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Copyright 2015 Triton HR

ACA Reporting and Product Alignment Designed to Manage ACA Costs

Hosted by : Steve RosenthalPresident & CEOTriton HR & Triton BenefitsMay 4, 2015

Disclaimer: The information contained in this webinar and related materials is not intended to constitute legal advice or the rendering of legal, consulting, or other professional services of any kind. Users of these materials should not in any manner rely upon or construe the information or resource materials in these materials as legal, or other professional advice and should not act or fail to act based upon the information in these materials without seeking the services of a competent legal or other professional.

About Triton HR

• 1989 to 2001 Founded one of the Largest PEO’s in the Country (2001 – Ranked #231

on Forbes Private Business List). Company was sold to Zurich Insurance in 1998

• 2001 to 2008 Founded Checkpoint HR, a Payroll and Benefits Company with over 500

Clients and revenues of $10M (sold to Private Equity Company)

• 2008 to Current Triton has become one of the largest HR Outsourcing and Benefit

Companies in the Nation for mid-sized businesses. We currently serve over 600

Clients, have offices in NJ, NY, TX, FL, and manage over $150M in Annual Insurance

Premium

ACA Reporting and Insurance Products to Manageyour ACA Costs

• ACA Reporting

• Minimum Essential Coverage (MEC Plans)

• Minimum Value Plans (MVP Plans)

• Affordable Care Plans using Medicare Rate Reimbursement

Strategy

• Level Funded Plans

• Level Funded Plans with MEC Waivers

• CDHD Plans

• Implementation Specialists

Copyright 2015 Triton HR

Approach to Determining Full-Time Status Step - 1

Copyright 2015 Triton HR

Approach to Determining Full-Time Status Step - 2

Tracking and Reporting

Calculating FTE’s

ACA Reporting

ACA Reporting

ACA Reporting

ACA Reporting

ACA Reporting

Form 1095-C (data capture)

• ADP System (1095-C Section 14)

• Validation Tables

Form 1095-C (data capture)

• ADP System (1095-C Section 15)

• WFN Benefit Module

Form 1095-C (data capture)• ADP System (1095-C Part III)

• WFN On-Line Employee Benefit Enrollment

• Captures the dates of offering or waiver of coverage with reason type

Minimum Essential Coverage (MEC Plans)

• MEC Plans provide ACA required Preventative Care Coverage

• Eliminates the $2,000 Employer Pay to Play Penalty

• Does not eliminate the $3,000 Employer Penalty should an Employee obtain a

subsidy from the Exchange

• Eliminates the 2015-$295 and 2016- $695 Penalty

• Can be used by Certain Carriers as Legitimate Waivers

• MEC Plans costs about $68 per member per month

• Assumes Maximum Funding Level

• Providers who offer MEC Plans

MagnaCare, Key Benefits, Allied Benefits, CHP, Meritain

Minimum Value Plan Requirements and Penalty Avoidance

• MINIMUM VALUE REQUIREMENTS

Under the ACA, a plan fails to provide minimum value if the plan’s share of total allowed

costs of benefits provided under the plan is less than 60 percent of those costs. Minimum

value is calculated by dividing the cost of essential health benefits (EHBs) the plan would

pay for a standard population by the total cost of EHBs for the standard population

(including amounts the plan pays and amounts the employee pays through cost-sharing)

and then converting the result to a percentage.

• Plans that offer Minimum Value or greater avoid all plan penalties under Pay to Play Rules.

When offered with a MEC Plan the Employer avoids the $3,000 Penalty should an Employee

obtain a subsidy from the exchange

Skinny Plan Evolution – Affordable Care Plans

Skinny Plan Evolution – Affordable Care Plans

Minimum Value Plans Most Commonly UsedIn The Marketplace Today

Minimum Value Plans Using Level Funded Strategy

Level Funded - Financial

Level Funded - Financial

Level Funded Plans with MEC Waivers

Consumer Driven HD Plans- CDHD

Wellness Program used to Monetize Benefits Strategy – Categories:

• Participatory programs reward customers for completing a health action – but not meeting a health goal. Examples include completing a health assessment, preventive care visit, or biometric screening.

• Activity-based programs reward customers for completing a health goal or activity – but not one that requires a measured health outcome. Examples include completing a nutrition or exercise program.

• Outcome-based programs reward customers for meeting a measured health outcome – like blood pressure less than 140/90, or BMI less than 30.

Wellness - Outcome vs Activity Fitness

• Activity-Fitness is a proactive approach and long term strategy that’s designed to Benefit the Employee and Company

• Most people want to be healthy and lose weight • Most people would rather not have to take medication• Most smokers want to stop smoking• Employees who regularly exercise have:

• Lower Cholesterol• Lower Blood-pressure• Better Immune System• Greater Flexibility • Increased Metabolism• Better Diet and Eating Habits• Less Likely to Smoke

How do we Motivate our Employees to Exercise on a Steady Routine• Free Gym Membership

• 30% Reduction in Medical Deduction “Single Rate Base Medical Plan”

• Ongoing Basis Providing - “ They Use it”• Agreement they join one of the Preferred Vendor Gyms”

• Agreement they will utilize 12 times per Month

Architectural Strategy• Employee/Company Agreement

• Employee Agrees that in consideration for participation in Fitness Program they will utilize a bona-fide fitness center 12 times per month and in return receive “free gym membership to Preferred Fitness Center”. In addition, their payroll deduction for medical insurance for the single coverage portion will be decreased by 30% (can be off of the base medical plan rates). If the employee does not comply in a given month, the gym membership becomes a cost if they continue and the 30% contribution decrease goes back to the standard 9.5% of wage contribution (or deduction program established by company).

• Fitness Center Strategy

• Preferred Fitness Center for Company Members if Business doesn’t have a bona-fide gym on its premises

• Powerhouse Fitness, Planet Fitness, NY Sports, LA Fitness, Etc.

• Broker Relationship with Fitness Center to set-up Program and Validate Membership Usage

• ABC Reporting, Mind-Body Reporting, etc.

• Broker Relationship with Payroll Provider to enforce Deduction Incentive as a result of Membership Usage Agreement

All Parties and Systems Need to be in Sync• HR System

• Captures New Hire & Status Changes

• Payroll System

• Captures Hours Worked over Measurability Periods, Health Ins. Deductions and Total Wages

• Benefits Application

• Captures Information about MEC Plans, MV- Base Plans and Buy-up Plans

• Captures Contribution Levels

• Captures Eligibility Rules

• Captures Measurability Periods

• Captures Enrollment and Waiver Data

• Reporting System

• Uses information above to notify Company about: FTE’s, Measurability Results, Enrollment Status

• Uses information above to create Employee Statements and IRS Reporting

• Insurance Broker

• Ability not only to understand the Procurement of Insurance but the Administration & Communication to Assist with the Systems and

Application Set-up

For More Information and to Learn More…

• Please contact a Triton HR Representative at: (877) OK-TRITON

• Email us at: Tina.Freedman@tritonhro.com

• This PowerPoint presentation is available upon request

Thank you for joining us today!