2014: Health Care Reform Requirements & Opportunities. Presented by: Brad Pricer, JD, GBA & Annette Bechtold
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1 2014: Health Care Reform Requirements & Opportunities Presented by: Brad Pricer, JD, GBA & Annette Bechtold
2 Session Overview Today, we ll cover: Background Employer Requirements The Marketplace Potential Opportunities Question & Answer Brad Pricer Senior Manager Employee Benefits CUNA Mutual Group Annette Bechtold Senior Vice President Regulatory Affairs and Reform Initiatives Digital Benefits Advisors 2
3 Health Care Reform Patient Protection and Affordable Care Act of 2010 (PPACA) How Did We Get Here & Where Do We Go Now? 3
4 Where Do We Stand? SCOTUS Ruling o 5-4 vote o Chief Justice Roberts wrote majority opinion Rationale: No Commerce Clause or Necessary and Proper clause authority Authority to enact mandate comes from taxing power Individuals can choose to obtain coverage or pay higher taxes Dissent Would have overturned entire law Election o Who was waiting? Businesses Government look for a flurry of proposed rules and clarifications
5 What Does All This Mean to Credit Unions? Time to Act Broker/consultant and/or carrier must confirm you are in compliance ACA changes already in effect will remain in effect ACA s provisions that are not currently in effect will continue to be implemented Continue to prepare and take stock of steps already taken
6 Act Now Why? DOL is beginning to audit ACA compliance New development, ramifications still not clear but concerning What has the DOL requested? Depends on status of plan Grandfathered plans o Records documenting the terms of the plan on March 23, 2010, and any additional documents to confirm the plan s grandfathered status; and o The participant notice of grandfathered status included in materials that describe the benefits provided under the plan Non-grandfathered plans o Documents related to preventive health services for each plan year beginning on or after 9/23/10; o The plan s internal claims and appeals procedures; o Contracts or agreements with independent review organizations or TPAs providing external review o Notices regarding adverse benefit determinations and final external review determination notices; and o Documents relating to the plan s emergency services benefit All plans o A sample notice describing enrollment opportunities for children up to age 2 for plans with dependent coverage; o A list of participants who have had their coverage rescinded and the reasons for the rescissions; o Documents related to any lifetime limit that has been imposed under the plan since 9/23/10; and o Documents related to any annual limit that has been imposed under the plan since 9/23/10
7 How Are Credit Unions Doing? 6% 17% 31% Prepared for 2013 & 2014 Requirements Prepared for 2013 Requirements Only Have Started Preparations Will Begin Preparations After % 14% Not Prepared But Have a Timeline for Beginning Preparations 11% Not prepared and Do Not Have a Timeline for Preparations CUNA, Credit Union Staff Survey for Human Resources Planning,
8 Health Care Reform Patient Protection and Affordable Care Act of 2010 (PPACA) Sharing Responsibilities EMPLOYERS 8
9 Employer Responsibilities Delayed Mandate Employers with 50 or more full-time and full-time equivalent employees Must offer coverage to full-timers and dependents Compliance Assessment penalties if no offer of coverage or coverage doesn t meet requirements Reporting requirements Timing Assessment penalties waived until 2015 Reporting requirements waived until 2015 (Administration announcement 7/2/13; rules to follow)
10 Requirements and Obligations Group Size Applicability Funding Applicability Fully-insured Self-funded Applies to grandfathered plans? Yes No 1. Mandatory plan changes from Maximum waiting period of 90 calendar days 3. Removal of annual plan limits effective Expanded wellness incentives 5. Reporting to substantiate individual offerings
11 Requirements and Obligations Group Size Applicability Funding Applicability Fully-insured Self-funded Applies to grandfathered plans? Yes No 1. Nondiscrimination rules a. Existing rules and penalties for selffunded If plan favors the highly compensated, difference is taxable to the highly compensated b. New expansion to fully-insured Penalties suspended pending further guidance 2. Expansion of preventive care with no cost-sharing 3. Guaranteed availability and renewability (under review)
12 Requirements and Obligations Group Size Applicability Funding Applicability Fully-insured Self-funded Applies to grandfathered plans? Yes (#1 & 3 only) No 1. Employer Sharing must offer coverage to full-time employees and their dependents a. Variable hour and seasonal employees b. Affordability rules 2. Minimum Value a. Plan s share of the total allowed costs of benefits provided under the plan b. Must be at least 60% 3. Reporting to justify mandate compliance
13 Requirements and Obligations Group Size Applicability Funding Applicability Fully-insured Self-funded Applies to grandfathered plans? Yes No 1. Market rules a. Essential health benefits b. Community-rating c. Limited rating rules 2. Minimum actuarial value of 60%, i.e. metal tier plans, i.e. bronze, silver, gold, platinum 3. Limit on annual deductible: 1. $2,000 individual 2. $4,000 family 3. (small group plans only) under review
14 Applicable Large Employer Review of Prior Rules All employees, including seasonal, are counted to determine status An employee is an individual who is an employee under common law standard Employer Sharing Responsibility REG Proposed Amendment (CMS-9958-P) 1/2/13 Leased employees are not crossreferenced under IRC 4980H A sole proprietor or 2% S-corp. shareholder is typically not an employee If an applicable large employer, must offer coverage to full-time employees and their dependents
15 Employer Definitions Employer Entity that is the employer of an employee under the common-law test. Entities Counted as One Employer All entities treated as a single employer under 414(b), (c), (m), or (o) are treated as a single employer for purposes of 4980H. IRS 4980H, IRS 414(b), (c), (m), or (o) IRS (b) - all corporations of a controlled group of corporations 414(c) - trades or businesses under common control 414(m) - all employees of an affiliated service group 414(o) Discretionary regulations to prevent the avoidance of any employee benefit requirement
16 Am I an Applicable Large Employer? Type Full-time employees Seasonal employees All other non-full-time employees Monthly totals Annual total Definition 30 hours or more of service Calculation Count one for each full-time employee Labor or services on a seasonal basis Total hours 120 = All others no equivalent FT exceptions Full-time and fulltime equivalent employees Average monthly totals Add FT and equivalents 12 +
17 Applicable Large Employer Who is an applicable large employer? 50 or more fulltime equivalents UNLESS Less than 50 full-time equivalents SMALL BUSINESS Seasonal exception applies: 50 or more employees for no more than 4 calendar months IRS/HHS Notices , , , DOL , IRS 4980H
18 Employer Sharing As an applicable large employer, I must offer coverage to: All employees averaging 30 hours or more of service per week; (130 hours if using a monthly standard) Employer Sharing Responsibility REG Proposed Amendment (CMS-9958-P) 1/2/13 Dependents = children up to age 26 Employees performing services outside the U.S. for which an individual receives U.S. source income
19 Variable Hour and Seasonal Employees Determining Full-time Status Ongoing full time employees New hires Tools to help with developing the optimal look-back strategy Standard Measurement Period Initial Measurement Period Look-back Period Employer s choice of 3 6, 9 or 12 months Can be no less than 3 months of selected SMP Administrative period = Can be no more than 90 days. Duration rule = IMP and admin period no more than 13 months.
20 Assessments H(a), (b) Penalties Associated With Non-Compliance Employers may be assessed fees for any month they: 1. Fail to offer employer-sponsored minimum essential coverage to FTEs and their dependents a. AND at least one person enrolls for coverage, from the Exchange, and receives a subsidy b. Assessment = 1/12 of $2,000, or $ per month, for each FTE, less the first 30 employees 2. Offer employer-sponsored minimum essential coverage to FTEs and their dependents but the employee contribution is deemed unaffordable a. AND 1 or more employees enroll for coverage, from the Exchange, and receive a subsidy b. Assessment = the lesser of: i. 1/12 of $3,000, or $250 per month, for FTE receiving a subsidy OR ii. 1/12 of $2,000, or $ per month, for each FTE, less the first 30 employees Employer Sharing Responsibility REG Proposed Amendment (CMS-9958-P) 1/2/13
21 Minimum Value of Employer Plans ACA, IRS Proposed Rule - 5/3/13; Commentary due by July 2, 2013 What is affordable? Employee s contribution, toward the employee-only premium, does not exceed 9.5% of the employee s W2 income. Example Employee earns $24,000; spouse earns $7,500 Employee-only coverage = $400/month ($4,800/yr.) Employee + Spouse = $750/month ($9,000/yr.) Employer contributes 50% of employee-only amount and 0% of spouse s amount 50% * ($4,800)/$24,000 = 10.0% = UNAFFORDABLE
22 Compliance with 4980H(a), (b) Affordability Safe Harbors applies only for purposes of whether the employer satisfies the 9.5% affordability test 1. Form W2 safe harbor wages to be reported in Box 1 of Form W2 Must offer its full-time employees (and their dependents) AND Employee contribution toward self-only premium for not exceed 9.5% of the employee s Form W2 wages for that calendar year. 2. Rate of pay safe harbor Take the hourly rate of pay for each hourly employee and multiply by 130 hours/month Use this monthly amount to compare to premium contributions 3. Federal poverty line safe harbor Employer can use FPL for a single to set premium contribution, i.e. set employee contribution for selfonly coverage of the lowest cost plan to 9.5%. Can use the most recently published FPL guidelines as of the first day of the plan year. Employer Sharing Responsibility REG Proposed Amendment (CMS-9958-P) 1/2/13
23 Compliance with 4980H(a), (b) Assessment penalties can be avoided if the employer offers minimum essential coverage under an employer-sponsored plan to its full-time employees and their dependents. Definition of dependent: An employee s child under age 26 does not include spouse Employers will not face a tax penalty if not offering coverage to spouses, who will be able to seek a federal premium tax credit to purchase health insurance in an Exchange if other minimum essential coverage is not available. Offer of coverage in case of non-payment: Employer will not be deemed as not offering coverage if employee fails to pay their portion of the premium this regulation adopts the COBRA 30-day grace period rule Offer of coverage: Employer will satisfy requirement as having offered if they offer to 95% of their employees Assessment payments: These are not tax deductible Employer Sharing Responsibility REG Proposed Amendment (CMS-9958-P) 1/2/13
24 Minimum Value of Employer Plans ACA, IRS Proposed Rule - 5/3/13; Commentary due by July 2, 2013 Group Size Applicability Funding Applicability Fully-insured Self-funded Applies to grandfathered plans? Yes No Background Individuals may not receive a premium tax credit (subsidy) if offered an eligible employer-sponsored plan providing affordable, minimum value coverage, i.e. minimum essential coverage (MEC) Applicability All employer-sponsored plans Traditional small group plans offered in the public Marketplace, private exchanges and private market (bronze, silver, gold, platinum) will meet minimum value Plans offered in the large group market will need to be tested to determine minimum value
25 Minimum Value of Employer Plans ACA, IRS Proposed Rule - 5/3/13; Commentary due by July 2, 2013 What is minimum value? The plan s share of the total allowed costs of benefits provided under the plan Minimum Value Anticipated amount plan would pay for covered costs for essential health benefits Anticipated amount both plan and participant would pay for covered costs for essential health benefits Methods of Determination Minimum value calculator - Safe harbor established by HHS and IRS Actuarial certification from a member of American Academy of Actuaries Plans in the small group market satisfying any of the levels of metal coverage
26 Proposed Safe Harbor Plans ACA, IRS Proposed Rule - 5/3/13; Commentary due by July 2, 2013 If the plan covers all of the benefits included in the Minimum Value (MV) calculator, the following plans designs will be considered to meet minimum value Plan Attribute Plan #1 Plan #2 Plan #3 Medical deductible $3,500 $4,500 $3,500 Dental deductible Integrated with medical plan Integrated with medical plan Coinsurance 80% 70% Maximum out-ofpocket limit $0 60% medical 75% drug ($10/$20/$50 copays tier 1-3 and 75% for specialty) $6,000 $6,400 $6,400 Employer HSA contribution None $500 None
27 Valuations of Alternative Arrangements ACA, IRS Proposed Rule - 5/3/13; Commentary due by July 2, 2013 Arrangements affecting minimum value: HSA: All amounts contributed by an employer for the current plan are treated as amounts available for first dollar coverage HRA integrated with employer-sponsored plan: Amounts newly made available count only if they may be used for costsharing and may not be used to pay insurance premiums Arrangements affecting affordability: HRA integrated with employer-sponsored plan: Amounts newly made available count only if they may be used for determining affordability if the employer may only use the amounts for premiums or may choose to use the amounts for either premiums or cost-sharing
28 Health Care Reform Patient Protection and Affordable Care Act of 2010 (PPACA) Sharing Responsibilities THE MARKETPLACE 28
29 Public Marketplace A web portal marketplace for health insurance Small Businesses If up to 100 employees, can buy thru Exchange Individuals (no subsidies for ones offered employer-based coverage, unless that coverage is unaffordable ) Self-insured plans not eligible to Participate Federal Government sets criteria for plan participation and purchaser eligibility provides subsidies for small businesses and individuals sets up Exchange if a state fails to States each sets up own Exchange will be involved in premium reasonableness reviews; can approve/reject as provided under state law
30 Individual Marketplace/Exchange WA MT ND NH VT ME OR ID SD MN WI NY MA WY MI CA NV AZ UT CO NM NE KS OK IA MO AR IL IN TN KY OH WV SC PA VA NC CT NJ DE MD DC RI Operational State Exchanges (1) AK TX LA MS AL GA FL State Exchange Established (15+DC) Federally -Facilitated Exchange (27) HI State Partnership Exchange (7) Information from: CIAB - June 28, 2013
31 SHOP Marketplace/Exchange WA MT ND NH VT ME OR ID SD MN WI NY MA WY MI CA NV AZ UT CO NM NE KS OK IA MO AR IL IN TN KY OH WV SC PA VA NC CT NJ DE MD DC RI Operational State Exchanges (2) AK TX LA MS AL GA FL State Exchange Established (15+DC) Federally -Facilitated Exchange (26) HI State Partnership Exchange (7) Information from: CIAB - June 28, 2013
32 Medicaid Expansion Moving Eligibility from 100% FPL to 133% FPL WA MT ND NH VT ME OR ID SD MN WI NY MA WY MI CA NV AZ UT CO NM NE KS OK IA MO AR IL IN TN KY OH WV SC PA VA NC CT NJ DE MD DC RI AK TX LA MS AL GA FL Will expand (25) + DC Alternative Method (4) Undecided (0) HI Leaning toward no expansion (4) Information from: CIAB - June 28, 2013 No expansion (17)
33 Requirements and Obligations Group Size Applicability Funding Applicability Fully-insured Self-funded Applies to grandfathered plans? Yes No 1. Market rules a. Essential health benefits b. Community-rating c. Limited rating rules 2. Minimum actuarial value of 60%, i.e. metal tier plans, i.e. bronze, silver, gold, platinum 3. Limit on annual deductible: 1. $2,000 individual 2. $4,000 family 3. (small group plans only) under review
34 Essential Health Benefits Definition Applies to: Individual plans Small employer group plans Offered in and out of the Exchange Plan requirements: Specific categories of benefits Certain cost-sharing standards Provide certain levels of coverage Items and Services Must include: 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder 6. Prescription drugs 7. Rehabilitative and habilitative services 8. Laboratory 9. Preventive and wellness 10.Pediatric services Applicability Effective Date: First plan year, for individual and small group market, starting on or after January 1, 2014 Plan types that won t meet the criteria: Mini-meds Specified disease or illness Accident only coverage Other types of excepted benefits HHS Pre-rule bulletin 12/16/11 and PPACA; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation 11/26/12 proposed rule
35 Rating Rules & Methodologies 1. Issuers = individual member ratings Employers = individual or composite rating 2. Age rating limited to 3:1 3. Tobacco rating limited to 1.5:1 4. Family size individual v family a. Maximum of 3 oldest family members under age 21 b. No cap for family members over age Geographic region a. States or CMS can establish one or more rating areas b. Maximum rating areas cannot exceed the number of MSAs plus one c. One rating area for state, county-based or 3-digit zip codes, or metropolitan statistical areas (MSAs) and non-msas 6. Re-underwriting is prohibited Apportioned to each family member Applies to nongrandfathered health insurers (not self-funded) Will apply to nongrandfathered large group if state permits coverage to be offered through an Exchange in /26/12 HHS proposed rule; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation
36 Employer Notice Requirement ACA Section 1512 Notifications: New employees: at the time of hire beginning October 1, 2013 Current employees: no later than October 1, 2013
37 Health Insurance Marketplace Notice Dept. of Labor (DOL), Technical Release Who must notify? FLSA applicable employers: Employ one or more employees who are engaged in, or produce goods for, interstate commerce Specific entities: Hospitals Institutions caring for the sick or disabled Schools Federal, state and local government agencies Providing notice Must be provided to: All employees, regardless of plan enrollment status, or of part-time or full-time status Format and delivery: Written manner to be understood by the average employee Delivered by first-class mail or electronically, if the DOL s electronic disclosure safe harbor standards are met Timing of notice For new hires: At the time of hire beginning October 1, (For 2014, within 14 days of employee s start date.) For current employees: No late than October 1, 2013, automatically and free of charge
38 Model Notice employers with benefit plans Dept. of Labor (DOL), Technical Release v/ebsa/pdf/flsa withplans.pdf NOTE: It is likely that a new template will be issued as a result of the delay in the employer penalty mandate
39 Model Notice employers without benefit plans Dept. of Labor (DOL), Technical Release v/ebsa/pdf/flsa withoutplans.pdf
40 COBRA Model Election Notice - REVISED Dept. of Labor (DOL), Dear: [Identify the qualified beneficiary(ies), by name or status] This notice contains important information about your right to continue your health care coverage in the [enter name of group health plan] (the Plan), as well as other health coverage alternatives that may be available to you through the Health Insurance Marketplace. Please read the information contained in this notice very carefully. There may be other coverage options for you and your family. When key parts of the health care law take effect, you ll be able to buy coverage through the Health Insurance Marketplace. In the Marketplace, you could be eligible for a new kind of tax credit that lowers your monthly premiums
41 Recommended Checklist July 2013 Go to Determine if you are subject to FLSA (Fair Labor Standards Act) and required to provide the notice Document applicability Develop timeline for one-time 2013 delivery August 2013 Review acceptable options for distribution of the notice including, mail, , new hire packets, etc. Assess feasibility and distribution costs and document final determination Review template forms to determine whether the template will work or if something more custom is needed September 2013 Gather information needed to complete the form Determine who will respond to employee inquiries about the notice Complete the form and any accompanying cover letter Document process, procedure and timeline for annual review and form update
42 Plan Fees Provision Qualification Effective Date Patient- Centered Outcomes/ Comparative Effectiveness Fees (PCORI) Applies to health insurance issuers and selffunded plan administrators Transitional Reinsurance Program- Applies to health insurance issuers and selffunded plan administrators The amount of the fee is $1 for each covered life for the 2012 policy or plan year, $2 for each covered life for the 2013 policy or plan year Report and pay fee annually on IRS Form fee = approx. $5.25/month per capita. Total fees to collect are $10, $6, and $4 billion for 2014, 2015, 2016, respectively IRS Final regulation 12/10/12, FR Due by July 31 of each year, beginning July 31, 2013 Plan years on or after 10/1/12 and before 10/1/19 Begins 1/1/14 and applies for a 3- year period (e.g. 2014, 2015, 2016) First invoice to be issued by HHS in 11/14/13 for payment 1/1/15 Group Size Applicability Funding Applicability Fullyinsured Selffunded Fullyinsured Self- Funded Applies to grandfathered plans? Yes No Yes No
43 PCORI Fees Provision Qualification Effective Date Patient- Centered Outcomes/ Comparative Effectiveness Fees (PCORI) Applies to health insurance issuers and selffunded plan administrators The amount of the fee is $1 for each covered life for the 2012 policy or plan year, $2 for each covered life for the 2013 policy or plan year Report and pay fee annually on IRS Form 720 Due by July 31 of each year, beginning July 31, 2013 Plan years on or after 10/1/12 and before 10/1/19 Group Size Applicability Funding Applicability Fullyinsured (Carrier pays) Selffunded (Employer pays) Applies to grandfathered plans? Yes No ACA, IRS Final Regulation- 12/18/12; FR
44 Counting Number of Lives STANDARD METHODS: 1. Actual count method a. count each covered life for each day of the plan year b. divide by number of days 2. Snapshot method a. choose one or more corresponding days each calendar quarter b. add covered lives on those dates c. divide by number of days chosen method (if filed by 7/31) a. Offering employee coverage only - add number of participants reported at beginning of year to the number reported at end of year and divide by 2 b. Offering employee and any other family coverage - add the total participants covered at the beginning of the plan year to the total participants covered at the end of the plan year (IRS Final Regulations ; Dept. of Treasury )
45 Multiple plans FEE REQUIREMENTS: Plan Types Treat as 1 plan 2 or more self-funded plans with same plan year 2 or more self-funded plans with different plan years Stand-alone health reimbursement arrangement (HRA) Health reimbursement arrangement (HRA) integrated with fully-insured plan Health reimbursement arrangement (HRA) integrated with self-funded plan X X X Treat as multiple plans X X (IRS Final Regulations ; Dept. of Treasury )
46 Carrier/Manufacturer Fees Provision Qualification Effective Date Health Insurer Fee Applies to all entities with >$25 million in aggregate net premiums in the preceding calendar year, except: VEBA s, governmental, or non-profits Imposes an aggregate fee of: $8 billion for 2014 $11.3 billion for $13.9 billion for 2017 $14.3 for 2018 Subsequent years will be assessed at $14.3 billion plus the rate of premium growth. Estimates indicate it will cost about $300-$500/ family Due annually, no later than September 30 Fees beginning 9/30/14 Group Size Applicability Funding Applicability Fullyinsured Selffunded Applies to grandfathered plans? Yes No Medical Device Tax - Applies to manufacturers, producers or importers of medical devices A tax equal to 2.3% of the sale price of any taxable medical device. Does not apply to eyeglasses, hearing aids or other types for individual use. Applies to sales after December 31, Fullyinsured Self- Funded Yes No ACA, IRS Final Regulation- 12/18/12; FR
47 Summary of Benefits & Coverage Revised template: Compliance for year 2: Provides language indicating whether the plan provides: 1. Minimum essential coverage 2. Minimum value 1. Utilize new template OR 2. Create a cover letter for the existing template using the model language to address minimum essential coverage and minimum value Does this Coverage Provide Minimum Essential Coverage? The Affordable Care Act requires most people to have health care coverage that qualifies as minimum essential coverage. This plan or policy [does/does not] provide minimum essential coverage. Does this Coverage Meet the Minimum Value Standard? The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). This health coverage [does/does not] meet the minimum value standard for the benefits it provides. (Department of Labor DOL; FAQs Part XIV)
48 Individual Mandate Penalty Transition Relief Applies to: Employees and related individuals enrolled in, or eligible to enroll in, an employer s non-calendar year plan Where the plan year begins 2013 and ends 2014 Transition Relief: No individual mandate penalty for months in 2014 prior to the first day of the plan year beginning in 2014 Example: Employee and minor daughter eligible to enroll in a non-calendar year plan that begins August 1, 2013 and ends July 31, 2014 Neither employee nor daughter enroll in plan for the plan year Employee and daughter eligible for transition relief for January 2014 through July 2014 (IRS Notice )
49 Wellness Incentives Types of wellness programs 1. Participatory a. No required standard related to a health factor OR b. No reward offered 2. Health-contingent* a. Requires individuals to satisfy standard related to a health factor AND b. Offers a reward *Consumer-protection conditions: a. Total reward does not exceed 20% of the total cost of coverage b. Reasonably designed to promote health or prevent disease c. Gives eligible individuals an opportunity to qualify at least once per year d. Reward available to all similarly situated individuals e. Plan materials must highlight reasonable alternative standard Departments joint final regulations issued 12/13/06-71FR75014
50 Wellness Incentives ACA Reflects the 2006 regulations Extends nondiscrimination provisions to individual market Affordable Care Act HHS Proposed Rule 11/26/12 Proposed Rules Applicability: Grandfathered and non-grandfathered plans Plan years on or after January 1, 2014 Extension to individual market Increase in incentives: 30% maximum program reward 50% maximum tobacco prevention or reduction reward
51 Preparing for Safe Harbor Full-time Employee Premium Subsidies Minimum Essential Coverage Nondiscrimination Annual Limits Employer Mandate Stability Period Risk Retention Fees Wellness PCORI Fees Essential Benefits Reporting Medical Loss Ratios Initial Measurement Period Exchange Operation Actuarial Values Cadillac Plans Auto Enrollment 51
52 Health Care Reform Patient Protection and Affordable Care Act of 2010 (PPACA) Potential Opportunities? 52
53 Health Care Reform: State Exchanges Exchange An organized marketplace to help qualifying individuals and employer groups (initially small employers) buy health insurance in a way that permits easy comparison of available plan options based on price, benefits and quality. Must be established by January 1, 2014 Purpose To facilitate the purchase of qualified health plans (QHPs) To provide small employers a Small Business Health Options Program (SHOP Exchange)
54 Qualified Health Plans Four Coverage Level Requirements for Essential Benefits Package Bronze: designed to provide benefits actuarially equivalent to 60% of full value; Silver: designed to provide benefits actuarially equivalent to 70% of full value; Gold: designed to provide benefits actuarially equivalent to 80% of full value; and Platinum: designed to provide benefits actuarially equivalent to 90% of full value.
55 Public and Private Marketplaces Plan Types Public Marketplace Private Marketplace Operated by State, state partnership with federal government or federally-facilitated Carrier, broker, other private entity or partnership of entities Participating carriers Approved carriers Select carriers Type of plans offered Individualized selection of plans and products Select plans submitted and approved Yes, limited by Marketplace All plans filed with the state narrowed down by employer/individual Yes; limited by employer Availability of subsidies Yes No, unless web-broker Availability of small employer tax credit Yes Can work with broker Yes, if certified Yes, if approved No
56 Marketplace Employer Menus Public Marketplace Health options: Employers may select from approved QHPs: One carrier plan (only option for FFEs in 2014) Multiples plans and carriers Metal tier with multiple carriers One carrier with multiple plans Other insurance options: Dental and vision offerings will vary by state Only available from health carriers Life and disability will be rare Additional offerings: Whatever is offered by health carrier selected Private Marketplace Health options: Employers may select from all plan options: One carrier plan One carrier with multiple plans Metal tier with one carrier Other insurance options: Multiple options from medical or ancillaryonly carriers Products include: dental, vision, disability, life, voluntary, pet, accident, cancer, etc. Additional offerings: Wellness programs Administration and payroll Compliance, education and other resources 56
57 Private Marketplace The 3 C s of Benefit Marketplace: The employer has an expectation of being removed from the day-to-day management of a benefit plan such an enrollment, changes, terminations, managing eligibility, reconciling multiple carrier bills, making premium payments, etc. 1. Consolidated benefits administration An online employee enrollment system that integrates into the carriers & payroll service provider An online employer administrative system that easily provides the important data to manage the program Benefit administration service team to manage the day-to-day activities of the benefit program. 2. Complete array of benefit choices Health Plans: 8-15 health plan choice to meet the many demographics within the workforce Ancillary Benefits: build your own dental, vision, life, disability, accident, critical illness, and more New Benefits: such as telemedicine & concierge medicine 3. Customer service including decision support before, during, & after enrollment Educational tools including videos Decision support for medical, dental, vision, life insurance, & disability insurance Plan recommendations based on an individual s personal situation Benefit counselors available telephonically and via chat
58 Defined Contribution Health Plans Theory of gradual shift to defined contribution health plans Shifting risk of incurring high health-care costs from employers to workers Similar to previous shift for retirement plans Today, market is predominately defined-benefit plans Employers determine a set of health-insurance benefits Move to defined-contribution where Employers pay a fixed amount Employees use money to buy or help pay for insurance they choose themselves
59 Overview of Defined Contribution Approach
60 Shift in Funding Strategies. Current and Future Approach to Providing Health Care Benefits Employer selects the health plan for all employees (no options, employer pays 100%) 7% 7% Employer suggests a few plans for employees to choose from (through sponsorship of traditional health benefit plans where employers pays a percentage of premium) Employer provides access to a corporate or private health exchange giving employees variou plans to choose from (employer sponsorship through a fix dollar amount) Employees choose a plan on their own from options available on the open market (employer does not contribute to health benefits) 4% 4% 8% 31% 44% 77% Other 8% 10% Current Approach Future Approach (next 3-5 years) Aon Hewitt, Corporate Health Care Exchange Survey, The Time is Now, Rethinking Health Care Coverage, % 20% 40% 60% 80% 100%
61 Do you have the answer? Should my Credit Union offer Coverage in light of Health Care Reform? Have to consider Play or Pay What will be offered through each state s Exchange? What will I need to do to remain competitive?
62 Strategic Inventory Why do you offer health insurance as part of your current benefits package? a. Protection for employee and family b. Attract and retain talent c. Obligation d. Personal need Why do your employees participate in your health insurance program? a. Lower cost b. Tax advantages c. Protection for family d. Transfer of responsibility e. Tax advantages f. Employee expectation
63 What if? If you eliminate health insurance as part of your benefits package, would you replace it? With other benefits? With salary? What would employee reaction be if you eliminated this benefit? How might productivity be affected? Will all your employees obtain health insurance coverage on their own? What would you do personally for your own benefits?
64 Summary HCR not likely to change substantially in the near future in wake of SCOTUS ruling and Presidential election Danger in waiting too long to ensure compliance o DOL Audits o Lack of time to create strategy Potential opportunities for credit unions thru HCR o Private Exchanges making shift to defined contribution funding easier o Public Exchanges o Possibility of dropping coverage if needed o Employer of Choice strategies
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