Taking on PPACA: Five Years and Counting

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Taking on PPACA: Five Years and Counting

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Speakers: Kari Stevens, Esq. Managing Counsel Cigna Health Care Reform Consulting and Communication Kathy Vaccaro Executive Consultant Cigna Health Care Reform Consulting and Communication Moderator: Ladan Nikravan Senior Editor Workforce magazine


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Ladan Nikravan Senior Editor Workforce magazine


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Kari Stevens, Esq

Managing Counsel Cigna Health Care Reform Consulting and Communications


Kathy Vaccaro

Executive Consultant Cigna Health Care Reform Consulting and Communications

TAKING ON PPACA: FIVE YEARS AND COUNTING

Cigna Health Care Reform Consulting and Communications March 4, 2015 Kari Stevens and Kathy Vaccaro

Agenda

11 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

Legislation and impacts: Establishing a leadership position

Evolving and differentiating in a highly regulated environment: Cigna’s Health Care Reform Consulting and Communications Team

Q&A

Establishing a Leadership Position

LEGISLATION AND IMPACTS

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

13

March 23, 2010 Patient Protection and Affordable Care Act (PPACA)


Challenges, Delays and Breakdowns: Uncertainty Amid Implementation


2010 - 2013 2014 2015 +

Focus on definition, communication, interpretation,

and execution of immediate requirements and preparing for

longer-term shifts

Navigate significant market disruption with the launch of exchanges, and other major

reforms

Capitalize on opportunities created by major market

shake-out and a new market reality

Early Groundwork New Status Quo Market Transition

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna 15

PPACA Roadmap: Early Analysis

Presenter

Presentation Notes

Cigna’s Collaborative Approach


Legal & Government

Affairs

Healthcare Business Teams

Technology Solution

Group

Shared Responsibility

2010 Provision Timeline


2011 2012 2013 2014 2015 2016 AND BEYOND

55 PPACA provisions already implemented with 12+ in progress or on the horizon

Large employer reporting requirements

Employer Mandate

Minimum essential coverage reporting

Cadillac tax

Small group definition change

Public exchanges may open to large employers

Summary of Benefits and Coverage

Comparative Effectiveness Research Fee

No pre-existing conditions for all ages

Essential health benefits

Health Insurance Marketplaces/Exchanges

Individual mandate

Clinical trials

Wellness programs and incentives

Waiting periods

Guaranteed availability/renewability

No annual dollar limits

Health insurance industry fee

Reinsurance fee

HSAs Medical loss ratio

Eliminating the Medicare Part D “Donut Hole”

OTC drug limits

Medicare Part A tax on wages and investment income

FSA limits

Grandfathered plans

Early retiree reinsurance program

Appeals and external review

Dependent coverage to age 26

Doctor choice

Phasing out annual limits

No lifetime limits

Prohibition in favor of highly compensated individuals

No unreasonable premium increases

Temporary high-risk pools

100 % preventive care

No pre-existing conditions for under age 19

Presenter

Presentation Notes

2010 – 2013 Ten consumer-focused provisions in the first six months, e.g. dependent coverage to age 26 and 100% preventive care 2014 - Increased focus on benefit plans, e.g. fees/taxes and essential health benefits/cost-sharing limits 2015 and beyond: Increased employer administrative responsibilities, e.g. employer mandate and related reporting

Established Program Management Office, Developed Guiding Tenets


• Position clients and customers for long-term success

• Effect real ‘reform’ together

• 100% compliant • Dedicated

implementation resources

• “Go-to” resource for clients and brokers

• Award-winning website and web meeting series

• Dedicated communications team

• Advocate for sustainable, market-based reform

• Preferred partner; maximum influence; early insight

Advocacy Communications Compliance Strategy

Fees & Taxes: A Closer Look at ‘CERF’ Implementation and Communication


• Impact on employer and insurer costs

• Impact on rates • Pass the cost onto

employees or not • Administrative

support or not

• Cross functional team, including o Finance o Underwriting o IT o Service o Product

• Budgetary impacts • Multi-year

implementation with tight timeframes

• Detailed alerts identifying key elements and requirements

• Internal and external communication plan

• Training for clients, brokers and sales teams

• Toolkit for clients and brokers

• Feedback through regulatory process

• Industry meeting and feedback session participation

• Ensure regulators understood the impacts of the decision

• Impact and difficulty for employers

Advocacy Communications Compliance Strategy

Presenter

Presentation Notes

Comparative Effectiveness Research Fee (CERF) is one of PPACA’s fees and taxes designed to generate revenue for funding of expanded programs and services. 2012 legislation clarified that insurers were not permitted to calculate or pay the fee for self-funded employers Established communication plan (dates, deliverables and timing) to determine how Cigna would speak to all audiences across the organization and also externally� New responsibilities for self-funded employers presented new opportunities for Cigna support, such as: Reporting and payment grid Development of ‘one-stop shop’ toolkit on Cigna.com that included key forms and reporting ASO Service Team

“Informed on Reform” Branding: Establishing Flagship Communications


InformedOnReform.com 25,000 monthly visits

Web Meeting Series 57,000 participants

94% average satisfaction rate

Breaking News Alerts 93 and counting

InformedOnReform.com 25,000 monthly visits

Web Meeting Series 57,000 participants

94% average satisfaction rate

Breaking News Alerts 93 and counting

Cigna’s Health Care Reform Consulting and Communications Team

EVOLVING AND DIFFERENTIATING


• Team of communications and legal professionals dedicated to health care reform – Communication and educational

resources about the law and its impacts

– Speak, engage, strategize and provide consulting services

• Closely aligned with legal partners in Washington, D.C. and the states that help influence key aspects of the law

Health Care Reform Consulting and Communications Team: ‘You don’t have to go it alone!’


COMMUNICATIONS AND SALES SUPPORT

CONSULTING SERVICES

Key Strategic Alignment: An Enterprise View


Total health and network

Enrollment and retention

Implementation

Government affairs

Sales/ Sales Effectiveness Product

Corporate communications Cigna U

Service operations

Cigna creative communications

Customer experience

Brand

• Legal and business impact

• Compliance focused

Strategy

Today’s Guiding Tenets: Expanded Consultation Focus


• Foster client and customer success

• Deliver best-in-class solutions

Consultation

• Enterprise training and resources

• Award-winning website and web meetings

Education

• Dedicated team • Enterprise view

Communication

Spotlight on communications and education Cigna’s industry-leading tools and resources include:


• InformedOnReform.com

• Informed On Reform web meeting series

• Health Care Reform for you infographic tool (HCRforYOU.com)

• Breaking news alerts

• Partnership with Groom Law Group

• Internal Training and Development

http://www.cigna.com/health-care-reform/

http://www.cigna.com/health-care-reform/health-care-reform-webinars

http://cigna.promo.eprize.com/hcrig/?affiliate_id=ior

http://www.cigna.com/aboutcigna/informed-on-reform/news/

Spotlight on consulting and events

Cigna’s Health Care Reform Consulting and Communications team serves as a resource for benefits professionals. Our communication and legal experts are available for: • Presentations, panels and

speaking opportunities • Strategy sessions • Web meetings • Roadshows • Roundtables • Educational events


What’s Next? Leading in a Highly Regulated Environment


New standards and potential penalties

New reporting requirements: First report due in 2016 on coverage offered in 2015 EMPLOYER MANDATE IMPACTS

New Congress has identified full-time definition as a priority (40 hours vs. current 30)

2015 U.S. Supreme Court ruling on public exchange subsidies

2016 Small group expansion from 50 to 100 full-time employees

2017 Public exchanges may open to large employers

2018 Cadillac tax OTHER REGULATORY

TOPICS

Presenter

Presentation Notes

Employer mandate talking points: Minimum essential coverage - most medical plans qualify Minimum value - 60% of expenses covered Affordable - employee contributions for lowest-cost, self-only plan – less than 9.5% of income Penalties if: No coverage is offered - $2,000 per FTE (minus first 30) OR Coverage doesn’t meet standards - Lesser of $3,000 per FTE receiving tax credits OR $2,000 per FTE (minus first 30) There are varied strategies employers are taking to address the mandate. Some employers are maintaining the status quo and moving forward with their current benefits strategy and plans with an eye toward avoiding penalties. Other employers are slimming down their current benefit offerings to provide just minimum value or the required minimum coverage. Some employers are even making workforce adjustments to manage penalty exposure or eliminating coverage altogether and paying the full penalty. The marketplace has evolved to address new employer strategies, for example, through the increased availability of private exchange offerings and lean benefit plans. Other regulatory topics: The new Congress has identified PPACA’s full-time employee definition as a priority for 2015 – changing from the current 30 hours to 40 hours. It’s hard to tell where this discussion will go, but it’s one we will be monitoring carefully. The U.S. Supreme Court announced last fall they will rule on public exchange subsidies in 2016. In question is whether Congress intended to limit federal tax credits to residents of states running their own insurance exchanges. Currently only 13 states and the District of Columbia operate exchanges on their own; another 10 are in partnership with the federal government. Federal officials run the rest. Should the Court find that subsidies in federal exchanges are not allowed, the immediate impact would be that the Internal Revenue Service would stop paying subsidies to those in federally run exchanges. In 2014, more than 4.6 million people were getting those subsidies, with higher projections each year. In 2016, the definition of “Small Group” will expand from 50 to 100 full-time employees. This will subject these employers – who are no longer deemed large employers – to additional requirements including covering all essential health benefits. Lastly, the Cadillac Tax – an excise tax on plans valued over certain thresholds – is scheduled to take effect in 2018. Employers are already starting to prepare. Consumer-driven plans are among the top strategies. It’s important to note that we haven’t yet received any regulations for the Cadillac Tax, and a lot could happen between now and 2018. However, we still recommend that employers proactively prepare. Expat relief talking points: On December 16, 2014, the President signed into law the Expatriate Health Coverage Clarification Act, which was passed by Congress on Dec. 13. The legislation helps preserve U.S.-based employer-sponsored expatriate insurance options and ensures U.S. carriers a level playing field against non-U.S. carriers who are not subject to the requirements, fees, and taxes of the Patient Protection and Affordable Care Act. The legislation also provides relief from portions of PPACA that were unworkable for plans providing worldwide coverage. It allows expatriate plans to be considered minimum essential coverage for expatriates and clarifies that these plans are considered eligible employer-sponsored plans for purposes of the employer mandate. However, the legislation does not exempt employers from the employer mandate or reporting requirements. Other exemptions include relief from: most benefit requirements (except the plans will still be required to provide coverage for dependents up to age 26); the health insurance fee after 2015; the reinsurance fee; the Comparative Effectiveness Research Fee (CERF), which is also known as the Patient-Centered Outcomes Research Institute (PCORI) Fee; the Cadillac Tax in most instances; and Administrative Simplification requirements such as the Summary of Benefits and Coverage (SBC). The relief also makes permanent an existing Medical Loss Ratio (MLR) accommodation, which is a special formula addressing the often higher administrative costs of expat plans. As with the transitional relief, there are conditions for plans, insurers and customers. Photo in upper right corner: On Jan. 5th, several elected officials representing both U.S. political parties joined us in Wilmington, Delaware office to celebrate the recently passed law that gave our expatriate plans relief from adverse requirements of health care reform. The event was a great recognition of the terrific work we do in the U.S. on behalf of our expatriate customers around the world, and of the leadership demonstrated by these elected officials. � Left to right: David Cordani, Gov. Jack Markell (DE), Rep. Charlie Dent (PA), Rep. Pat Meehan (PA), Sen. Chris Coons (DE), Rep. John Carney (DE) and Sen. Tom Carper (DE).

Cigna Health Care Reform Resources


Visit our website www.InformedonReform.com

• Optimized for desktop, tablet or mobile devices

• News alerts, fact sheets, timeline, FAQs and more

• Try our Health Care for You infographic tool

http://www.informedonreform.com/

Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. “Cigna” and the “Tree of Life” logo are registered service marks, and “Together, all the way.” is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company, and not by Cigna Corporation. All models are used for illustrative purposes only. 000000 04/15 © 2015 Cigna. Some content provided under license.

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