes that smaller businesses are less likely than larger ones to offer health insurance. It explains that under the ACA, small businesses can keep existing "grandfathered" plans, but new requirements will apply to other plans. New plans purchased by small businesses must guarantee coverage regardless of health status, cover essential benefits, and meet other standards. The ACA also creates insurance exchanges for small businesses to purchase coverage more easily and provides tax credits to help cover costs. However, some small employers may face penalties if they do not offer affordable coverage.
Stop loss coverage is a form of excess risk insurance that protects self-funded employer health plans. It helps manage costs for very large medical claims by having the insurance carrier pay for claims above a certain threshold amount.
The plan fiduciary is responsible for the administration and management of an employee benefit plan. For a self-funded employer health plan, the employer is generally considered the plan fiduciary since they are responsible for purchasing administrative services, such as from a third party administrator (TPA). The TPA then provides various services on behalf of the employer plan.
A company must formulate a sound compensation policy that determines the nature, administration, and review of cash compensation, near-cash compensation, and benefits in a strategic manner. An effective compensation policy pays employees based on performance, is competitive with the market, engages employees in the company's success, and communicates a link to corporate performance. Compensation includes guaranteed cash like salary, variable pay like bonuses and commissions, benefits like health insurance and retirement plans, and other elements like allowances and recognition programs. The document also discusses Social Security System benefits provided in the Philippines like sickness, maternity, disability, retirement and death benefits.
R. Scott Baxter has provided graphic design, marketing, and creative services for various clients. His portfolio highlights projects including marketing campaigns, brochures, websites, packaging, signage, and publications. For each project, he utilized design, photography, and production skills to effectively communicate clients' messages and achieve their goals.
The document discusses a study conducted by Burson-Marsteller examining social media use among Fortune 100 companies. The study found that 76% of Fortune 100 companies have official Twitter accounts, while 14% have Facebook pages and 10% have corporate blogs. 21% of companies use just one channel, most commonly Twitter, while 22% use two channels and 17% use all three channels. The technology industry is the most active on social media. The document provides examples of how Fortune 100 companies use Twitter for news/updates, customer service, promotions and other purposes.
Building and nurturing a strong network of contacts is increasingly a key skill for today’s CEOs and non-executive directors. Learning from those outside your normal circle of business interaction can inform and enlighten your ability to tackle the challenges faced in an organisation, and develop and sharpen your own personal leadership skills.
In this article, Matthew Blagg, CEO of Criticaleye, articulates why executives need to foster a value-rich community of business relationships.
Senate "Free-Rider" Provision fails to hold large employers accountableufcwinternational
A new report, "Health Care Reform and Walmart: What the Senate Health Care Reform Bill Means to the Country’s Largest Employer," outlines how that the Senate Health Care Bill, as written, fails to hold Walmart responsible for the health care costs of its 1.4 million employees.
Should an Employer Be Self-Funded?
That is quite a question. In the past we cautioned that claims savings was not guaranteed by self-funding. And with a small difference in fixed fees vs. fully insured retention, there was not much incentive for smaller employers to take the risk, given that they were more susceptible to wide fluctuations in claims cost.
Review our research and analysis on self-funding to help determine if the program is the right fit for your business. Contact McGohan-Brabender to discuss self-funding in detail.
https://www.mcgohanbrabender.com/
ACA Healthcare legislation and attempts at increasing regulation of self-funding and stop loss coverage are driving more employers toward stop loss captives.
Controlling Workers’ Compensation Costs by as Much as 20% - 50%Richard Swartzbaugh
What is Workers’ Compensation?
Who Benefits from Workers’ Compensation Cost Control? Everyone!!!
Worker’s Comp costs can be one of your Company’s greatest “out of control” costs, or, YOU can but in a proven 19-step system to reduce Workers’ Comp costs by as much as 20% - 50%, and utilize critical metrics to address:
- Why workers’ compensation metrics are important
- The formulas for how to calculate 5 critical metrics
- How to leverage these metrics to make an impact at your organization
Following the step-by-step instructions in 19-Step system for the calculation and application of critical metrics will address:
- Workers’ comp viewed as a cost of doing business
- Getting management to understand value of return to work
- Convincing policy holders to embrace a worker recovery program
- Lack of informed and effective employer involvement in WC claims issues
- Stakeholder apathy
- Managers and supervisors not taking seriously their duty to protect workers
Avoiding Workers’ Comp mistakes & loopholes will help drive three major points:
- Drivers of human behavior
- Disincentives to “Return to Work”
- Most common employer mistakes
Finally:
- Evidence-based medicine will create better Workers’ Comp claim outcomes.
- In organized environments, executing successful return to work programs with Unions (and members) is essential.
- As part of a comprehensive workers compensation program, employers should maintain close communications with injured employees to ensure they recover quickly, do not drop out of the workforce and return to work rapidly. Get Well Cards are part of a positive, proactive communication strategy.
The House and Senate bills have substantial similarities but also key differences that will need to be resolved. Both bills provide early reforms starting in 2010, improve insurance coverage and exchanges beginning in 2013-2014, improve Medicare, and are fully paid for. However, there are differences in subsidies, employer and individual requirements, benefit standards, and other areas that will require negotiation.
Chapter 6Alternative Responses and Initiatives of Institutions aJinElias52
Chapter 6
Alternative Responses and Initiatives of Institutions and Professions
Nongovernmental health care organizations provide most medical services and handle the financing of much of the system. For-profit and nonprofit institutions operate side by side, often competing directly for the same business.
This chapter identifies a number of strategies that individuals and organizations adopt in response to governmental programs or initiate on their own to influence health policy. We start with Table 6-1, which outlines the actors and the alternatives for responding to government actions and the marketplace. Where alternatives have been addressed and terms defined in earlier chapters, we try not to repeat that information.
6.1 COMMON RESPONSES
All of the players listed in Table 6-1 employ strategies to influence the marketplace and its regulators. These can be classified into three main types of interventions:
• Public relations
• Marketing and education
• Lobbying
Table 6-1 Responses and Initiatives of Institutions and Professions
Common Approaches
• Public relations
• Marketing and education
• Lobbying
Payers
• Employers
• Eligibility
• Subsidy offered
• Plans offered
• Relationship with insurers/self-insurance
• Worker education and training
• Insurers
• Method of organization
• Method of payment
• Plans offered
• Case management/carve-outs
• Utilization constraints
• Consumer education
Providers
• Professionals
• Organization of practice
• Services offered
• Incentives
• Pricing
• Patient relationships
• Primary versus specialty care
• Efficiency
• Institutions
• Organizational structure
• Scope and scale of services
• Pricing/discounts
• Efficiency
• Quality improvement
• Consumer information
• Credentialing decisions
• Involving payers in change processes
• Professions
• Quality improvement
• Provider education
• Consumer education
Consumers
• Plan selection
• Provider selection
• Self-help
Each player manages its relationships with the media and with politicians and regulators directly, and each acts indirectly through trade associations and professional groups. You will see illustrations of this throughout the cases included in this text and in subsequent chapters dealing with political feasibility and values. The focus of each intervention changes depending on the nature of the specific market. Lobbying is particularly intense in administered markets such as Medicare and Medicaid, especially when new legislation is under consideration. Lobbying also goes on continuously with the relevant executive branch agencies. Public relations and education are used more assertively when regulators are considering changes, and marketing, especially advertising, is most intense where the market is less regulated. The term education can apply to the many different types of efforts to influence behavior. Government antismoking campaigns can be characterized as education, for example, but the term can also ...
Please find attached our 4th Quarter Benefits Bulletin. Highlights include updates on Pay or Play Penalties and an overview of what\'s next now that the election is over.
This document discusses why the Mid-Market Med group captive program is a viable solution for mid-market employers given changes under the Affordable Care Act. The program offers comprehensive services, low collateral requirements, top-tier reinsurance, flexibility, and has achieved positive results including an 18% annual premium return and 99% client retention. The program allows mid-market employers to share risks and lower healthcare costs through a medical stop loss group captive.
The Gardner Group's eighth newsletter provides updates on self-funded employee health benefits and data analytics. Self-funding allows employers to avoid premium taxes and state-mandated benefits, saving thousands per year. While it presents financial risk, purchasing stop-loss insurance mitigates exposure to catastrophic claims. Data analytics helps self-funded employers streamline inefficiencies, identify at-risk members, and lower costs through wellness programs. The newsletter also discusses consumer-directed health plans that function as a form of modified self-insurance, saving employers money versus traditional insurance.
Reporting Requirements for Every Business
At the minimum, the IRS requires every employer to document, track and prove their employer status. Get the complete break down of requirements for employee counts from 0 to 100+.
Learn Critical Terms You Need to Know
From Form 1095-C to Safe Harbor Rules, we break down the most frequently used ACA terms employers will encounter.
Get A Blueprint for Measurement Periods
Break down the who, what, and how of ACA reporting to learn how to measure data for new hires and current employees.
Break Down the Form 1095-C by Sections
Get a clear understanding of the Form 1095-C and navigate the tougher sections to know what information you’ll need to file to avoid costly penalties.
Special Health Care Reform Edition of BIZGrowth Strategies NewsletterCBIZ, Inc.
Be sure to check out the Special Health Care Reform Edition of BIZGrowth Strategies Newsletter. Article topics include Private Exchanges, Health Care Reform's Impact on Compensation, the Shared Responsibility Penalty's Effect on Worker Classification, How to Manage Change during these Times and How the ACA Affects Your Payroll System.
#2 What is voluntary insurance why do employees need itThomas C. Williams
Voluntary insurance provides additional coverage to employees to help pay medical and living expenses not covered by major medical insurance. It is not required but is completely optional for employees to enroll in. Many employees are interested in voluntary insurance because nearly half have less than $1,000 to pay out-of-pocket medical costs, and two-thirds would struggle with the costs of a serious injury or illness. Voluntary insurance can help employees pay deductibles, coinsurance, copays, and bills that continue after an illness or injury when someone cannot work. It benefits both employees and employers by providing financial protection for employees with no direct cost to companies.
This document provides a timeline and overview of key provisions and deadlines established by the Patient Protection and Affordable Care Act (ACA). Some of the major provisions that took effect from 2010-2018 include requiring insurance plans to cover dependents up to age 26, prohibiting denial of coverage due to pre-existing conditions, establishing health insurance exchanges, expanding Medicaid eligibility, and implementing individual and employer mandates. The timeline highlights how various insurance market reforms, taxes, and penalties were phased in over this period to increase access to health insurance coverage.
Health Care Reform After The Supreme Court Rulingwisdomjl
The document summarizes key aspects of the Supreme Court ruling on the Affordable Care Act and the expected impact of health care reform. It discusses the individual mandate being upheld under the taxing power, changes to insurance plans and exchanges beginning in 2014, penalties for employers not providing coverage, and increased costs and regulations for insurers, providers, and consumers. The document aims to help financial advisors and brokers understand and explain health care reform to their clients.
Employers are always looking for ways to reduce one of their biggest expenditures–the cost of providing health insurance to employees. Many employers have explored solutions such as adding wellness plans, reducing usage, and providing different provider access mechanisms, all with modest success.
Stemming the rising costs of health insurance requires management to understand and improve healthcare outcomes for their employee and dependent populations. Changing the future of employer health insurance will require a multi-faceted approach:
Driving additional value by reducing utilization of healthcare services within these employer populations.
Utilizing a wider lens through which to view performance of various providers, then making decisions based on those who are consistently providing low cost, high quality care.
Employer will need to combine their data with other companies across a geographic region to get a better picture of the provider landscape than has ever been possible before.
This document provides a summary of the major provisions of the Affordable Care Act that impact employers and recommendations on how to prepare. It includes an overview of requirements that are already in place and future requirements. It also notes that Colonial Life's voluntary benefits are exempt from many of the health insurance reforms and discusses important considerations for voluntary benefits like the health insurance exchanges, employer reporting on W-2 forms, and the excise tax.
Every American is entitled and bound to avail Minimum Essential Coverage (MEC) under the Affordable Care Act (ACA) - also known as Obamacare. While some opt for individual health insurance plans offered by private institutions, more than 60% opt for Employer-Sponsored Health Insurance. Employer-Sponsored Health Insurance makes your work easy because you don't have to go through multiple insurance plans available online. Employers, on an average pay 82% of your premium for a single insurance policy. For employers also this is a win-win situation because it results in employee retention, better health of employees thus more productivity. Employers use good health benefits as a great tool to recruit sought-after talent in the industry.
The slide deck talks about Employer-Sponsored Health Insurance, its comparison to individual health insurance and the win-win situation for employee and employer.
Shifting away from employer-provided healthcare means individuals will be responsible for cost containment.
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Senate "Free-Rider" Provision fails to hold large employers accountable
1. Health Care Reform
and Walmart
What the Senate Health Care
Reform Bill Means to the
Country’s Largest Employer
2.
3. December 8, 2009
Health Care Reform
and Walmart
What the Senate Health Care Reform Bill Means
to the Country’s Largest Employer
When President Barack Obama announced his As written, this bill will:
intent to pursue comprehensive health care
reform, he stated that for reform to be effective • Incentivize the hiring of a largely part-time
it must be based on a principle of shared workforce, and encourage reducing workers’
responsibility. All Americans, including hours as a way to reduce health care costs.
employers, must do their part in contributing • Force low-income Walmart employees into
to solving this health care crisis. high-deductible company-provided
In this historic effort, The U.S. House of insurance.
Representatives has succeeded in making this • Make few, if any, Walmart employees eligible
critical provision a reality. for tax credits to purchase better insurance
Unfortunately, the Senate is headed in the through the health insurance exchange.
opposite direction. • Continue Walmart’s dependence on
The Senate health care reform proposal federal and state subsidies for Medicaid for
currently under debate includes provisions its employees, and encourage Walmart to
that attempt to make sure every employer pays have even more employees dependent on
their fair share into the health care system. Medicaid.
However, this report outlines how that • Provide little or no incentive for Walmart to
legislation, as written, falls far short of that provide better care to their employees.
goal.
In order for health care reform to effectively
It fails to hold Walmart, the nation’s largest pri- lower costs and expand coverage to the
vate employer, responsible for the health care underinsured and uninsured, it must include
costs of its 1.4 million employees. the choice of a public option and strong
Health Care Reform and Walmart 1
4. employer responsibility provisions that ensure and is ineligible to enroll in the exchange 5.
that large employers like Walmart pay their fair Hence, if an employer has employees on
share for their employees’ health insurance. Medicaid, the company will not pay any penalty
for these employees.
BACKGROUND • If the employer offers health insurance that
Walmart Stores, Inc. (Walmart) is the world’s meets the minimum qualification of having
second largest private sector corporation, with an actuarial value of 60%6,7 , and the
annual sales of $406 billion in its latest fiscal employee opts out of it and purchases
year. It is also the world’s largest private sector insurance through the exchange instead, the
employer, with around 2.1 million employee is eligible for the tax credit only if
employees. It operates more than 8,100 stores the lowest-premium plan offered by the
worldwide, with 4,300 of them in the United employer is unaffordable. Affordability is based
States. Walmart employs 1.4 million people on percentage of income required to be paid
in the U.S., making it the second biggest U.S. in premiums alone (not including other forms
employer after the federal government. of cost-sharing such as deductibles and
co-pays). The threshold percentage of
income that must be paid in premiums for a
SUMMARY OF EMPLOYER
plan to be deemed unaffordable is 9.8% 8.
RESPONSIBILITY PROVISION
• If an employee can obtain coverage through
The “employer responsibility” provisions of a spouse or (for a young employee) a parent,
the Senate health care reform bill1 require that, or if the employee is over 65 and therefore
if an employer with more than 50 employees2 qualifies for Medicare, or if the employee has
has employees who receive a subsidy (i.e., tax more than one job and can obtain qualifying
credit) for insurance through an exchange, the coverage (meeting the actuarial value floor
employer has to pay a penalty equal to $3,000 and the premium share of income ceiling)
times the number of full-time employees of the through another job, the employee is
company 3. ineligible for tax credits and therefore the
This means that if an employer has only employer pays no penalty.
part-time employees receiving tax credits for
insurance purchased through the exchange, the
employer pays no penalty.
To qualify for the tax credit for insurance
purchased through the exchange:
5 Ibid., TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS,
• If the employee’s family income is below Subtitle E—Affordable Coverage Choices for All Americans, PART I—PRE-
133 percent of the Federal Poverty Level MIUM TAX CREDITS AND COST-SHARING REDUCTIONS, SUBPART B—ELIGI-
BILITY DETERMINATIONS, Sec. 1413, pp. 295-296.
(FPL)4 , the employee qualifies for Medicaid
6 Actuarial value is defined as the percentage of health care charges that a
plan pays on average. For example, if the average participant in a plan pays
1 Patient Protection and Affordable Care Act, TITLE I—QUALITY, AFFORD- 10% of health care charges and the plan pays 90%, the plan has an actuarial
ABLE HEALTH CARE FOR ALL AMERICANS, Subtitle F—Shared Responsibility value of 90%. For further details see McDevitt, Roland, “Actuarial Value: A
for Health Care, PART II—EMPLOYER RESPONSIBILITIES, Sec. 1511-1515, pp. Method for Comparing Health Plan Benefits,” prepared by Watson Wyatt
346-364, available at: http://democrats.senate.gov/reform/patient-protec- Worldwide for California Health Care Foundation, October 2008, available
tion-affordable-care-act.pdf. at: http://www.chcf.org/documents/insurance/HealthPlanActuarialValue.
pdf
2 Ibid., Sec. 1513, p. 352.
7 The actuarial value floor of 60% is from Patient Protection and Affordable
3 Ibid., Sec. 1513, pp. 350-352. The monthly “applicable payment amount” Care Act, TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERI-
is 1/12 of $750. Therefore, 400% of the annual applicable payment amount CANS, Subtitle E—Affordable Coverage Choices for All Americans, PART
comes to $3,000 per year. I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS, SUBPART A—
PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS, Sec. 1401, p. 249.
4 Ibid., TITLE II—ROLE OF PUBLIC PROGRAMS, Subtitle A—Improved Access
to Medicaid, Sec. 2001, p. 397. 8 The premium share of income ceiling of 9.8% is from Ibid., p. 248.
2 Health Care Reform and Walmart
5. FLAWED INCENTIVES IN value threshold). Employees are then forced
EMPLOYER RESPONSIBILITY to choose to accept this coverage, purchase
PROVISION coverage through the exchange without
receiving any tax credits, or pay a penalty
The employer responsibility provision as for being uninsured.
described above has several serious flaws, i.e.
it creates incentives for employers to institute IMPACT OF THE EMPLOYER
hiring, scheduling, and pay practices that hurt RESPONSIBILITY PROVISION ON
low income workers. In particular:
WALMART EMPLOYEES
• The employer pays a penalty only for full-
Walmart currently offers a range of health
time employees who qualify for tax credits.
plans. According to the company, 51.8 percent
The definition of full-time employment in
of employees are insured through company
the bill is 30 hours per week 9. This gives an
plans.10
employer the incentive to cut the hours for
low income workers who would qualify for The lowest-premium plans offered by Walmart
credits down to part-time to avoid paying in 2010 are affordable in terms of the premium,
the penalties, instead of offering affordable but have high deductibles. For example, the
coverage. lowest-premium family plan has a premium
per pay period (two weeks) of $27 and an
• The employer pays no penalties for
annual deductible of $4,400. This amounts to
employees who are on Medicaid. This
an annual premium expenditure of $702.11
gives employers the incentive to cut back
employees’ wages so that more of them Walmart discloses its average wage for full-
qualify for Medicaid, instead of offering time employees as $11.24 per hour.12 The
affordable coverage. obvious caveat regarding this number is that
it is an average, and the lowest (i.e. starting)
• This provision gives employers the incen-
wage is significantly lower.
tive to preferentially hire employees who
would be covered under another health An internal memo by a Wal-Mart Vice
care plan. For example, those over 65 who President13 states that full-time Walmart work-
qualify for Medicare, teenagers who are on ers in 2005 worked an average of 34 hours a
their parents’ health plans, and workers with week. While the memo argued for increasing
coverage through a spouse or a second job. the average hours to spread the fixed cost of
It also encourages companies to discriminate health benefits across more hours to enhance
against those who would create a health care cost-efficiency, we do not know if those
burden. For example, a single mother with practices have been implemented. Since we
two children and without any other job. have no way of determining if the average
• Employees do not qualify for tax credits if
the employer offers coverage deemed to be 10 Walmart Health Care Benefits Enrollment Rises, Uninsured Rate Declines,”
affordable based on premiums as a share of Walmart press release, February 13, 2009, available at: http://walmartstores.
com/FactsNews/NewsRoom/8970.aspx
income. The employer then has the incentive
11 This information is taken from the guide to annual enrollment that
to offer bare-bones, high deductible, high Walmart distributed to its employees in September-October 2009 for
co-pay coverage with low premiums (as benefit year 2010.
long as the coverage meets the 60% actuarial 12 “Corporate Facts: Walmart By the Numbers,” Walmart fact sheet available
for download at: http://walmartstores.com/FactsNews/FactSheets/
13 “Supplemental Benefits Documentation,” confidential internal memo
9 The definition of full-time employee is from Ibid., TITLE I—QUALITY, by Susan Chambers (Executive Vice President, People Division), presented
AFFORDABLE HEALTH CARE FOR ALL AMERICANS, Subtitle F—Shared at Board of Directors retreat for fiscal year 2006, leaked to the New York
Responsibility for Health Care, PART II—EMPLOYER RESPONSIBILITIES, Sec. Times, available for download at: http://www.nytimes.com/packages/pdf/
1513, p. 354. business/26walmart.pdf
Health Care Reform and Walmart 1
6. hours of a Walmart employee has changed under our assumption is 133% of $22,050,
since 2005, we assume that the average hours which amounts to $29,326.50 a year.
have remained at the 34 hours per week level.
2. For the second family configuration, the FPL
We come to the conclusion then that a full-time threshold is $18,310. The family income of
Walmart worker making the average wage of $19,872.30 is 108.5 percent of the
$11.24 an hour has a gross annual income of: threshold. Note that this is less than 133%
of FPL, and that therefore this employee
($11.24/hour) x (34 hours/week) x (52 weeks) qualifies for Medicaid, and is ineligible to
= $19,872.30 purchase insurance through the exchange.
The calculation assumes that the employee Walmart is therefore not liable to make any
works the full 52 weeks in the year. This “employer responsibility” payments on
assumption has the effect of increasing the account of this employee.
annual earnings, and therefore increasing the The analysis of affordability of coverage
amount of Federal Poverty Level that the obtained through the exchange is therefore
employee’s income constitutes, unlike an performed only for the first family
assumption of fewer than 52 weeks worked. configuration.
Now, assume two different family configurations: The assumption that a family of 4 with 2
1. A family consisting of two adults with two earning members, one of whom is a Walmart
children, with one or more of the adults worker, could be at 133% of FPL is realistic, as
a Walmart employee, with annual family stated earlier. Consider a family with a male
income that places the family at exactly 133% Walmart worker, and his spouse who does not
of the Federal Poverty Level. If a health plan have a high school degree and has earnings
meets the premium affordability criterion of that place her in the bottom decile of full-time
9.8% for this family, it will meet the criterion women workers without a high school degree.
for all other 4-person families with income Her weekly income is therefore at most $25215 .
greater than or equal to 133% of Federal Assuming 52 weeks worked in a year, her
Poverty Level. It is realistic to assume that annual income is $13,104. If the family
a family of 4 with 2 earning adults, one of income is assumed to be 133% of FPL, which
whom is a Walmart employee, could be at amounts to $29,326.50 a year for a family of
133% of FPL, as discussed below. 4, her spouse (who is a Walmart worker) has
an annual income of $16,222.50. Assuming 34
2. A family consisting of a single Walmart hours worked in a week and 52 weeks worked
employee earning the average Walmart in a year, this translates into $9.18 per hour. A
wage, with two children. The family income detailed analysis of Walmart’s wage
is, therefore, $19,872.30. distribution for the year 2006 estimated that
more than 27% of Walmart workers earned less
Federal Poverty Level thresholds for the
than $8/hour . Walmart reported a 2006
different family configurations were obtained
average wage of $10.11/hour, while current
from the Centers for Medicare and Medicaid
average wage is $11.24/hour – an 11% increase.
Services, Department of Health and Human
Assuming that Walmart’s entire wage scale
Services website: 14
grew by approximately the same percentage,
1. For the first family configuration, the FPL the 2006 wage level of $8/hour16 corresponds to
threshold is $22,050. The family income
15 “Highlights of Women’s Earnings in 2008,” Bureau of Labor Statistics, U.S.
Department of Labor, Report 1017, July 2009, Table 6, p. 42, available at:
http://www.bls.gov/cps/cpswom2008.pdf
14 http://www.cms.hhs.gov/MedicaidEligibility/Downloads/POV09Combo.
pdf 16 Dube, Arindrajit, Dave Graham-Squire, Ken Jacobs, and Stephanie Luce,
4 Health Care Reform and Walmart
7. a 2009 wage of $8.89/hour. Hence it is highly care (for in-network providers). Thus, the
plausible that a Walmart worker today could family has to pay a minimum of $5,102 before
earn wages of $9.18/hour or lower. Walmart’s plan pays anything.
The employer responsibility provision as For a family of four with family income at
described earlier requires that, if an employee 133% of FPL, $5,102 amounts to more than 17%
is offered health coverage by their employer of income. Thus, a Walmart worker’s family
that meets the 60% actuarial value threshold, could pay more than 17% of their income in
but opts out of the coverage and obtains insur- health care costs before the Walmart health care
ance through the exchange instead, the plan pays anything towards their expenses.
employee is not eligible for tax credits unless
the cheapest employer health care offering has Therefore, Walmart workers who earn too
premium expenses of at least 9.8% of the much to qualify for Medicaid but are eligible
employee’s income. (on the basis of income alone) for tax credits
for insurance purchased through the exchange,
The actuarial value of three specific Walmart will either have to accept Walmart’s current
health plan offerings for 2010, including the high deductible health coverage or purchase
cheapest plan discussed above, were estimated insurance through the exchange without being
for UFCW using the known deductibles, able to use any affordability tax credits. Under
co-insurance, and out-of-pocket maximums this assumption, the company appears to be
of the plans. The calculations showed that all unlikely to have to pay any penalties under the
three plans analyzed, including the cheapest employer responsibility provision, since
Wal-Mart plan, met the actuarial value floor of employees earning as little as 133 percent of
60%. Therefore, the affordability comparison FPL will still pay premiums considered
can be made using the cheapest plan. affordable on the basis of the 9.8% cap on
premium expenses, and therefore will not
For a family of four, the FPL is $22,050. The qualify for tax credits, while employees
Medicaid threshold of 133% of FPL is therefore earning less than 133 percent of FPL would
$29,326.50. Applying the premium expense cap qualify for Medicaid.
of 9.8 percent of income, we obtain a maximum
annual premium expenditure of $2,932.65,
which is well above the actual employee ZERO IMPACT ON WALMART IS
premium expenditure for Walmart’s lowest A PROBLEM
premium plan ($702/year). Therefore, Walmart Based on data disclosed by a number of states,
is not liable for any penalty payments if this Walmart appears to follow a pattern of having
family chooses to reject the coverage offered by a large number of workers qualifying for
Walmart and obtain health insurance through Medicaid and other publicly subsidized care.17
the exchange instead. Two examples follow:
However, if we examine the total health care
Ohio. A September 2009 report issued by the
expenditures incurred by this family before
Ohio Department of Jobs and Family Services18
Walmart’s plan starts making payments, they
identifies Walmart as the company with the
have to pay a deductible of $4,400, plus $702 in
annual premium, after which the plan will pay
80 percent of costs for doctor visits, 17 According to data compiled by Good Jobs First, in 21 of 23 states which
hospital inpatient services, and preventive have disclosed information, Walmart has the largest number of employees
on the public rolls of any employer. The list of states with summarized
disclosure data is available at: http://www.goodjobsfirst.org/corporate_sub-
sidy/hidden_taxpayer_costs.cfm
“Living Wage Policies and Wal-Mart: How a Higher Wage Standard Would 18 The report is not available on the Ohio Department of Jobs and Family
Impact Wal-Mart Workers and Shoppers,” UC Berkeley Center for Labor Services website, but has been made available for download by Progress
Research and Education Research Brief, December 2007, Table A1. Ohio at: http://pnohio.3cdn.net/5ddd17f44b6d3a8a58_sjm6bx1ew.pdf
Health Care Reform and Walmart 5
8. greatest number of employees and their
dependents on Medicaid (15,246 in August
2009). As of June 2009, the state spends an
average of $245 per month on each recipient.
Extrapolating this number to one year, medical
coverage for Walmart workers in Ohio will cost
taxpayers $44.8 million for 2009.
Massachusetts. An April 2009 report issued by
the Massachusetts Division of Health Care
Finance and Policy19 identifies Walmart as the
one employer in the state with the greatest
number of employees using publicly
subsidized health care (4,796). Walmart has
held this dubious distinction every year for the
three years for which this report has been
published. In 2009, this amounts to 40.4 percent
of Walmart’s total workforce in Massachusetts
of 11,881 (as of September 2009). The
discrepancy in time periods between the data
on number of employees on subsidized care
and on the total number of employees adds
some uncertainty to the results. The cost to
taxpayers of publicly subsidized coverage in
2008 was $9.3 million for Walmart employees
in Massachusetts, and $15.5 million for
employees and dependents.
Ultimately, the “employer responsibility”
provision is constructed such that Walmart, a
company with a proven track record of failing
to insure a large percentage of its workforce
and of offloading a large number of its workers
onto the public rolls, is likely to end up paying
nothing to provide enhanced coverage or to
compensate the government for subsidies paid
to its employees.
19 “Employers Who Had Fifty or More Employees Using MassHealth, Com-
monwealth Care, or the Uncompensated Care Pool/Health Safety Net in
State FY08,” report by the Executive Office of Health and Human Services
Division of Health Care Finance and Policy, Commonwealth of Massachu-
setts, April 2009, available for download at: http://www.mass.gov/Eeohhs2/
docs/dhcfp/r/pubs/09/50_plus_employees_04-09.pdf
6 Health Care Reform and Walmart