health decisions webinar: obamacare compliance: how it helps self-funded plans
DESCRIPTION
Here’s the “dirty little secret” about the new “pay-or-play” requirements: Most plans will pass easily and few plans will have any problems with penalties. Here’s the less obvious part of compliance: The steps called for by the new regulations make good sense for a plan to do. Inventorying enrollees to confirm coverage, adopting uniform plan definitions and approaches to calculating cost-sharing, and engaging benefit “consumers” are all steps that can benefit a self-funded plan. This webinar, the third in our series, explores these themes and presents the positive side to “Obamacare” compliance. For more information, please visit: http://www.healthdecisions.comTRANSCRIPT
- 1. Obamacare Compliance:Obamacare Compliance: How It Helps Self-funded PlansHow It Helps Self-funded Plans Presented by: Si Nahra, Ph.D., President June 27, 2013
2. 2 About Health Decisions, Inc. Pioneering Specialists in Group Health CarePioneering Specialists in Group Health Care Post-Payment AdministrationPost-Payment Administration For Over 25 YearsFor Over 25 Years RespectRespect for Existing Proceduresfor Existing Procedures EmphasisEmphasis on Customizationon Customization FocusFocus on Solutionson Solutions Customer Philosophy: Copyright 2013 Health Decisions, Inc. 3. Orientation towards our topic Distrust of government is an American value. Disrespect for anything the government does is not. Partisan politics do not apply. Copyright 2013 Health Decisions, Inc. 3 4. Presidents Policies Presidents Health Policy Legacy Roosevelt/Truman Social Security Eisenhower Employment-based Benefits Kennedy/Johnson Medicare/Medicaid Nixon/Ford HMOs Carter National Health Planning Reagan Dismantle Carter program. Rely on Market Forces Bush I Federally Qualified Health Centers Clinton HIPAA Bush II Medicare Part D (Rx) Obama ACA and the Rise of the Consumer Market Post-Obama 2016/17 may be tougher than 2014 4 Copyright 2013 Health Decisions, Inc. 5. Focus Today Affordable Care Act (Title I, Subtitles A, C, and F) Self-funded Group Health Plans Shared Responsibility AKA Pay-or-Play Other related requirements Copyright 2013 Health Decisions, Inc. 5 6. Gauging Intent No lifetime limits Coverage of preventive health Extension of dependent coverage Uniform explanation of coverage Standard plan comparisons Limits on coverage costs Common eligibility rules Confirmed offer of coverage Limits on out-of-pocket costs Taxes for research and risk Who Benefits Most? Individual consumers Self-funded plan role? Implementation A way to get to individuals Copyright 2013 Health Decisions, Inc. 6 7. What Plan Compliance Means 1. Play by the same rules 2. Manage eligibility and enrollment 3. Pay taxes for research and risk Copyright 2013 Health Decisions, Inc. 7 8. 1. Play by the same rules Provision Consumer Impact Plan Consequence Minimum Value Consumer knows what they are getting and how it compares Easy to pass for most. Out-of-pocket limits an issue for some. Spending accounts help. Affordability Consumer costs for getting coverage capped at 9.5% of family income. Easy to pass for most. Issue for some low-wage workers. Per occurrence fine small and unlikely. Out-of-pocket accumulator All consumer cost sharing for services counts towards limits tied to spending accounts. Brings order to chaos. Many will need to re-do cost sharing rules and administration. Copyright 2013 Health Decisions, Inc. 8 9. 2. Manage eligibility and enrollment Provision Consumer Impact Plan Consequence FTE Eligibility Same eligibility rules apply wherever you go. New process needed. Brings direction to most overlooked area. Impacts certain groups (hourly, seasonal) more. Offer of enrollment Presents and explains options. Opportunity to take Or Obstacle to avoid Overall fine can be large but easy to avoid. Copyright 2013 Health Decisions, Inc. 9 10. 3. Pay taxes Provision Consumer Impact Plan Consequence Research None Disturbing precedent. See slide 3: Distrust of government is an American value. Risk Copyright 2013 Health Decisions, Inc. 10 11. Options Ignore Delay Fight Comply Copyright 2013 Health Decisions, Inc. 11 12. Why Comply? The Good Creating a market with comparable products Adopting uniform plan definitions Standardizing how individual liability is calculated Defining eligibility-enrollment-entitlement processes Outweighs the Bad Changes to existing policies and procedures Taxes Copyright 2013 Health Decisions, Inc. 12 13. 131313 Past Webinars Available Recordings of past webinars are available upon request, including: Mid-June 2013 Employer Mandate Calculations Explained May 2013 Pay or Play: A Bigger Challenge for TPAs than for Plans April 2013 - The Most Overlooked Part of Health Reform: Enrollee Communications March 2013 Why Cost Sharing is not Working February 2013 Loss of Fiduciary Control January 2013 Top 10 Dos and Don'ts of Data Warehousing December 2012 Union Trusts: Health Reforms Most Overlooked Winner? November 2012 Year-end Renewal and Bidding: Opportunities for Control and Savings October 2012 The 5 Most Important Things an Effective Dependent Audit Should Include September 2012 Old Question, New Twist: Is Self-funding Right for Your Group Health Plan? August 2012 Are You Ready to Manage Your Health Plan Costs? June 2012 - Group Health Brokers Future: Disintermediation or Re-intermediation For more information, please visit www.healthdecisions.com Copyright Health Decisions, Inc. 6/2013 14. Copyright 2013 Health Decisions, Inc. 14 For More Information Contact [email protected] 734-451-2230 Connect with me on LinkedIn Add me to your circles on Google+ Follow us on Twitter: @hlthdecisions Like us on FaceBook