The T A he CA A CA Thr T ough Y ough our Y Eyes E wha h t a t i s i s in i n it i t fo f r r me m? Nov o e v mber r 1, 1,

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1 The ACA Th hrough Your Eyes what is in it for me? November 1, 2013

2 Disclaimer This presentation is tailored for independent health insurance agents in the state of Texas that intend to write BCBSTX in the HIMs. 7-13

3 Valuable ACA A Resources Visit our Health Care Reform section at Perplexity is the beginning of knowledge Khalil Gibran

4 Resources at

5 Scroll down to Health Care Reform, where ACA related resources may be found.

6 Health Care Reform (ACA) Resources

7 (available in Spanish)

8 CuidadoDeSalud.gov

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10 No Bueno : Spanish online enrollment is not going to happen this year However! An estimated 10 million Latinos are eligible for coverage, and 4 million of them speak Spanish primarily. The state of Texas is 40%+ Latino

11 Use for YouTube video learning

12 Registration Process for Agents / Brokers The Brokerage cannot help you register. The Brokerage cannot do anything All we can do is sympathize with you! If you need assistance, call The certification process works. to fix the technology challenges.

13 Getting set up to market on the HIMs Four step process: 1. Register at the CMS Enterprise Portal (Part 1) 2. Complete your certification at the HIM website 3. Register to enroll people in the HIMs (Part 2) 4. Complete the BCBSTX required certification

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15 Register at The CMS Enterprise Portal

16 Certify com

17 Get certified with The Blues er

18 Get started! The message is simple: On January 1, 2014 you will then be required by law to own a qualified health insurance plan (QHP). If you cannot afford a QHP, you will be subsidized. If you choose not to own a QHP, you will be penalized. If you need help, I can help you.

19 Simplify the message by using the HealthCare.gov resources

20 Marketing tips Know how to calculate subsidies Know how to complete a HIM subsidy application Hint: no health questions, more qualification questions The Health Insurance Marketplace ap pplications for a QHP is at in the HCR Resources section Know how to calculate Health Insurance Tax Credits for groups of 2-25 Use HITCs to prospect small groups of 2-25 lives

21 Health Insurance Marketplace (Short Form)

22 HIM (Short Form)

23 HIM (Short Form)

24 Who are thes se 50,000,000 uninsured? How do you get quotes? How do you sign them up?

25 The young and invincible 34 Federally & State Partnership Marketplaces finds that out of 2.9 million single young adults ages 18 to 34 who may be eligible for coverage in the Marketplace 1.3 million (46%) could purchase a bronze plan for $50 per month or less after tax credits. 1.9 million young adults (66%) of the potentially Marketplace-eligible uninsured ages 18 to 34 may be able to pay $100 or less for coverage in Source: U.S. Department of Health and Human Services

26 Individuals Eligible for a Premium Tax Credit (by employment status)

27 Individuals Eligible for a Premium Tax Credit (by age)

28 Subsidy Calculator

29 Enter demographic info & click submit

30 Family of 4 at $60,000 = 255% FPL

31 Family of 4 at $50,000 income annual household

32 Subsidies are based on the 70% Actuarial Value Plan or The Silver Plan 70% AV Plan Premium $8,362 Minus the subsidies - $4 4,996 Net premium cost to family = $3,365 per year Total Family Premium is $280 per month

33 60% AV Plan or The Bronze Plan 60% AV plan premium $5,718 Minus the subsidies - $4,996 Net premium cost to family = $7 722 per year Total Premium is $60 per month

34 ACA MOOP (Max Out of Pocket) $6,350 for an individual $12,700 for a family Same as the MOOP of an HDHP (high deductible health plan) Bronzeor Silverplans have the same max out of pocket If you only make $50K per year, how can you pay this MOOP? Add a supplemental health plan

35 Sales Idea: The Combo Plan Bronze Plan and Active Care Bronze Premium $60 Active Care Premium $153 Total Family Premium $213 per month $67 less per month than The Silver Plan at $280 per month, but the supplemental health plan helps offset the $12,700 MOOP.

36 What is Active Care? New supplemental health product combines Critical Illness, Cancer, Heart Attack, Stroke, ESRD, and Accident benefits into one product Simplified underwriting May be list billed Agent commission is 50% Contact for complete details Visit

37 Let s review these numbers again HIM Plan Amount paid by family Subsidized Amount Total Premium Commission 70% value (Silver) $3,365 +$4,,996 =$8362 6% = $502 60% value(bronze) $722 +$4,,996 =$5,718 6% = $343 Active Care + $1,836 = $2,558 +$1, % = $918 =$7,554 = $1,261 6% commission is paid by BCBSTX for years 1-3, and 4% levell after that.

38 Which plan is best suited for the family? The Silver Plan costs $280 per month The Bronze Plan / Active Care plan costs $213 per month The Combo Plan saves the family $804 per year in total premium The Combo Plan offers better protection to the family The Combo Plan pays the agent more commission!

39 <250% Federal Poverty Level = CSR or Cost Sharing Reductions Similar to the Medicare Savings Plan (Low Income Subsidy), a person at or below the 250% FPL is eligiblee for cost sharing on the Silver Plan Think of how the low income subsidies work within the Medicare Savings Program How might this impact your recommendations? Should they even consider a supplemental plan(s)? Or should they consider less of a supplemental benefit plan(s)?

40 2014 BCBSTX HIM Plans Rx Benefits The Gold Plan On Exchange & The Gold Plan Off Exchange The Silver Plan On Exchange & The Silver Plan Off Exchange The Bronze Plan On Exchange & The Bronze Plan Off Exchange

41 14 BCBSTX Individual Plans Rx Benefits Structure Benefit Structures Drug Card Coinsurance after Medical Deductible Formulary Standard Formulary on PPO Network Generics Plus formulary on narrow networks Generics Plus is essentially a leaner version of the standard formulary and includes non-specialty and specialty drugs for all major therapeutic categories 5-Tier Drug (2-tier Generics) Drives utilization towards Generic drugs PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. 41

42 Exchange Gold PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

43 Exchange Silver PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

44 Exchange Bronze PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

45 ting Characteristics Age Bands Age 0-20 is one age band Age have single year age bands Age 64+ is one age band Family Demographics The maximum number of depend dents (age 0-20) that will be rated on a family plan is capped at 3 Dependents age 21+ do not count toward the cap Under age 20 or younger count toward the cap Benefit Design Metallic Level & Actuarial Value Cost Sharing Network PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

46 ting Characteristics Tobacco Use 6 month look back to qualify for non-tobacco BCBSTX tobacco rates are 10-33% higher than the non-tobacco rates (permitted to rate up to 50% higher) Rates are subject to the 3:1 rating ratio Geographic Rating Areas Geographic rating will be by county, not Zip Code Based on the address of the Primary Insured -Even if any member on a policy has a different address than the Primary Insured Texas has 26 defined rating areas PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

47 BSTX Agent Compensation Commissions 6% -Years 1-3 4% -Years 4+ Based on full premium, not subsidized premiums $25 per app bonus for effective dates PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

48 etting paid: Points to Remember Use the Retail Shopping Cart (through December 2014) Use your ExpressLink (for all ACA plans) If multiple applications are receiv ved, the agent on the last application received, prior to the 15 th of the month, will be assigned as the AOR (on and off exchange) Applications with incomplete or missing broker information will be processed as direct PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

49 ining & Certification On Exchange (Public) You must obtain CMS Certification You must submit your Marketplace ID to BCBSTX You must complete the BCBSTX Product Training module Off Exchange (Private) You must complete the BCBSTX Product Training module PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

50 The Small Business Health Options Program The SHOP Exchange

51 Health Insurance Tax Credits (HITCs) How can you use HITCs (Health Insurance Tax Credits) to prospect for more business? How many CPAs understand HITCs? Where do you get info to see if your clients will qualify? How do you get employer HITC calculations? Or are they called health premium tax credits?

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53 HITC calculator at

54 HITC info at

55 Employers

56 htm

57 IRS Tax Tips: The Small Business Health Care Tax Credit

58 Early renewal strategies New policy effective date in December 2013 will push the ACA requirements back by one calendar year, delaying the move to a plan that may be more expensive Creates a new health plan year from through What may happen in December 2014 Convert to an ACA compliant product Convert to a defined contribution strategy Drop your health plan How could this impact calendar year Section 125 plans?

59 Wrap up go sell! The Brokerage is proud to be a BCBS General Agent in: Texas New Mexico* Oklahoma* Illinois* You will be able to sell in the: Public Exchanges Private Exchanges SHOP Exchanges *Medicare related products only

60 Your time is now! Get appointed with BCBSTX through The Brokerage Get certified For help getting started, call The Brokerage Toll free Direct lines: Belynda DiCiaccio Cristin Hopkin-Bishop Dana Ragsdale Click here to meet our staff online

61 Don t forget 6,200,000 uninsured Texans About 2.2M are 138% FPL or below let the Navigators enroll this population That leaves 4,000,000 uninsured Texans Say 1 out of 4 enroll There are about 13,000 BCBSTX appointed agents 1,000,000 divided by 13,000 is 777 apps per agent Go forth and prosper!

62 During the Q & A session Typing a question in the GoToMeeting box is best Keep your phone on mute: Either press *6* Or press the mute button on your phone device To ask a question, please unmute your phone To unmute, press *6* or the unmute button on your phone device Reminder: do not place your phone on hold at anytime Any background music playing while on hold ruins the event for all participants and may result in a session terminating prematurely Either remain on mute or hang up if you need a break

63 Thank yo ou for your participation! This presentation has been recorded and will be posted in the HCR Resources section at