understanding the impact of health care reform on your...
TRANSCRIPT
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Understanding the Impact of Health Care Reform on Your Plan
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The Objective
Health Care Reform – Overall Update
Small Group Requirements
Choices for Small Groups
New Plans, New Features
Questions?
Overview 2
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Minimize impact on
you & your employees…
provide options to meet your needs
The Objective 3
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Delayed Until 2015:
Health insurance coverage reporting (employer contributions)
Employees working 30+ hours are considered full-time and could be subject to penalty
Penalties for large groups (50 or more employees) if they don’t provide coverage; look-back period
Health Care Reform Update: 2015 4
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What Still Impacts You in 2014?
Out-of-Pocket (OOP) Maximum
No pre-existing condition limitations
Waiting periods limited to 90 days
W-2 reporting
Individuals must have coverage or pay a penalty
Health Care Reform Update: 2014 5
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Small Group Requirements
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Essential Health Benefits
Provider network adequacy – type, number, reporting
Drug formulary – type, number that must be covered
State mandated “standard plans” (allowed to offer other options)
Actuarial Value & Metal Plans – Named after precious metals (Platinum, Gold, etc.) What the health plan must pay vs. what member pays
Small Group Requirements 7
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Essential Health Benefits 8
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Staying with 3 Tier Formulary Tier 1 = Generics Tier 2 = Preferred Brands Tier 3 = Non-Preferred Brands
Small Group – Open Formulary On & Off Exchange What you have today Smooth transition since no major changes
Rx Overview – Formulary Options 9
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How Do the Metal Plans Work?
All plans must fall within pre-set actuarial value ranges named after precious metals
Actuarial Value Ranges Allowed for Small Groups by Metal Plan
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Bronze Silver Gold Platinum
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Choices for Small Groups
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You can:
Simply renew; automatically compliant with mandates
Choose another plan
Go to the SHOP Exchange Rates are the same on & off the exchange All employees must complete new paperwork
Choices for Small Groups 12
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New Plans, New Features
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Due to requirements of health care reform, all small group plans will be retired
You will be transferred to new, fully-compliant plan
New plan is closest match to current cost sharing
HealthyRewards for small groups is replaced by ExerciseRewards™ with new $600 gym reimbursement
New Plans for Small Groups 14
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Introducing: SimplyBlue Plus
More options… Low cost Gold & Silver hybrid
plans offer first dollar drug coverage, HRA compatible
Some hybrid plans have higher deductibles for lower premium ($1,000 - $3,000)
HDHP Silver and Bronze packages offer HSA or HRA compatible options
Numerous deductible options
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SimplyBlue Plus
Moving to SimplyBlue Plus
Healthy Blue
SimplyBlue
BlueChoice/HMO Blue SSA Plans
HNY Branded EPO*
*Pending approval
Actuarial value of current plan determined, then your group is moved to closest match for cost sharing
Healthy NY Group
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All benefits follow model language provided by NYS
State mandated plans called “standard”
In-network, out-of-network = separate out-of-pocket maximum
All cost shares (copays, coinsurance, deductibles, Rx) accumulate toward the out-of-pocket maximum
Accumulating benefits will reset (nothing carried over from the previous product)
Non-standards named by metal level and a number (examples: Bronze 2, Platinum 9)
Groups transition to new plan at renewal
New Plans – Fully Compliant 17
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Dependent to 29 Coverage
Domestic Partner Coverage (no cost)
Family Planning Exclusion*
Pediatric Dental Removed**
New Plans – Available Riders 18
*Group must file for religious exemption ** If stand-alone dental plan is purchased, coverage can be removed
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New Features for Fitness
With $600 Gym Reimbursement Program & ExerciseRewardsTM – members enjoy:
Gym discounts
Three one-week free trial memberships to participating fitness facilities
Online interactive tools
Discounted, family programs offered through many of the facilities in the gym network
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ExerciseRewards™ Online
Create individualized fitness plans
Find your ExerciseRewards facility & try it out for free!
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Take one of many Ecoaching courses Build a 28-day customized meal plan
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New Features: Dental & Vision Coverage
Adult vision coverage offered on all non-standard plans both on and off exchange
Pediatric dental & vision embedded into medical plans
Pediatric coverage for kids up to age 19 Uses Excellus BCBS Dental Networks
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Your Questions?
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Engaging Your Members
Thank you!