Healthcare Reform: Preparing Your Practice For Implementation of the. HMWC Healthcare Education Leadership Program. Affordable Care Act (ACA)

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1 Healthcare Reform: Preparing Your Practice For Implementation of the HMWC Healthcare Education Leadership Program Affordable Care Act (ACA) September 12, 2013

2 Main Provisions Signed into law on March 23, 2010 Will require most Americans to have health insurance by 2014 Individual: Individual mandate Minimum essential coverage requirement Projected to extend coverage to roughly 32 million additional Americans Expands Medicaid and Federal subsidies to lower costs and help middle income Americans buy private coverage Prohibits insurers from denying coverage on basis of pre existing conditions (2014 all health plans included)

3 Main Provisions Creates insurance exchanges for individuals and small businesses to buy health care coverage (Federal Exchange & State Exchange) Individual: Covered California Small Business: SHOP Will require businesses with 50 or more employees full time or full time equivalent (FTE) to provide affordable and qualified coverage or pay tax penalties by 2014 (Delayed to 2015)

4 Protections / Provisions 2010: Coverage for adult children up to age 26 No lifetime amount on annual coverage limits 100% coverage for preventative care No rescission of coverage for individuals Small business tax credit: up to 35%

5 Protections / Provisions 2011: Minimum Medical Loss Ratio (MLR) for insurers: 80% premium must be spent in health care services for Small Group and Individual health plans 85% premium must be spent on health care services for Large Group health plans 2012: Coverage reporting on W 2 (250 + W2 s) Uniform Explanation of Benefits (SBC s)

6 Protections / Provisions 2013: Employee notification of Exchanges (October 1, 2013) Medicare Part A tax rate on wages goes up from 1.45% to 2.30% for certain individuals Individuals earning $200,000 Joint filers earning $250,000

7 Protections / Provisions 2014: Individual mandate Requires individuals to purchase minimum essential coverage or else pay tax penalties State or Federal based exchanges for individuals and small groups Small employer tax credits only available in Exchanges Uniform Plan Benefits: Metallic Levels: Platinum, Gold, Silver, Bronze Rated based on the percentage of medical expenses paid by the plan

8 Protections / Provisions 2014: Continued Mandated minimum level of coverage Office visits, hospitalization, emergency care, maternity, pediatric care & Rx benefits Exclusions for pre existing conditions prohibited Prohibit benefit waiting periods beyond 90 days (60 days in CA) Elimination of Health Status Rating New fees/taxes on health insurance Small Group defined as employees (1 50 until 2016 CA)

9 Protections / Provisions 2015: Employer Mandate (50 or more Full Time or Full Time Equivalent (FTE) must provide affordable and qualified 9.5% of employee s income Not less than 60% of actuarial value Employers (50+ employees) must report annually to Secretary of Treasury whether they offer health coverage to employees (provide number, employee names, length of waiting period, cost of plan) 2016: Small Group redefined in CA as 1 100

10 Protections / Provisions 2018: Tax on employer plans valued at over: (Cadillac Plans) Individuals: $10,200 Families: $27,500

11 Preparing Your Practice Must notify your employees in written notice of the existence of the Covered California Exchange Exchange: Individual Market SHOP: Small Business Market Early renewal option with your current Group Health plan Keep your current plan longer (through fall of 2014) Predictable budget for healthcare cost

12 Looking Forward Small Group Considerations Changes to Small Group Rating Plans & Options 19 Rating Territories No longer RAF ( Rate Adjustment Factor ) included in rates Each family member will be rated Qualification for tax credit Small Group only offered in Exchange only Maximum waiting period 60 days CA

13 Looking Forward Small Group Considerations Changes to Small Group Rating Plans & Options Ratio 3:1 Metallic plans available in Exchange (Potentially more Metallic plan variations available outside Exchange SHOP) Platinum / Gold / Silver / Bronze A limited number of companies are participating in the Exchange

14 Companies in Covered California SHOP Blue Shield of California Chinese Community Health Plan Health Net Kaiser Permanente Sharp Health Plan Western Health Advantage

15 Looking Forward Small Group Considerations Continue with your existing Small Group Health plan? Grandfathered Plans Provide Group Health coverage for your employees? If you offer coverage to employees is it affordable and qualified? Not to exceed 9.5% of employee income At least Bronze level (60%) Dependent coverage must also meet requirements (need dependent information going forward)

16 Looking Forward Small Group Considerations If plan is not affordable and qualified Employee and dependents may be eligible for Expanded Medi Cal Eligibility Employee and dependents may be eligible for subsidy Qualified base on income Considered an eligible waiver?

17 Individual Mandate Requires most US citizens and legal residents to have qualifying coverage beginning January 1, 2014 Must include Essential Health Benefit (EHB) = 10 categories Minimum Creditable Coverage = Bronze Level Through Exchanges, private market, employer or other government program (Example: Medicaid or Medicare) Through the Exchanges Federal subsidies are available Cost sharing if their income is less than 400% of Federal Poverty Level 1. Premium Assistance Subsidy 2. Cost Sharing Assistance Subsidies

18 Covered California Exchange Example of Premium Assistance & Cost Sharing Assistance Subsidies Rating Area: Orange County Total Monthly Premium: $237 Age 27 (Member Only) Premium Assistance: $67 Annual Income: $27,040 Cost Monthly to Member: $170 Company: Anthem Blue Cross Plan Type: Enhanced Silver HMO Cost Sharing: 73 / 27 $1500 Deductible On average the member will be $40 PCP responsible for 27% of their health $50 Specialist care costs 20% Hospitalization $5200 Max out of pocket (Individual)

19 Covered California Exchange Example of Premium Assistance & Cost Sharing Assistance Subsidies Rating Area: Orange County Total Monthly Premium: $237 Age 27 (Member + 1 child under 18) Premium Assistance: $121 Annual Income: $27,040 Cost Monthly to Member: $115 Company: Anthem Blue Cross Plan Type: Enhanced Silver HMO Cost Sharing: 87 / 13 $500 Deductible On average the member will be $15 PCP responsible for 13% of their health $20 Specialist care costs 15% Hospitalization $4500 Max out of pocket (Family)

20 Companies in Covered California Individual Exchange Alameda Alliance For Health Anthem Blue Cross of California Blue Shield of California Chinese Community Health Plan Contra Costa Health Plan Health Net Kaiser Permanente L.A. Care Health Plan Molina Healthcare Sharp Health Plan Valley Health Plan Western Health Advantage

21 Individual Mandate Open Enrollment: October 1, 2013 March 31, 2014 Individuals who enroll in the Exchange and pay premium by December 15, 2013 will have coverage effective January 1, 2014 Individuals with coverage ending prior to March 31, 2014 can use the Exchange starting October 1, 2013 After March 31, 2014 individuals can get new private health insurance through the Exchange for 2014 only if they experience a qualifying life event Eligible for Special Enrollment within 60 days of the event 1. Loss of job 2. Divorce 3. Death of spouse or child

22 Individual Mandate Individuals who do not secure health insurance in 2014 when eligible must wait until open enrollment for 2015 beginning October 1, 2014 Penalties for not securing health insurance 2014: $95 or 1% of taxable income 2015: $325 or 2% of taxable income 2016: $695 or 2.5% of taxable income 2017: Calculated based on cost of living formula

23 Large Group Employer Mandate 50+ Full Time Equivalent Employees Delayed until 2015

24 Contact Information: Don Emory (800) Extension 103

25 New Health Insurance Marketplace Coverage Options and Your Health Coverage Form Approved OMB No (expires ) PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain costsharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer offered coverage. Also, this employer contribution as well as your employee contribution to employer offered coverage is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after tax basis. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. 1 An employer sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

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