jeff crawford, vice president [email protected] ph: 800-821-7715, ext. 148
DESCRIPTION
AWISA Winter 2013 C hanges Under PPACA: What You and Your Students Need to Know About Health Care Reform. Jeff Crawford, Vice President [email protected] Ph: 800-821-7715, Ext. 148 Monica Olson, M.Ed., Regional Sales Director [email protected] Ph : 206-618-8337. - PowerPoint PPT PresentationTRANSCRIPT
AWISA Winter 2013Changes Under PPACA:
What You and Your Students Need to Know About Health Care
ReformJeff Crawford, Vice President
[email protected]: 800-821-7715, Ext. 148
Monica Olson, M.Ed., Regional Sales [email protected]
Ph: 206-618-8337
PPACA: Patient Protection and Affordable Care Act
MURKY WATERS AHEAD?
Shifting Sands Ahead
Brainstorm a short list of what is valuable, important or necessary in an insurance plan.
What is important to you, your staff or yourself when you think about using or administering an international student
insurance plan?
Top 5 List: International Insurance Plan
PPACA: Patient Protection and Affordable Care Act ACHA: American College Health Association Deductible: Small amount of money paid out of
pocket for each sickness or injury Co-pay: Small set amount of money paid out of
pocket for each office or hospital visit Co-Insurance: a certain set percentage of money
to be paid for each service SHP: Student Health Plan MLR: Medical Loss Ratio
Terms and Definitions
March 23, 2010: Affordable Care Act was signed into law
March 21, 2012:Final regulations on student health insurance plans
June 28, 2012:United States Supreme Court upheld the constitutionality of most of PPACA
Affordable Care Act: Timeline of Events
For plan years beginning January 2014: No annual limits
For plan years beginning September 2012-December 2013: Annual coverage limits of no less
than $500,000
For plan years beginning July 2012-September 2012: Annual coverage limits of no less than
$100,000
Affordable Care Act: Changes in Progress - Annual
Limits
PPACA requires all compliant student health plans (SHPs) to have:
◦Preventative Care: Student health coverage is required to provide preventive services without
cost-sharing and co-pays. ◦Pre-existing Condition Limitations: Plans may
not impose pre-existing condition limitations on those younger than age 19.As of 2014, pre-existing conditions cannot be
excluded.
Affordable Care Act: Changes in Progress -
Requirements
Individual Mandate - January 1, 2014
Essential Health Benefits: must include these 10 categories Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Pediatric services, including oral and vision care Mental health and substance use disorder services, including
behavioral health treatment Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services, chronic disease management,
and prescription drugs
Affordable Care Act: Changes in Progress -
Requirements
WaiversExamine waiver policy to close the gap for waivers and keep your risk exposure low Cost-Benefit You want enhanced benefits, but there is a tipping point for cost and use…where is it?
PPACA Ripple Effect:Things to Consider
2014 Policy Year and Beyond: PPACA Plans
Unlimited Coverage
No Exclusion for Pre-Existing Conditions
MLR – 80% (Medical Loss Ratio)
Cost Increase and Destabilization
PPACA Ripple Effect: Things to Consider
What is MLR?Medical Loss Ratio
Current Premium $100,000Claims $75,000Loss Ratio (LR) 75%Target 70%Potential Refund
$0
PPACAPremium $120,000Claims $90,000Loss Ratio (LR) 75%Target 80%Potential Refund
5%
What is Important for Your Students?
Plan A
Unlimited Coverage $250 Deductible 20% Coinsurance No Pre-existing Exclusion Wellness Coverage Increased $$ Premium
Plan B
Current Accident & Sickness Coverage
$0 Deductible
100% Network Coverage
Pre-existing Exclusion
Limited Wellness Coverage
Stable Premium
Policy Year: 2013-2014
Compliant Plan• Participation mandate important• Benefits include wellness and immunizations
Action Options: What Can You Do?
Other Options• Limited Duration:
Accident and Sickness Only Plan
Top 5 List: International Insurance Plan
Now that you have learned about the upcoming PPACA changes…
What is important to you, your staff or yourself when you think about
using or administering an international student insurance plan?
http://www.healthcare.gov/law/full/patient-protection.pdf
Affordable Care Act
http://acha.org/Topics/Affordable_Care_Act/AffordableCareAct.cfm
ACHA Website http://www.healthcare.gov/news/factsheets/
2010/09/affordable-care-act-immunization.htmlACHA Immunization List
Resources