MVP 50 Plus Plan

Agent Training Webinar

Topics for Today•Who is Allied National

•Pay or Play Mandates & Penalties

•MVP 50 Plus Plan

•Plan Design Limitations

•MediPay Reimbursement (no network)

•Guaranteed Pricing

•Underwriting

•Submissions – Documentation

•Underwriting Time Table

•Compensation2

Allied NationalOperational Profile•Underwriting

•Claims Administration

•Policy Service

•Actuarial

•Compliance

•Product Development

•Case Management

•Sales & Marketing

•Legal

3

44

Primary Risk PartnerAmerican Alternative Insurance Company

A division of Munich Re

$320.0B $28.4B

Assets Equity

4

55

Other Allied National Risk Partners

5

Pay or Play Rules

ACA Pay or Play Regulations and Language:• What is an applicable large employer? ALE• What is an FTE? How to count FTEs?• MEC• Minimum Value• Affordability Rules• Penalties

These are the high points -THIS IS NOT ALL!!!! Expect the rules to

change6

ACA Employer Reporting Requirements• Insurers and self-funded group health plans are required

under IRC section 6055 to file reports with the IRS to verify whether particular individuals had “minimum essential coverage” (MEC) during the prior calendar year, to satisfy the Individual Mandate. (1095 B)

• “Applicable large employers” (ALEs) are required under IRC section 6056 to file reports with the IRS showing whether they offered minimum value and affordable coverage to full-time employees and their dependents in the prior calendar year, to meet the Employer Mandate. These employers are also required to provide information to certain employees about the health coverage they offered using From 1095-C.

7

ACA Employer Failure to File Penalties

Failure to file/furnish an annual IRS return or to provide individual statements to all full-time employees

• Penalty is $250 per return and $100 per statement• Annual cap on penalties $3,000,000

Lower cap for entities with gross receipts of not more than • $5,000,000 • $1,000,000 • $500,000

Failure to file return or furnish statement when corrected within 30 days of required filing date (penalty per return/statement) $50/$30

(see IRC Section 6055 for complete details) 8

For the Individual - Employee

What does Pay or Play mean for an individual?

1. Individual Mandate says individuals must have MEC or pay a penalty.• 2015 - $325/person, $162.50/child, max 2% of household

income• 2016 - $695/person, $347.50/child, max 2.5% of

household income• 2017 and beyond – 2016 penalty adjusted for inflation

2. Insurance can be employer provided or an individual plan.

3. Penalties will be assessed as part of the income tax filing process.

9

For a Business – Employer

What you need to know about Pay or Play for businesses . . .

10

Do I have to offer health insurance to my employees on January 1, 2016?

less than 50 50 or more

Based on full-time equivalent employee counts.Part-timers count!

11

NAHU Quote “…whatever decisions that are made regarding the definition of small group in each state……there will be no change of the employer shared responsibility, employer reporting, or other compliance requirements for groups over 50 employees."

What type of coverage must I offer?

Employer coverage must meet TWO levels of tests under Section 4980H

“A” test – “The Sledgehammer”• Must provide Minimum Essential

Coverageto 95% of full-time eligible employees (70% in 2015)

• The Penalty? $2,000* for each full-time eligible employee less the first 30 (80 in 2015)

• Penalty triggered by employee going to the Exchange and receiving subsidy

*Adjust each year for premium inflation

12

What type of coverage must I offer?

Employer coverage must meet TWO levels of test under Section 4980h

“B” test – “The Tackhammer”• Must provide Minimum Value

Coverage to 95% of employees• Coverage must be Affordable (no

more than 9.5% of household income).

• The Penalty? $3,000* per employee who receives subsidized coverage on the Exchange

*Adjust each year for premium inflation

13

*Pay or Play Mandate PenaltiesFor employers who fail to offer qualified plans - an annual escalation clause.

Per IRC 4908H(c) (5) and PPACA 1302 (c) (4) the $2,000 “sledgehammer” and $3,000 “tackhammer” are subject to adjustment based on the national premium growth average.

Currently HHS is using 4.2%. IRS has not updated penalty amounts yet but 2015 penalties would be $2,084 and 3,126.

What If I Don’t Play?PENALTY EXAMPLES - 2016

Employer with 180 full-time eligible employees

(A) Failure to provide MEC: $2,000 (180 - 30*) = $300,000non-tax deductible penalty

(B) Failure to provide Minimum Value affordable coverage:$3,000 per employee who obtain subsidized coverage

* less 80 in 2015….less 30 in 2016 15

What are an Employer’s Options?

1. Pay the penalty?

2. Find the cheapest way to avoid penalties?

3. Provide an expensive major medical health plan to everyone?

4. Provide an affordable alternative in the middle?

IMPORTANT: This will cost the employer money, either in penalties or premiums!

16

Purpose: 1.To offer minimum value coverage that is affordable to employer and employee2.To keep employer cost at or below the penalty cost

Allied National – MVP 50 Plus

For ALE’s

17

• Available now• Affordable Pay or Play Solution for ALE’s• Avoids both “A” and “B” penalty• Guaranteed Rate – 1.20 Medical Load• NOT Guaranteed Issue• Adverse risks will be declined

Allied National – MVP 50 Plus

For ALE’s 50-500 Life Cases

18

• Referenced based pricing solution• Pays a % of Medicare allowable

reimbursement• 150% Facilities• 125% Physicians

• Employee MAY be subject to balance bills• Plan includes patient advocacy services

“MediPay”Reimbursement Solution

for MVP 50 Plus

19

• Minimum $3000 deductible• Generic Rx only – No specialty drugs• 60% participation – after valid waivers• Employer must pay enough so

“affordable” AND get participation

• Dependent children only – NO SPOUSES!!• Level Funded self insurance program• 12/21 contract

Allied National – MVP 50 Plus

20

• May be offered as a dual option in conjunction with the Allied National Funding Advantage plan

• Dual option can include other network reimbursements such as Provider Freedom, Cigna, etc.

• If offered as a dual option participation for the entire group, must be 75% after valid waivers

Allied National – MVP 50 Plus

21

•Provide an accurate spread sheet census•Provide a plan design that meets the MVP 50 Plus requirements•Allied will prepare a proposal that includes the 1.20 rate load•This rate is guaranteed….IF……the group meets underwriting requirements•To obtain underwriting approval each employee must complete an Allied enrollment form•Accepted cases will be issued at the guaranteed rate, unacceptable cases will be declined

The MVP 50 Plus guaranteed rate process

22

Enrollment Forms

Based on number of employees enrolling:•2 to 49 use long form•50 Plus use short form

Forms are located on our website on the Funding Advantage Resources page under the “Enrollment” section: www.alliednational.com/faresources.html

23

New Case Transmittal FormMust be filled out with submission

This form is located on our website on the Funding Advantage Resources page under the “Enrollment” section: www.alliednational.com/faresources.html

Underwriting Time Frame

25

26

Time Frame: MVP 50 Plus Cases

27

Jan 1, 2016 Effective Date (FOR ILLUSTRATIVE PURPOSES)Group Size – 340 (Average Age – 31) Restaurant ChainEmployee: 221 (= 60% participation)Office visit copay: $30 (unlimited)Deductible: $5,000 Coinsurance: 80% ACA Max OOP: $6,850 Prescriptions: Generic only MEDIPAY ReimbursementEliminates Both “A” & “B” PenaltyEmployee rate (with 1.20 load): $221Employer Contribution: $155 per month or 1,860 a yearEstimated Penalty (2016): $2175 per employeeEmployer Annual Cost at 70% of EE $411,000Employer Penalty (340-30) x 2000 = $620,000 non-tax deductible

MVP 50 Plus Sample Case

28

MVP 50 Plus Sales Flyer Available at www.alliednational.com/faresources.html

 

29

Retail Agent’s Default Compensation

Structure<25 lives 6%>26<50

lives 5%>51-100 lives 4%>100-151 lives 3%

151+ lives 2.5%

29

You may request any level of compensation. Must be requested at time of quote AND on case transmittal at time of submission

30

Contact your local GA

30Contact your local General Agent or call Allied to find one.

CA

ID

NE

KS

OK

TX

FL

GA

SC

TN

MO

ILIA IN OH

Boise

Sacramento Omaha

Kansas City

Davenport Chicago

St. Louis

Indianapolis Columbus

Oklahoma City

Dallas

Austin

Nashville Columbia

Atlanta

Tampa

Wichita

31

www.alliednational.com

Our Sales TeamContact Us

Email or fax data to “Sales” sales@alliednational.com

888-767-7133Fax: 913-945-4390

Our Team•Dan Meylan: National Sales Director; 913-945-4253•Bill Ringhofer: Regional Sales Manager; 913-945-4266•Randy Wehner: Sales Manager; 913-945-4267•Jill Carroll: Account Executive; 913-945-4255

32

Questions?Allied Sales Support

888-767-7133

www.alliednational.com

sales@alliednational.comtwitter.com/alliednational

Fax: 913-945-4396

Allied National, Inc.4551 W. 107th St. #100Overland Park, KS 66207

33