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NADP Member's Internal Use Only / Do Not Distribute 1
Summary & Discussion of Passed Health Care Reform
April 2009April 1, 2010
AgendaNADPs Next Steps: Internal & External Important Provisions for Dental TimelineImminent Issues & Deadlines
Congressional and RegulatoryThreats to the Dental MarketCommitment to Direction
4/1/2010 NADP Member's Internal Use Only / Do Not Distribute 2
NADP Internal Next Steps • Education & Analyses
– News & Background Handouts – Webinar Series specific to HCR & Additional Analyses
(dependent on resources)• Applicability of Market Reforms • Medicaid, Medicare Advantage & CHIP• Large Group vs. Small Group & Individual Market• Exchanges & State Participation• HIT / Administrative Simplification• Taxes / Pay-fors (tax model)• Impact of HCR on Market Trends & Segments
4/1/2010 NADP Member's Internal Use Only / Do Not Distribute 3
NADP External Next Steps Continue Congressional Lobby EffortsInitiate Federal Regulatory Efforts
Legal Memo: Market Reforms ApplicabilityOperational Memo: Offer of Separate Dental in ExchangesInfluencing Regulations from Dental Perspective
4/1/2010 NADP Member's Internal Use Only / Do Not Distribute 4
NADP Member's Internal Use Only / Do Not Distribute 5
SenateHELP
Senate Finance
Senate Manager’sAmendment
Health Care Reform: The Sum of Parts
4/1/2010
Important Provisions to Dental• Overview• Taxes• Application of Market Reforms• Impacts on Coverage
– Individuals and Small Groups– Large Groups
• Timeline
NADP Member's Internal Use Only / Do Not Distribute 64/1/2010
Health insurance admin fee
(includes dental)$14.3 billion
Health insurance admin fee
(includes dental)$13.9 billion
Health insurance admin fee
(includes dental)$11.3 billion
High-cost excise tax is established(dental excluded)
Health insurance admin fee
(includes dental)$8 billion
Health insurance admin fee
(includes dental)$11.3 billion
2014 2018201720162015
NADP MEMBER INTERNAL USE ONLY: DENTAL BENEFITS UNDER HEALTH CARE REFORM
Timeline of Taxation
PRELIMINARY NOTES1. Applicable to carriers by tiers of “net” premium: <$25 million, $25 to $50 million (50%);
and over $50 million (100%).2. Some exceptions for non‐profits, exempt activities & specified government programs.3. Total to be collected adjusted by the rate of premium growth in future years.
4/1/2010 NADP Member's Internal Use Only / Do Not Distribute 7
HHS Sec & States Set Review Process for "unreasonable premium increases" (dental
included)
NEW COVERAGE as of Sept 23: "Improving Coverage
REFORMS"No Lifetime Limits*
Restricted Annual Limits for Essential Benefits*
Recission Prohibited*No Cost Sharing for
PreventionQuality Reporting
Dependant Coverage to Age 26*
New Internal/External Appeals Processes
Non‐Discrimination on Salary
Eliminate Pre‐ex for Children*
*Also Applies to Grandfathered Plans
MARKET
REFORMS
2010Determine Applicability of Market
Reforms
Inform Development of Regulations
Lobby for Technical Fix to Stabenow Lincoln
File Rates ‐‐ New Process
Adjust grandfathered Plans & New Coverage to Meet "Improving
Coverage REFORMS"
NADP & Industry
Dental Plans
NADP MEMBER INTERNAL USE ONLY: DENTAL BENEFITS UNDER HEALTH CARE REFORM
8
HHS Sec & States Set Review Process for "unreasonable premium increases" (dental
included)
NEW COVERAGE as of Sept 23: "Improving Coverage
REFORMS"No Lifetime Limits*
Restricted Annual Limits for Essential Benefits*
Recission Prohibited*No Cost Sharing for
PreventionQuality Reporting
Dependant Coverage to Age 26*
New Internal/External Appeals Processes
Non‐Discrimination on Salary
Eliminate Pre‐ex for Children*
*Also Applies to Grandfathered Plans
MARKET
REFORMS
2010Determine Applicability of Market
ReformsTrack & Disseminate Exchange
Requirements
Influence Development of Regulations
Inform Development of Regs‐‐esp. definition of pediatric dental services
Lobby for Technical Fix to Stabenow Lincoln
Monitor Changes in HCR and Lobby if Impacting Dental
File Rates ‐‐ New Process File Rates ‐‐ New Process
Adjust grandfathered Plans & NewCoverage to Meet "Improving
Coverage REFORMS"
Develop & file new
products/alliances for 2014 Exchanges & Indi/Sm Group Mkt.
2011
Jan 1‐‐MLR Mandated (85% large group & 80% small group)
By March‐‐Uniform Coverage Explanation & Definitions Set by HHS (consultation with
states)
2011
NADP & Industry
Dental Plans
NADP MEMBER INTERNAL USE ONLY: DENTAL BENEFITS UNDER HEALTH CARE REFORM
9
HHS Sec & States Set Review Process for "unreasonable premium increases" (dental
included)
NEW COVERAGE as of Sept 23: "Improving Coverage
REFORMS"No Lifetime Limits*
Restricted Annual Limits for Essential Benefits*
Recission Prohibited*No Cost Sharing for
PreventionQuality Reporting
Dependant Coverage to Age 26*
New Internal/External Appeals Processes
Non‐Discrimination on Salary
Eliminate Pre‐ex for Children*
*Also Applies to Grandfathered Plans
MARKET
REFORMS
2010Determine Applicability of Market
ReformsTrack & Disseminate Exchange
Requirements Track & Disseminate Exchange
Requirements
Inform Development of RegulationsInform Development of Regs‐‐esp. definition of pediatric dental services
Inform Development of Regulations
Lobby for Technical Fix to Stabenow Lincoln
Monitor Changes in HCR and Lobbyif Impacting Dental
Monitor Changes in HCR and Lobby if Impacting Dental
File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐ New Process
Adjust grandfathered Plans & NewCoverage to Meet "Improving
Coverage REFORMS"
Develop & file new
products/alliances for 2014 Exchanges & Indi/Sm Group Mkt.
Complete approval of products for 2014
2011 20122012
Jan 1‐‐MLR Mandated (85% large group & 80% small group)
By March‐‐Uniform Coverage Explanation & Definitions Set by HHS (consultation with
states)
NADP & Industry
Dental Plans
NADP MEMBER INTERNAL USE ONLY: DENTAL BENEFITS UNDER HEALTH CARE REFORM
10
HHS Sec & States Set Review Process for "unreasonable premium increases" (dental
included)
NEW COVERAGE as of Sept 23: "Improving Coverage
REFORMS"No Lifetime Limits*
Restricted Annual Limits for Essential Benefits*
Recission Prohibited*No Cost Sharing for
PreventionQuality Reporting
Dependant Coverage to Age 26*
New Internal/External Appeals Processes
Non‐Discrimination on Salary
Eliminate Pre‐ex for Children*
*Also Applies to Grandfathered Plans
MARKET
REFORMS
2010Determine Applicability of Market
ReformsTrack & Disseminate Exchange
Requirements Track & Disseminate Exchange
Requirements Track & Disseminate Exchange
Requirements
Inform Development of RegulationsInform Development of Regs‐‐esp. definition of pediatric dental services
Inform Development of Regulations Inform Development of Regulations
Lobby for Technical Fix to Stabenow Lincoln
Monitor Changes in HCR and Lobbyif Impacting Dental
Monitor Changes in HCR and Lobbyif Impacting Dental
Monitor Changes in HCR and Lobby if Impacting Dental
File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐Adj for 2014 Admin Tax & Required Child Coverage
Adjust grandfathered Plans & NewCoverage to Meet "Improving
Coverage REFORMS"
Develop & file new
products/alliances for 2014 Exchanges & Indi/Sm Group Mkt.
Complete approval of products for2014
Train sales force and market new products for 2014
2011 2012 20132013
Jan 1‐‐MLR Mandated (85% large group & 80% small group)
By March‐‐Uniform Coverage Explanation & Definitions Set by HHS (consultation with
states)
NADP & Industry
Dental Plans
NADP MEMBER INTERNAL USE ONLY: DENTAL BENEFITS UNDER HEALTH CARE REFORM
11
HHS Sec & States Set Review Process for "unreasonable premium increases" (dental
included)
NEW COVERAGE as of Sept 23: "Improving Coverage
REFORMS"No Lifetime Limits*
Restricted Annual Limits for Essential Benefits*
Recission Prohibited*No Cost Sharing for
PreventionQuality Reporting
Dependant Coverage to Age 26*
New Internal/External Appeals Processes
Non‐Discrimination on Salary
Eliminate Pre‐ex for Children*
*Also Applies to Grandfathered Plans
MARKET
REFORMS
COVERAGE
Health Insurance Exchanges Begin Operation
Essential Health Benefit Pkg. (including pediatric oral
health services) Established
Medical Plans to Include EHBP in all Indi/Sm. Group
Coverage
Separate Dental Allowed in Exchanges for Children
GENERAL
REFORMS
Guaranteed Issue & Renewal Required
Rating Restrictions Imposed (allows use of geography, age, tobacco use and
Indi./family within limits)
Excessive Waiting Periods Prohibited (Over 90 days)
Pre‐ex Prohibited
Coverage for Clinical Trials
2010Determine Applicability of Market
ReformsTrack & Disseminate Exchange
Requirements Track & Disseminate Exchange
Requirements Track & Disseminate Exchange
Requirements Track Impacts of "Essential Health
Benefit Package"
Inform Development of RegulationsInform Development of Regs‐‐esp. definition of pediatric dental services
Inform Development of Regulations Inform Development of Regulations Inform Development of Regulations
Lobby for Technical Fix to Stabenow Lincoln
Monitor Changes in HCR and Lobbyif Impacting Dental
Monitor Changes in HCR and Lobbyif Impacting Dental
Monitor Changes in HCR and Lobbyif Impacting Dental
Monitor Changes in HCR and Lobby if Impacting Dental
File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐Adjust for 2014 AdminTax & Required Child Coverage
File Rates ‐‐ New Process
Adjust grandfathered Plans & NewCoverage to Meet "Improving
Coverage REFORMS"
Develop & file new
products/alliances for 2014 Exchanges & Indi/Sm Group Mkt.
Complete approval of products for2014
Train sales force and market new products for 2014
Issue certifications of essential coverage
2011 2012 2013 20142014
NADP & Industry
Dental Plans
Jan 1‐‐MLR Mandated (85% large group & 80% small group)
By March‐‐Uniform Coverage Explanation & Definitions Set by HHS (consultation with
states)
Applicability to Separate Dental
Coverage for Children in Exchange
NADP MEMBER INTERNAL USE ONLY: DENTAL BENEFITS UNDER HEALTH CARE REFORM
Imminent Dental Issues ‐ CongressAmend the PPACA (HCR bill) to Implement Stabenow-Lincoln Amendment
Separate Coverage Outside the ExchangeDrafting Issues Inside the Exchange
Maintenance of Congressional RelationshipsMonitoring of Other Technical Changes
4/1/2010 NADP Member's Internal Use Only / Do Not Distribute 14
Imminent Dental Issues - RegulationFederal
Establish dialogue with HHSClarify applicability of Market ReformsEngage in Regulatory Developments
StateNAICState Exchanges
4/1/2010 15NADP Member's Internal Use Only / Do Not Distribute
Threats to Dental MarketThe Price of Inaction on Regulations
All ‘Improving Coverage’ Reforms Could ApplyTechnical drafting issues can result in varied interpretationsImpacts on Operations
Some changes by 9/23/2010Adjustments to policy forms, claims administrationAssumption of expanded financial risk within current premiums
4/1/2010 16NADP Member's Internal Use Only / Do Not Distribute
Threats to Dental MarketThe Price of Inaction on Legislation
Small Group/Individual Market Integrates Children’s Dental into Medical Outside the ExchangeOver Time Medical Coverage May Integrate Adult Dental Benefits
Small Group/Individual MarketLarge Group
4/1/2010 17NADP Member's Internal Use Only / Do Not Distribute
Threats to the Dental MarketAbdicating NADP Leadership Role
Technical fix retooled to favor a single industry segment or carrierSubcontracting becomes technical fix
NADP Member's Internal Use Only / Do Not Distribute 184/1/2010
Commitment To DirectionA Crossroads• Board Examination of 2010 Budget Impacts
– Developed Alternatives to Maintain NADP as Industry’s Voice & HCR Leader• Congressional• Federal Regulations
– Alternatives Require Voluntary 2010 Contributions• $800 to $4000 Dependent on Dues Category• 17 Members Contributed• 51 Outstanding
4/1/2010 19NADP Member's Internal Use Only / Do Not Distribute
Commitment To DirectionDelegate Ballot
Continue Congressional ActivityInfluence Regulatory Implementation2010 Funding CommitmentWebinar Topics
4/1/2010 20NADP Member's Internal Use Only / Do Not Distribute
Commitment To DirectionDeveloping Alternatives for 2011 & Beyond
Additional ServicesDetailed Tracking/Comments on Exchanges from Dental PerspectiveContinued Federal Regulatory/Congressional Activity
Dues Restructuring to Support Funding
4/1/2010 NADP Member's Internal Use Only / Do Not Distribute 21