Expert Support Navigating Health Exchanges

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1 Expert Support Navigating Health Exchanges

2 2 HealthAdvocate

3 Health Insurance Exchanges: Health Advocate Can Help Support You Introduction Health Advocate has received many questions regarding the impact of healthcare reform and health insurance exchanges, and how we can help employers and their employees proactively prepare for and navigate this changing and often-confusing landscape. Confronting Confusion Despite what some people believe, the advent of health insurance exchanges will not necessarily make things easier for consumers or employers. In fact, according to a recent Kaiser Health Tracking Poll, 73 percent of those surveyed indicated that they knew only a little or nothing at all about public health exchanges in their state. Even less is known about private insurance exchanges. Indeed, as the nation s largest and most recognized healthcare advocacy and assistance company, Health Advocate has been actively involved in providing specialized support since the Patient Protection and Affordable Care Act (PPACA) was first enacted in Coupled with years of experience with the entire spectrum of health insurance options, including consumer-driven and high-deductible programs, we are ideally suited to support all of our clients ongoing needs. Providing Personalized Service Our highly personalized health advocacy service offers a robust level of support to fully meet the needs of your organization and employees, regardless of which direction you choose. We have the knowledge, expertise and systems in place to take the worry out of the many challenges the new mandated requirements present. We are dedicated to helping you save time and money, and making things easier for you. Best of all, Health Advocate will fully support your needs at no extra cost. HealthAdvocate 1

4 What are health insurance exchanges, and what is the difference between public and private exchanges? Public exchanges are online health insurance marketplaces run by the state or federal government. Expected to transform the current individual and small group markets, they will provide coverage for millions of previously uninsured Americans. Under the PPACA, most individuals are required to have health insurance starting in As a result, all states must establish public exchanges to make affordable, quality coverage available to qualified individuals who do not have access to coverage through an employer. Each exchange will also operate a Small Business Health Options Program (SHOP), where qualified small employers can obtain coverage for their employees. Initially expected to become available in January 2014, due to operational challenges the federal government has delayed the launch of the SHOP program until This is clearly another example of the complexity resulting from health reform. Private exchanges, by contrast, are not regulated in the same way as public exchanges. These exchanges are being organized by insurers, consulting firms and, in some cases, consortiums of employers. While the precise character of private exchanges is still being formulated, in general they are being organized to promote more direct employee involvement and responsibility in shopping and paying for healthcare insurance and, in some cases, other benefit programs (e.g., wellness). Some highlights: Public exchanges will enable consumers to compare costs and benefits, and choose a private plan from a menu of options Plans cannot refuse to sell a policy and must comply with the new consumer protections Available plans will vary from generous to modest but each plan must include basic, comprehensive medical coverage and prescription drug benefits How much individuals have to spend out-of-pocket on deductibles and copays will have annual limits Subsidies or tax credits will be available to those with low or moderate incomes who choose to purchase coverage through a public exchange What are the key issues facing employers and individuals regarding exchanges, and is support available? Uncertainty, confusion and complexity It is generally recognized that healthcare reform and the associated health exchanges are creating questions and, in some cases, confusion. One thing is clear. The issues we encounter today will remain and will most likely be amplified by the complexity of the new environment. Health Advocate s expertise and capabilities are extremely well suited to support the world of exchanges and the associated complexity. Expert, reliable support Health Advocate s expertise navigating the healthcare and insurance systems essentially shifts the burden from employers and HR departments, optimizing benefits utilization and generating measureable cost savings. Our experience helping thousands of organizations achieve this level of results has made us the number one healthcare advocacy and assistance company in the nation. 2 HealthAdvocate

5 How does the Affordable Care Act affect different size companies? The health reform legislation affects different size employers differently. Here is a summary of key distinctions. Employers with 50 or more employees Large employers, defined as having 50 or more full-time equivalent employees (FTEs), (those working an average of 30 or more hours per week) will be impacted most by health reform, beginning in The new law requires large employers to either offer affordable healthcare to all of their employees or pay an annual, nondeductible penalty for noncompliance. An affordable healthcare plan must meet certain requirements including a minimum actuarial value of at least 60%, minimum benefits standards, and limit employee premium costs to less than 9.5 percent of that employee s income. Employers failing to meet any of the standards are subject to penalties. Employers with employees Employers with between 26 and 49 FTEs are virtually unaffected by the PPACA with respect to offering health insurance or facing penalties. Simply put, employers in this category are not required to offer health insurance coverage. Their employees are eligible to join a public exchange subject to income eligibility guidelines. Employers with 25 or fewer employees Businesses with 25 or fewer workers (who pay annual average wages of less than $50k) may actually benefit from the PPACA by qualifying for federal tax credits in return for offering healthcare coverage to employees. The amount of the tax credit is determined by four key factors: (1) firm size, (2) average wage paid, (3) amount of employer contribution to premiums, and (4) tax year. What makes an employee eligible for a premium subsidy? To be eligible for a subsidy, an employee must meet two conditions. First, their household income must be less than 400% of the Federal Poverty Level (FPL), which varies with family size. For example, for a family of four (except in Alaska and Hawaii), 400% of the FPL in 2012 was $92,200. Household income includes both wage and investment income of all household members. Second, their portion of the insurance premium for the employer-sponsored health insurance plan must be more than 9.5% of their household income (including wage and investment income of the employee, spouse, dependent children, etc.). To receive the subsidy, they must opt to leave the employer s plan and purchase insurance in the individual health insurance exchange. Are your services compliant with the federal regulations under the Healthcare Insurance Portability and Accountability Act (HIPAA)? Yes. Health Advocate is in compliance with all regulations and requirements to protect the privacy and security of personal health information. Our entire systems infrastructure uses HIPAA-compliant encryption and other safety measures to ensure that the security of our data is not compromised. HealthAdvocate 3

6 Does using a health exchange option relieve our organization of involvement in health insurance issues? No. Even if your organization is no longer involved in the day-to-day administration of health insurance programs, employees questions will continue to build as they try to find their way in the new system. Additionally, few, if any, of the exchanges will handle the array of other employee benefits. We will continue to respond to all employees needs with solutions and ideas to resolve healthcare and other benefit issues, making our skills and services even more relevant in the new landscape. Employers can be sure that employees are getting the high-quality attention that healthcare challenges require, above and beyond administrative difficulties. In addition, many public exchange enrollees will be newly insured and less familiar with the healthcare and insurance systems. They may also have difficulty understanding plan information. Our Personal Health Advocates are trained to answer questions about exchanges, clarify benefits, locate providers, and help employees complete the necessary applications and paperwork. Overall, our services bring organizations of all sizes significant value for the long term, including supporting them through any difficult transition periods. I m considering a private exchange as an option down the road. What issues should I consider before I make a switch? Even if you decide to participate in a private exchange, your employees will continue to have challenges as they interact with the healthcare and insurance systems. For example, our health advocacy service helps by: Finding qualified doctors, hospitals and facilities Helping employees understand new plans and benefits Optimizing the use of network providers Locating eldercare services and resources Working with insurance companies to get approvals for covered services Unraveling medical bills and uncovering billing errors Helping to resolve insurance claims; negotiating billing/payment arrangements Obtaining pre-service, area-specific cost estimates for healthcare procedures We also provide a suite of turnkey communications to help employees understand the scope of our services. This includes general educational materials about health insurance exchanges and how they work. Health Advocate will be an active participant with private exchanges, a key testament to our expertise and dedication to helping improve the cost and quality of healthcare. 4 HealthAdvocate

7 Given the rising cost of healthcare, many of my employees need help understanding medical conditions and treatments. Will exchanges have resources to address these types of questions? Having clinical resources available to consumers is not specifically included in the new law s exchange provisions. Health Advocate has a staff of experienced registered nurses, supported by a team of medical directors, who are a key resource for employees who have questions about serious health conditions or complicated treatments. We also work closely with insurance companies and providers to coordinate second opinions, secure appointments with specialists, transfer medical records, and locate facilities who specialize in complex diseases and conditions. These ongoing relationships are critical to helping members get to the right care at the right time, and reducing overall medical costs. Can your service provide assistance to our employees who are helping their senior parents resolve eldercare issues? Yes. A standard component of Health Advocate is our extended family eligibility providing support for the parents and parents-in-law. This popular feature is intended to help your employees remain fully productive at work. Our trained staff of experts handles these issues, resulting in time and money savings. Questions, Questions and Answers Regardless of plan type or any administrative changes you make, employees will always have questions relating to their healthcare and benefits. Health Advocate is in a position to answer these questions, from understanding plan options to interpreting medical bills and determining errors to using network providers and much more. Our Personal Health Advocates are trained to understand these important issues and quickly resolve them. Contact us for more information , prompt #2 info@healthadvocate.com Web: HealthAdvocate.com HealthAdvocate 5

8 Health Advocate, Inc., is the nation s leading independent healthcare advocacy and assistance company. We help millions of Americans personally navigate the often complex healthcare system. Our leading-edge solutions include EmpoweredHealth, a fully integrated program that seamlessly combines health advocacy, wellness coaching, EAP+Work/Life and chronic care solutions. We also leverage the power of data analytics to help members make more informed decisions and get more value out of the healthcare system. TOLL FREE info@healthadvocate.com HealthAdvocate.com 2013 Health Advocate, Inc. HA-B BKLT