PPACA New DirectionsPPACA New Directions

Timeline Highlights 2012Timeline Highlights 2012

Steps for 2012 from the previous chartSteps for 2012 from the previous chart

W-2 ReportingW-2 Reporting MLR Refund (Not Listed)MLR Refund (Not Listed) Medical Device FeeMedical Device Fee SBC (Done by carriers)SBC (Done by carriers) 60 Day Advance Notice60 Day Advance Notice

Timeline Highlights 2013Timeline Highlights 2013

FSA's ReducedFSA's Reduced ER Ded for Medicare Rx endedER Ded for Medicare Rx ended EDUCATION for New HiresEDUCATION for New Hires Quality ReportingQuality Reporting CER FeeCER Fee

First Real Deadline: Delayed

Currently, the mandated Federal deadline for employers to notify employees about state-

specific exchanges to be set up before 2014 by state governments (or by the federal government on the states’ behalf) has been delayed. Many

expected that the exchange notification deadline would be extended, however, as the U.S.

Department of Labor (DOL) hasn’t yet released proposed regulations or indicated whether it will

provide a model notice.

Part 1 of 3

State exchange basics.

This is a description of the state exchange, the services provided by the exchange and how to contact the exchange (website and customer service number). One wrinkle: not all states

have decided how they’re going to comply (the National Conference of State Legislatures

provides an up-to-date chart of state implementation efforts). Employers in multi-plan states will have an even more challenging time.

Part 2 of 3

Individual plan value

This explains whether employees will receive at least 60 percent coverage of essential health

benefits through employer-provided coverage, and whether employees may be eligible for a premium tax credit if they purchase a plan on

the state exchange.

Tax implications.

Because health insurance premiums under employer-sponsored coverage may be paid

with pre-tax dollars, buying coverage through a state exchange may change an employee’s tax obligations. Employees using an exchange to purchase coverage may lose their employer’s

tax-free contribution (if any) to their health coverage.

Part 3 of 3

Impact on Small Businesses

The District groups will have to purchase their coverage through the HBX

The Health Benefit Exchange (“HBX”) Executive Board adopted recommendations to unify

commercial small group and individual plans within the District’s Exchange insurance

marketplace. Only Grandfathered plans will be allowed outside the HBX

Impact on Small Businesses Cont.

2014 ImplementationProhibiting Discrimination Due to Pre-Existing

Conditions or Gender.

Eliminating Annual Limits on Insurance Coverage.

Making Care More Affordable.

Establishing Affordable Insurance Exchanges.

Increasing the Small Business Tax Credit.

Increasing Access to Medicaid

Promoting Individual Responsibility.

Impact on Small Businesses Cont.

The District’s HBX will provide transparency for selecting health

coverage that does not currently exist by creating a single source to review price, quality, customer service information, and other consumer focused measures about all health plans available in the

District.

Impact on Small Businesses Cont.

Open enrollment for all HBX participants will begin on October 1, 2013 for plans that

will be effective on January 1, 2014. Small business employers will be able to choose coverage in the Exchange through their

existing broker or benefits manager during their regular renewal time. Grandfathered

plans, those in place since March 23, 2010, will be exempted from operating in the District’s HBX insurance marketplace.

Tax Credit

As an incentive for tax years

2010 through 2013,

the maximum credit is generally 35% of the cost of covering employees, although it is 25% for tax-exempt employers. The tax

credit increases on January 1, 2014 to 50% for most employers and 35% for tax-exempt

employers.

Impact on Small Businesses Cont.

There are no penalties for not offering coverage to employees for small

businesses with 50 or fewer employees.

Funding of HBX

The District of Columbia has been awarded over $82 million in grants from the federal government to

help plan for and set up a health exchange for the District. The government officials held meetings in

each ward to get resident input and conducted research on the best ways to set up the District’s

Health Benefit Exchange.

The District planning to be ready for residents and small businesses to sign up for health insurance

through the HBX starting October 1, 2013.

Consumer Information Cont.

On October 1, 2013, when the Health Benefit Exchange opens, it will be open

only to individuals buying their own coverage and to the employees of D.C.

small businesses (those with 1-50 employees) and their family members.

DC Producers(Insurance Agents & Brokers)

The HBX Executive Board and all District agencies implementing the HBX are encouraging producers to and small business owners as well as non-profit organizations to participate in public meetings and working groups that occur no less than every other

week.

Producers are an intricate part of the success of the plan

This will be a private & Government collaboration

Overview

Prepare for questions and frustrations Identify resources for ideas and compliance Define roll of Agencies and Brokers Promote compliance and planning

Overview

Prepare for questions and frustrations Identify resources for ideas and compliance Define roll of Agencies and Brokers Promote compliance and planning

The Present Situation

Plan sponsors and brokers are frustrated by being forced off the current system

Change implementation is close to deadlines before being clearly understood

Flow of income is at risk for all in the health delivery and insurance systems

Potential Alternatives

Remain unclear and risky Looking at other countries the brokers' role

may be at risk Brokers are needed more than ever Brokers role is being given attention

Recommendation

Stay informed Keep a positive outlook on our future Add value to brokers and clients Ask lots of questions Do not encourage risky behavior

PPACA New DirectionsPPACA New Directions

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