View
194
Download
1
Category
Preview:
DESCRIPTION
ARA of GA
Citation preview
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHealth Care Reform
Health Care Reform:What comes next?
Presentation for
GA Chapter, American Rental Association
CORE Benefit Solutions, LLCLisa Owen, President, RHU
lowen@corebenefitsga.com
Jennifer Gregory, Account Executive
jgregory@corebenefitsga.com
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareCORE Benefit Solutions
Tailored employee benefit programs:
- Group Health
- Individual/Personal Health
- Benefits Administration
- Human Resource Solutions
- EZ Enroll Kits
- Benefits Administration
CORE PRODUCTS- Medical/Rx/Dental/Vision/Life/
AD&D- Disability- Long Term Care- Wellness Programs- Self Insured Health Plans- Voluntary Benefits- Employee Assistance Programs
(EAP)- International Plans- FSA, HSA, HRAOTHER PRODUCTS- Property & Casualty- Worker's Compensation- General Liability- Retirement
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHCR Quiz
• A. Must purchase minimum essential coverage • B. Must purchase dental and vision coverage• C. Must purchase “Platinum, Gold, Silver, or Bronze Plan”
• D. All of the above
What does the Individual mandate require of all
US citizens?
• A. Provide affordable and minimum value coverage or be penalized
• B. Provide financial contribution to help employees purchase coverage
• C. Provide Marketplace Notice to existing and new hire employees & Summary of Benefits & Coverage (SBC), if employer offers group medical plan
What are employers with 49 or fewer employees
required to provide employees under the
ACA?
• A. Only if employer doesn’t offer coverage• B. Only if income is between 100-400% FPL and employer does not offer affordable minimum essential coverage
• C. Only if income is between 100-400% FPL• D. As long as individual is below the age of 30
Can any individual obtain a federal subsidy
to help pay for health insurance?
2010 Dependent coverage for adult children up to age 26 Elimination of pre-existing conditions for children under 19 Preventive services covered at 100% * Patient Protection provisions * (PCP, Emergency Room) Elimination of lifetime limits, restricted annual limits on essential
heath benefits Disclosure notices (Grandfathered/Non-Grandfathered, Patient
Protections) Non-discrimination provisions * (enforcement delayed) Small employer tax credit Federal pre-existing condition plan available
2011 FSAs, HSAs, HRAs Changes (OTC, non-qualified H.S.A. 20% excise tax) Medical Loss Ratio New long-term care program (not funded)
2012 Expanded Women’s Preventive Care * Summary of Benefits and Coverage
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHCR Timeline Overview
* Does not apply to grandfathered plans
2013 Medical FSA Limit of $2,500 W-2 Reporting (250+ W-2s in 2012) Taxes and Fees (CERF, Reinsurance, Medicare, etc.) Written notice of Exchanges (new hires included)
2014 Employer Mandate: Pay or Play (50+) (Delayed until 2015) Individual Mandate State/Federal Marketplace/Exchange (1-50=2014 & 1-100=2016) Adjusted Community Rating * (1-50, 2014 & 1-100, 2016) Guaranteed issued/Guaranteed renewability * (1-50=2014 & 1-
100=2016) No Pre-Existing Conditions Must cover Essential Health Benefits (EHB) * (1-50=2014 & 1-
100=2016) Deductible Limits* (2-50=2014 & 2-100=2016) Out of Pocket Expenses Limits * Health plans may not establish Annual Limits on EHB * 90 Day Limit on Waiting Periods
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHCR Timeline Overview
* Does not apply to grandfathered plans
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHCR Timeline Overview
2014 Continued Automatic Enrollment (200+) Increased Wellness Program Incentives
2016 Employer Size Redefined
- (Small group = 2-100 & Large group = >100) Community Rating (1-100)
2017 Exchange for Large Employers (>100)
2018 Cadillac Tax
* Does not apply to grandfathered plans
Individual Mandate
Source: BCBS Exchange Webinar
2014
2015
2016
Greater of $95 per person (cap of $285 per family)
or 1% of household income
Greater of $325 per person (cap of $975 per family) or 2% of household income
Greater of $695 per person (cap of $2,085 per family) or 2.5% of
household income
2017 and beyond: Annual adjustments
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareEmployer Mandate
Source: United Health Care
“Applicable Large Employers”• Employers with 50 Full-Time Equivalents (FTEs) on average
• Measured by looking at entire controlled group over prior calendar year
• Transition relief in 2013: employer can measure full-time equivalents for any continuous 6-month period in 2013 to determine 2014 large employer status; remove seasonal employees working less than120 days per year
What is an FTE?• Common law EE who, during the applicable calendar month, was
employed on average at least 30 hours of service per week • Number of FTEs = all part-time EE hours (up to 120 hours per EE)
for the applicable calendar month divided by 120• Only count U.S. hours• Leased EE rules do not apply
Controlled Group:1. Parent-child= business owns, directly or indirectly, at least 80% of another
business. 2. Brother-sister= 5 or fewer owners own at least 80% of 2 or more business &
combined identical ownership of the common owners in each entity is more than 50%.
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareMedical Loss Ratio
Source: BCBS Exchange Webinar
The health care reform components include new minimum loss ratios (MLR):
Taxe
s ($
0.0
24
)
Ad
min
istr
ativ
e E
xpen
se
($0
.10
)
Co
mm
issi
on
s ($
0.0
5)
Claims ($0.80)
Pro
fits
($
0.0
36
)
- MLR for small groups / individual plans = 80%
- MLR for large groups = 85%- Carriers provide rebates by
August 1 every year- Carriers rebate individuals
directly for individual plans- Carriers rebate employer directly
for group plans - Employer must follow certain
rebate distribution rules
For Small Group and Individual markets:
CURRENT: Guarantee Issue only required in the small group market (2-50) today. For all size markets, pre-existing condition exclusions may apply for members without creditable coverage for 63+ days.
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareUnderwriting Changes
Sources: National Association of Health Underwriters (NAHU), BCBS Exchange Webinar
Guaranteed Issue
No health status rating
(also known as adjusted community
rating)
3:1 age rating bands
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareDeductible/Out of Pocket
Sources: BCBS Exchange Webinar
Deductible/Out-of-Pocket Limits
Deductible Limit- Applies to 2-50 market- $2,000 single/$4,000 family, increased by employer
contribution to FSA
Out of Pocket Limit - Applies to all markets (individual, small group, large
group, and self-insured)- Copays apply to out of pocket limit- $6,350 individual/$12,700 family (no more than H.S.A.
limits)
Metallic Levels
Source: BCBS Exchange Webinar
Product Tier Requirements in Marketplace/Exchange:
Actuarial Value = Total Expected Payments by Health Plans for EHBs / Total Costs of EHBs for the Standard Population
Platinum 90%
actuarial value
Gold80%
actuarial value
Silver70%
actuarial value
Bronze 60%
actuarial value
All will include
Essential Health
Benefits
* Catastrophic plan for those under 30 and those over 30 whose premium would cost more than 8% of their income
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareIndividual Premiums for
QHP
Source: healthcare.gov
Metallic Levels Age 27
Age 50 FAM
Single FAM Couple
Child Only
Bronze $231 $394 $782 $531 $565 $140
Silver $276 $472 $935 $635 $675 $168
Gold $335 $568 $1,127 $765 $813 $202
Platinum $272 $463 $919 $624 $663 $165
Catastrophic $168 $285 $566 $384 $408 $101
Average premium across all Affordable Care Act plans offered in Georgia, effective January 1, 2014
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareAffordable Group Coverage
Source: CIGNA
Unaffordable group coverage = Employee share of premium for single coverage greater than 9.5% of the employee’s W-2 income (lowest cost plan offered) 9.5% of Salary: The Amount Employee Contributions
Cannot Exceed For Single Coverage in Lowest Cost Medical Plan
W-2 Salary Annual Monthly
$20,000 $1,900 $158.33
$30,000 $2,850 $237.50
$40,000 $3,800 $316.67
$50,000 $4,750 $395.83
$60,000 $5,700 $475.00
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareIncome Eligibility
Source: Calculations by Families USA based on data from the U.S. Department of Health and Human Services
Premium Tax Credit Eligibility- Employees with household income between 100% and
400% of the Federal Poverty Level (non Medicaid Eligible)
Household Size
Medicaid Eligible
Eligible for Premium Tax
Credit
100% 400%
1 $11,490 $45,960
2 $15,510 $62,040
3 $19,530 $78,120
4 $23,550 $94,200
If eligible for premium tax credit, the amount of premium you pay (and your corresponding premium tax credit) is based on your FPL household income.
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareAmount of Premium Tax
Credit
Source: CIGNA
Household Income Level
Premium as Percent of Income
100% FPL 2% of Income
150% FPL 4% of Income
200% FPL 6.3% of Income
250% FPL 8.05% of Income
300% -400%FPL 9.5% of Income
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareSilver Plan Pricing
Scenarios
Source: Atlanta Journal Constitution
ANNUAL COSTS / ADVANCED PREMIUM TAX CREDIT (Subsidy)
26 year old single person (man or woman):1) Income: $12K (just above FPL) - individual pays $240; receives
$3,000 subsidy2) Income: $35K - no subsidy; cost of silver plan is 9.5% of income
Husband is 32, wife is 30, 1 year old daughter3) Income: $20K (just above FPL) – family pays $400; receives
$8,800 subsidy4) Income: $60K (300% FPL) – family pays $5,700; receives $3,500
subsidy
Husband is 47, wife is 42, kids are 25, 20, and 165) Income: $28K (at FPL) - family pays $560; receives $15,500
subsidy6) Income: $84K (300% FPL) – family pays $8,000; receives $8,000
subsidy
Husband is 62, wife is 627) Income: $16K (at FPL) – husband/wife pay $320; receive
$17,600 subsidy8) Income: $47K (300% FPL) – husband/wife pay $4,500;
receive $13,500 subsidy
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term Care
2013 Early Renewal Option
Option for Non-grandfathered Small Group / Individual Plans:- Delay higher rates of Adjusted Community Rating and other
health care reform plan design requirements (deductibles, out of pocket limits, etc.)
- Keep current plan design for 11 months of 2014
- Renew December 1, 2013 with a significantly lower increase than you would otherwise see at your 2014 renewal
- Early renewal option may not benefit every group or individual and your health benefits broker should be reviewing these options with you now
Employer Group Plan
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareSmall Employer Tax
Credit
Source: BCBS Exchange Webinar
25 or fewer employees + average wage less than $50,000:
- Tax credit for employers with 25 or less employees and average wages than $50K
- Starting in 2014, available on the Small Employer Health Options Plan (SHOP) Exchange/Marketplace only for first two years
- Credit up to 50% of employer cost
- Credits decrease on a sliding scale as avg. compensation increases
*tax credit started for 2010 tax year (for employers with 25 or fewer employers) and currently offers a credit up to 35%
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareEmployer Options
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareIndividual Mandate
Health Care ReformImportance of your Trusted Advisors
• Benefits Broker
• Accountant
• Attorney
• Financial Advisor
Lean on your trusted advisors to understand
upcoming changes!
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareLong-Term CareQuestions?
What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsEmployer Mandate and
Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareLong-Term CareThank you for your time.
Lisa Owen, President, RHU
CORE Benefit Solutions, LLC404-478-2304
lowen@corebenefitsga.com
Jennifer Gregory, Account ExecutiveCORE Benefit Solutions, LLC
404-478-2305jgregory@corebenefitsga.com
Recommended