ACA Compliant Plans. Emerging Solutions

Transcription

1 ACA Compliant Plans Emerging Solutions

2 Today s Speakers Carl Pilger VP, Legal Counsel Abigail Pullman Account Executive Digital Benefit Marketplace Wayne Mertel VP, Integrated Solutions

3 Agenda 1. Skinny Plans 2.Private Marketplaces

4 Skinny Plans Defined Option 1 Limited Benefit Plan Offered to all employees or select classes as is compliant with employer laws. (including part-time) Targeted Monthly Cost $ Option 2 Minimum Essential Coverage (MEC) ACA Compliant affordable choice for newly benefit eligible employees $ Option 3 Minimum Value Plan (MVP) ACA Compliant choice for benefit eligible employees. 60% actuarial value $ Option 4 ACA Compliant Major Med coverage for eligible employees. When paired with other options not required to meet affordability requirements. $ 300 and up

5 Are they compliant? ACA Requirements Pay penalty or offer group health plan (GHP) Minimum essential coverage Eligible employer-sponsored plan Group health plan or group health insurance coverage offered by an employer to the employee which is offered in the small or large group market Self-insured health plan of any size NOT HIPAA excepted benefits (e.g., specific illness, fixed indemnity, limited dental/vision)

6 Are they compliant? GHP Defined Plan, fund, or program that provides participants or beneficiaries, through the purchase of insurance or otherwise, medical, surgical, or hospital care or benefits, or benefits in the event of sickness Provides medical care directly or through insurance, reimbursement, or otherwise. Medical care means amounts paid for diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body

7 Are they compliant? First-dollar preventive care and wellness benefit Meets requirement to provide preventative and wellness services and chronic disease management Self-Insurance Avoids need to offer essential health benefits or match such benefits in state benchmark plan

8 Important ACA Terms Applicable Large Employer: Employer who employs 50 or more full-time employees or full-time equivalents (FTEs). Affordable Coverage: Employee s share of plan cost cannot exceed 9.5% of safe-harbor income. (e.g., W-2, Box 1 wages) Minimum Value: A plan that at least meets the required 60% actuarial value rule. Essential Health Benefits (EHB)

9 Important ACA Terms Minimum Essential Coverage (MEC): Employer-sponsored plan Includes self-insured plan whether or not offered on Marketplace Plans in the individual market Grandfathered health plan Medicare Medicaid CHIP program TRICARE Certain other Peace Corps, Veterans or Department of Defense plans Medicare Advantage Refugee Medical Assistance supported by the Administration for Children and Families Self-funded student health plans (plan or policy years beginning on or before December 31, 2014) State high-risk pools (plan or policy years beginning on or before December 31, 2014) Other plans as approved by HHS

10 Avoiding Employer Penalties Tier 1 Penalty $2,000/year for each full-time employee (after subtracting first 30 employees) if offer no coverage and one person gets subsidized Marketplace coverage Avoid by offering group health coverage to all full-time employees 5% safe harbor Tier 2 Penalty $3,000/year for each full-time employee who actually gets subsidized Marketplace coverage because offered inadequate employer coverage Adequate Coverage Affordable Cost of lowest tier employee-only coverage does not exceed 9.5% of employee s household income Use income safe harbor (e.g., Box 1, Form W-2) Minimum Value Plan s share of total costs of covered services is at least 60% HHS calculator Capped at potential pay-or-play penalty max

11 Avoiding Individual Penalties Individual Shared Responsibility Tax Applies to any non-excepted individual who fails to obtain MEC In 2014 greater of $95/year for each individual ($47.50 for each dependent child) or 1% of amount of individual s household income above federal tax filing threshold Flat dollar amount capped at 300% (i.e., $285 in 2014) Percentage of income not capped Transition Relief No penalty for months during which could have been covered under non-calendar year plan

12 MEC Plan Components Design Partial self-funded medical plans Limited benefits medical plan (buy-up) Supplemental health benefits (voluntary buy-up) Anticipated program outcomes Savings compared to traditional major medical plans Lower cost point for entry into offering insurance options Provides built in employer expense predictability Benefits to employees First dollar coverage Easy access to PPO network providers and discounts Flexibility and affordability in a changing environment Partial Self-Funded Medical Limited Benefit Plan Supplemental Health Benefits

13 Employer Profile Any employer who Has at least 51 benefit eligible employees or FTEs Targeted Industries Staffing Hospitality Restaurant Many newly benefit eligible employees in the future Workforce consisting of low wage and/or variable hour employees Retail Convenience stores Has interest in looking for creative, multi-tiered solutions providing base and base-plus benefit options Healthcare / Nursing Homes Service Industries.many others

14 What is required to be covered? What is required to be covered in the MEC Preventive/Wellness Plan? 15 covered preventive services for adults 22 covered preventive services for women, including pregnancies 26 covered preventive services for children

15 Skinny Plan Providers

16 Frequently Asked Questions Why would I do this now? Who pays for it? Can an employee still go to the public marketplace? What happens after 12 months? If an ER funds for the EE, does that eliminate the EE from Medicaid? Is the Limited Benefit Plan buy-up required?

17 Articles of Interest Wall Street Journal Employers Eye Bare-Bones Health Plans Under New Law POLITICO Obamacare penalties spawn skinny plans Washington Post with Bloomberg Death of bare-bones health plans may be greatly exaggerated

18 Understanding Private Exchange / Marketplace Digital Insurance All Rights Reserved

19 Employee Benefits. Simplified. More than anything, today s executives, business owners and HR decision-makers most desire one characteristic from an employee benefits strategy: Simplicity. With Digital Benefits Marketplace, you determine how much you want to contribute toward each employee s benefits. That s it. Your costs are fixed, and you re done. Your employees choose the options that work best for them. Our experts provide complete administration plus individual decision support. It might be the easiest, most comprehensive approach that serves businesses of any size. It s that simple.

20 The Three C s of a Benefits Marketplace The employer has an expectation of being removed from the day-to-day management of a benefit plan such an enrollment, changes, terminations, managing eligibility, etc. 1. Consolidated benefits administration Employee enrollment system that integrates into the carriers & payroll service provider Employer administrative system that easily provides the important data to manage the program Benefit administration service team to manage the day-to-day activities of the benefit program 2. Complete array of benefits choices Health Plans: 8-15 health plan choices to meet the many demographics within the workforce Ancillary Benefits: build your own dental, vision, life, disability, accident, critical illness, and more New Benefits: such as telemedicine and concierge medicine 3. Customer service including decision support before, during and after enrollment Educational tools including videos Decision support for medical, dental, vision, life insurance and disability insurance Plan recommendations based on an individual s personal situation Benefit counselors available telephonically and via chat

21 Think of it Like a Benefits Shop BEFORE WITH DIGITAL BENEFITS MARKETPLACE HMO PPO EPO HDHP 1 HDHP 2 HDHP 3 1 plan HSA Dental Vision Life Dental Vision Life LTD STD Accident Critical Illness Telemedicine Wellness Pet And we simplify it all with one-call customer service!

22 Defined Contribution An employer can consider 4 types of defined contribution.

23 Employer Specific Portal

24 Providing Decision Support

25 Full Administrative Access for the Employer

26 Your Benefits Store Health The goal is value-based choices. In this example, an individual can make financial decisions that balance cost and risk.

27 Your Benefits Store Dental, Vision, and more

28 Annual Employer Cost Comparison Net employer health plan costs Net employer ancillary costs TOTAL NET EMPLOYER COSTS

29 Visit Register for a webinar to learn more.

30 Where do I get more information? Who to contact Your Digital connection Wayne Mertel [email protected]

31 Thank you for your participation.