Presented by Select Pointe LLC Gary Adkins

Transcription

1 Presented by Select Pointe LLC Gary Adkins

2 The letter announced that the AVMA GHLIT C.A.R.E. Insurance Exchange/Marketplace, a private insurance exchange for AVMA members that will help you secure insurance coverage tailored specifically to your needs, is now open for business to all AVMA members

3 Offer no coverage except for self and family---- As a small employer you still have the mandate to prove you have educated your employees about the public exchange and tax credits and/or subsidies that may be available and any fees for not having coverage. Select Pointe will provide webinars for your employees to login and obtain this information. 3

4 Do you re-enroll in your present plan? BE CAREFUL! (since July 17 additional companies have communicated to agents a strategy to get clients to amend and renew policies prior to Dec. 1) Are there options that are less expensive for the employer? Do these options provide equal or more value to the employees? The question for small businesses If some of my employees receive substantial tax credits or subsidies, is there a way I can help my employees without them losing the subsidies and tax credits? Why would I, as a business person, pay considerably more on the private exchange for the same or similar coverage that employees can receive on the public exchange? 4

5 An amount allocated by the employer, to be used to reimburse employees for specific IRS approved medical expenses. Is this something New?

6 TAX ADVANTAGES FOR GROUP VS. INDIVIDUAL COVERAGE Group policies enjoyed enormous tax advantages over individual plans: 1. Employers allowed to pay for group health insurance off the books 2. Employees allowed to pay (via salary reduction) for group health insurance off the books

7 2002: HRA s Health Reimbursement Arrangements for Employer Tax-Free Contributions 2009: PRAS Premium Reimbursement Arrangements for Employee Tax-Free Contributions

8 DEFINED CONTRIBUTION No Minimum Contribution business determines its own contribution strategy No Minimum Participation business sets its own eligibility requirements No Administrative Hassle spend less than 5 minutes per month GROUP INSURANCE Requires Minimum Contribution employers must contribute 50%-75% of premium Requires Minimum Participation 50%- 75% of employees must participate in the plan Requires Additional Admin requires paperwork & annual renewals

9 THE EMPLOYER 1. Determines Contributions 2. Sets Eligibility 3. Picks Start Date 4. Reimburses Employees THE EMPLOYEES 1. Purchase Individual Policies 2. Get an Explanation of Benefits from the Insurance Company (nothing paid out of pocket) 3. Submit Claims & Get Reimbursed

10 Employer determines; A monthly contribution (amount may be changed) May have multiple classes of employees (doctors, management, hourly) What IRS qualified medical expenses can be reimbursed from the monthly contribution If, how much and how long unused contributions can be rolled over and accumulated. To set up an HRA (Health Reimbursement Arrangement)

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12 An HRA is an employer-funded plan that may be used to reimburse employees for medical expenses. An HRA is not health insurance, but can be used to supplement health insurance benefits and pay for a range of medical expenses not covered by insurance. HRA s are notional (do not change hands) arrangements; No funds are expensed until reimbursements are paid. Reimbursements made are tax-deductible for the employer and tax-free to the employee.

13 All employees and former employees may be eligible to participate Employees need not have health insurance coverage to participate; however, the employer can require employees to have insurance coverage to enroll in the company s HRA plan For employees, HRA reimbursements are not taxable, and fund balances can roll over to subsequent years. Unless the employer decides otherwise Employees cannot take unspent funds with them when they leave the company; unspent funds remain with the employer. Employers determine the reimbursement amounts, and there is no maximum set for how much employers may allocate to an HRA.

14 HRAs may be used to cover a wide range of medical expenses. Employers have great discretion in what they choose to reimburse. These expenses include health insurance deductibles, copays and coinsurance; dental and vision care; prescriptions; and many other expenses such as smoking cessation and certain weight-loss programs

15 Each employee gets a fixed monthly HRA allowance Unspent allowances can accrue for future healthcare expenses or retirement Employees choose their own personal health policy Personal policies are permanent, portable and typically cost 1/2 the cost of group coverage Employees are reimbursed, tax-free through HRA HRA Reimbursements cover personal health insurance premiums and other medical expenses not covered by health insurance

16 8:00 AM Employee Pays Premium Employee visits a medical provider or receives their insurance premium statement, pays the bill, and gets receipt.

17 9:00 AM Employee Submits Claim Employee logs in to HRA and submits claim with receipt online or by fax. Submit a Claim

18 10:00 AM Claim Approved by HRA HRA Approves Claim Examine receipt and process claim. Employer receives instant notification of approved claim by e- mail.

19 11:00 AM Employee Reimbursed Employer receives instant notification 10:00 9:00 AM AM Employee Claim of Approved approved Submits by Claim claim HRA and reimburses 8:00 AM Employee Pays Premium employee with: ZaneHRA Submit Approves a Claim Claim Examine receipt and process claim. Employer Employee logs in to HRA and submits claim Employee receives instant visits a notification medical provider of approved with receipt online or by fax. or receives claim their by . insurance premium statement, pays the bill, and gets receipt. Paper check to employee, Addition to employee's monthly payroll, or Direct deposit to employee's checking account. Reimburse the Claim

20 Control costs with a set health care budget that's predictable. Eliminates annual group rate increases Simplify the complex administrative work that goes along with offering health benefits. Give active and retired employees control and responsibility to choose insurance coverage that best suits their health, family situations and budgets. Keep your health care program in line with changing health care reform requirements.

21 What if you have a renewal before January 1 st? What if your group plan has someone that is uninsurable and must renew before January 1 st? If a group plan is eliminated or not renewed, anyone by law is able to enrolled in a guaranteed issue plan if done within 62 days of the policy termination. Gary.adkins@selectpointe.com

22 Employee s Guide to Healthcare Reform s Tax Credits Defined Contribution Buying Guide Health Care Reform: Play or Pay? Healthcare Reform Checklist

23 The IRS approved list of items that may be reimbursed tax free from an HRA The difference in an HRA, HAS and FSA How to set up an HRA

24 Long Term Care Insurance Benefit Presented by & LifeSecure

25 TVMA Member LTCI Benefit Premium discounts for members, spouses and employees Opportunities for Simplified Underwriting through small group plans Unisex pricing (women are not charged more) Diabetics may qualify for coverage Spousal discounts 25

26 A Window of Opportunity Why TVMA is offering LTCI Now? If members choose to offer group plans Group or Multi-life LTCI may not be offered much longer. Only three (3) companies offer these policies. Life Secure, Med America and Trans America Simplified underwriting- only 5 questions- in 10/2013 weight, working status and diabetes are considered No gender based pricing Standard rates will apply 26

27 Likelihood of Needing Insurance 5 in 1,000 will suffer a catastrophic loss of their home due to fire. * 70 in 1,000 will have an automobile claim. * 700 in 1,000 (over age 65) will need some type of long term care! ** *Society of Actuaries, 2009 ** HIAA,

28 LTC Facts Average Duration of Care: Home Health Care 4.5 years Assisted Living 2.0 years Nursing Home 2.4 years Life span of Alzheimer s patient 5.0 years (once on claim) * Source 2010 National Nursing Home Survey, National Center for Health Statistics ** U.S. Department of Health & Human Services 1/10. Conning & Co. 28

29 What is the cost of LTC? Type of Care Home Health Aide Services Non-Medicare Certified, Licensed (based on 42 hrs per week/6 hrs daily) Tennessee Average Median Annual Costs* $39,422 Assisted Living Facility Private One Bedroom $39,646 Nursing Home Private Room $73,000 Based on information from the Genworth 2013 Cost of Care Survey April,