core hcr presentation rental association wo video

What can you do?Employer Mandate and Responsibility ProvisionsEmployer Mandate and

Responsibility ProvisionsEmployer Mandate and



Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHealth Care Reform

Health Care Reform:What comes next?

Presentation for

GA Chapter, American Rental Association

CORE Benefit Solutions, LLCLisa Owen, President, RHU

[email protected]

Jennifer Gregory, Account Executive

[email protected]

mailto:[email protected]







Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareCORE Benefit Solutions

Tailored employee benefit programs:

- Group Health

- Individual/Personal Health

- Benefits Administration

- Human Resource Solutions

- EZ Enroll Kits

- Benefits Administration

CORE PRODUCTS- Medical/Rx/Dental/Vision/Life/

AD&D- Disability- Long Term Care- Wellness Programs- Self Insured Health Plans- Voluntary Benefits- Employee Assistance Programs

(EAP)- International Plans- FSA, HSA, HRAOTHER PRODUCTS- Property & Casualty- Worker's Compensation- General Liability- Retirement





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHCR Quiz

• A. Must purchase minimum essential coverage • B. Must purchase dental and vision coverage• C. Must purchase “Platinum, Gold, Silver, or Bronze Plan”

• D. All of the above

What does the Individual mandate require of all

US citizens?

• A. Provide affordable and minimum value coverage or be penalized

• B. Provide financial contribution to help employees purchase coverage

• C. Provide Marketplace Notice to existing and new hire employees & Summary of Benefits & Coverage (SBC), if employer offers group medical plan

What are employers with 49 or fewer employees

required to provide employees under the

ACA?

• A. Only if employer doesn’t offer coverage• B. Only if income is between 100-400% FPL and employer does not offer affordable minimum essential coverage

• C. Only if income is between 100-400% FPL• D. As long as individual is below the age of 30

Can any individual obtain a federal subsidy

to help pay for health insurance?

2010 Dependent coverage for adult children up to age 26 Elimination of pre-existing conditions for children under 19 Preventive services covered at 100% * Patient Protection provisions * (PCP, Emergency Room) Elimination of lifetime limits, restricted annual limits on essential

heath benefits Disclosure notices (Grandfathered/Non-Grandfathered, Patient

Protections) Non-discrimination provisions * (enforcement delayed) Small employer tax credit Federal pre-existing condition plan available

2011 FSAs, HSAs, HRAs Changes (OTC, non-qualified H.S.A. 20% excise tax) Medical Loss Ratio New long-term care program (not funded)

2012 Expanded Women’s Preventive Care * Summary of Benefits and Coverage





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareHCR Timeline Overview

* Does not apply to grandfathered plans

2013 Medical FSA Limit of $2,500 W-2 Reporting (250+ W-2s in 2012) Taxes and Fees (CERF, Reinsurance, Medicare, etc.) Written notice of Exchanges (new hires included)

2014 Employer Mandate: Pay or Play (50+) (Delayed until 2015) Individual Mandate State/Federal Marketplace/Exchange (1-50=2014 & 1-100=2016) Adjusted Community Rating * (1-50, 2014 & 1-100, 2016) Guaranteed issued/Guaranteed renewability * (1-50=2014 & 1-

100=2016) No Pre-Existing Conditions Must cover Essential Health Benefits (EHB) * (1-50=2014 & 1-

100=2016) Deductible Limits* (2-50=2014 & 2-100=2016) Out of Pocket Expenses Limits * Health plans may not establish Annual Limits on EHB * 90 Day Limit on Waiting Periods












2014 Continued Automatic Enrollment (200+) Increased Wellness Program Incentives

2016 Employer Size Redefined

- (Small group = 2-100 & Large group = >100) Community Rating (1-100)

2017 Exchange for Large Employers (>100)

2018 Cadillac Tax


Individual Mandate

Source: BCBS Exchange Webinar

2014

2015

2016

Greater of $95 per person (cap of $285 per family)

or 1% of household income

Greater of $325 per person (cap of $975 per family) or 2% of household income

Greater of $695 per person (cap of $2,085 per family) or 2.5% of

household income

2017 and beyond: Annual adjustments





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareEmployer Mandate

Source: United Health Care

“Applicable Large Employers”• Employers with 50 Full-Time Equivalents (FTEs) on average

• Measured by looking at entire controlled group over prior calendar year

• Transition relief in 2013: employer can measure full-time equivalents for any continuous 6-month period in 2013 to determine 2014 large employer status; remove seasonal employees working less than120 days per year

What is an FTE?• Common law EE who, during the applicable calendar month, was

employed on average at least 30 hours of service per week • Number of FTEs = all part-time EE hours (up to 120 hours per EE)

for the applicable calendar month divided by 120• Only count U.S. hours• Leased EE rules do not apply

Controlled Group:1. Parent-child= business owns, directly or indirectly, at least 80% of another

business. 2. Brother-sister= 5 or fewer owners own at least 80% of 2 or more business &

combined identical ownership of the common owners in each entity is more than 50%.





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareMedical Loss Ratio


The health care reform components include new minimum loss ratios (MLR):

Taxe

s ($

0.0

24

)

Ad

min

istr

ativ

e E

xpen

se

($0

.10

)

Co

mm

issi

on

s ($

0.0

5)

Claims ($0.80)

Pro

fits

($

0.0

36

)

- MLR for small groups / individual plans = 80%

- MLR for large groups = 85%- Carriers provide rebates by

August 1 every year- Carriers rebate individuals

directly for individual plans- Carriers rebate employer directly

for group plans - Employer must follow certain

rebate distribution rules

For Small Group and Individual markets:

CURRENT: Guarantee Issue only required in the small group market (2-50) today. For all size markets, pre-existing condition exclusions may apply for members without creditable coverage for 63+ days.





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareUnderwriting Changes

Sources: National Association of Health Underwriters (NAHU), BCBS Exchange Webinar

Guaranteed Issue

No health status rating

(also known as adjusted community

rating)

3:1 age rating bands





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareDeductible/Out of Pocket

Sources: BCBS Exchange Webinar

Deductible/Out-of-Pocket Limits

Deductible Limit- Applies to 2-50 market- $2,000 single/$4,000 family, increased by employer

contribution to FSA

Out of Pocket Limit - Applies to all markets (individual, small group, large

group, and self-insured)- Copays apply to out of pocket limit- $6,350 individual/$12,700 family (no more than H.S.A.

limits)

Metallic Levels


Product Tier Requirements in Marketplace/Exchange:

Actuarial Value = Total Expected Payments by Health Plans for EHBs / Total Costs of EHBs for the Standard Population

Platinum 90%

actuarial value

Gold80%

actuarial value

Silver70%

actuarial value

Bronze 60%

actuarial value

All will include

Essential Health

Benefits

* Catastrophic plan for those under 30 and those over 30 whose premium would cost more than 8% of their income





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareIndividual Premiums for

QHP

Source: healthcare.gov

Metallic Levels Age 27

Age 50 FAM

Single FAM Couple

Child Only

Bronze $231 $394 $782 $531 $565 $140

Silver $276 $472 $935 $635 $675 $168

Gold $335 $568 $1,127 $765 $813 $202

Platinum $272 $463 $919 $624 $663 $165

Catastrophic $168 $285 $566 $384 $408 $101

Average premium across all Affordable Care Act plans offered in Georgia, effective January 1, 2014





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareAffordable Group Coverage

Source: CIGNA

Unaffordable group coverage = Employee share of premium for single coverage greater than 9.5% of the employee’s W-2 income (lowest cost plan offered) 9.5% of Salary: The Amount Employee Contributions

Cannot Exceed For Single Coverage in Lowest Cost Medical Plan

W-2 Salary Annual Monthly

$20,000 $1,900 $158.33

$30,000 $2,850 $237.50

$40,000 $3,800 $316.67

$50,000 $4,750 $395.83

$60,000 $5,700 $475.00





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareIncome Eligibility

Source: Calculations by Families USA based on data from the U.S. Department of Health and Human Services

Premium Tax Credit Eligibility- Employees with household income between 100% and

400% of the Federal Poverty Level (non Medicaid Eligible)

Household Size

Medicaid Eligible

Eligible for Premium Tax

Credit

100% 400%

1 $11,490 $45,960

2 $15,510 $62,040

3 $19,530 $78,120

4 $23,550 $94,200

If eligible for premium tax credit, the amount of premium you pay (and your corresponding premium tax credit) is based on your FPL household income.





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareAmount of Premium Tax

Credit

Source: CIGNA

Household Income Level

Premium as Percent of Income

100% FPL 2% of Income

150% FPL 4% of Income

200% FPL 6.3% of Income

250% FPL 8.05% of Income

300% -400%FPL 9.5% of Income





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareSilver Plan Pricing

Scenarios

Source: Atlanta Journal Constitution

ANNUAL COSTS / ADVANCED PREMIUM TAX CREDIT (Subsidy)

26 year old single person (man or woman):1) Income: $12K (just above FPL) - individual pays $240; receives

$3,000 subsidy2) Income: $35K - no subsidy; cost of silver plan is 9.5% of income

Husband is 32, wife is 30, 1 year old daughter3) Income: $20K (just above FPL) – family pays $400; receives

$8,800 subsidy4) Income: $60K (300% FPL) – family pays $5,700; receives $3,500

subsidy

Husband is 47, wife is 42, kids are 25, 20, and 165) Income: $28K (at FPL) - family pays $560; receives $15,500

subsidy6) Income: $84K (300% FPL) – family pays $8,000; receives $8,000

subsidy

Husband is 62, wife is 627) Income: $16K (at FPL) – husband/wife pay $320; receive

$17,600 subsidy8) Income: $47K (300% FPL) – husband/wife pay $4,500;

receive $13,500 subsidy





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term Care

2013 Early Renewal Option

Option for Non-grandfathered Small Group / Individual Plans:- Delay higher rates of Adjusted Community Rating and other

health care reform plan design requirements (deductibles, out of pocket limits, etc.)

- Keep current plan design for 11 months of 2014

- Renew December 1, 2013 with a significantly lower increase than you would otherwise see at your 2014 renewal

- Early renewal option may not benefit every group or individual and your health benefits broker should be reviewing these options with you now

Employer Group Plan





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareSmall Employer Tax

Credit


25 or fewer employees + average wage less than $50,000:

- Tax credit for employers with 25 or less employees and average wages than $50K

- Starting in 2014, available on the Small Employer Health Options Plan (SHOP) Exchange/Marketplace only for first two years

- Credit up to 50% of employer cost

- Credits decrease on a sliding scale as avg. compensation increases

*tax credit started for 2010 tax year (for employers with 25 or fewer employers) and currently offers a credit up to 35%





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareEmployer Options





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareIndividual Mandate

Health Care ReformImportance of your Trusted Advisors

• Benefits Broker

• Accountant

• Attorney

• Financial Advisor

Lean on your trusted advisors to understand

upcoming changes!





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareLong-Term CareQuestions?





Responsibility ProvisionsCost ContainmentCost ContainmentLong-Term CareLong-Term CareThank you for your time.

Lisa Owen, President, RHU

CORE Benefit Solutions, LLC404-478-2304

[email protected]

Jennifer Gregory, Account ExecutiveCORE Benefit Solutions, LLC

[email protected]



core hcr presentation rental association wo video

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