HEALTH CARE REFORM DOCUMENT FROM THE WEBSITE OF BLUE CROSS BLUE SHIELD OF NORTH DAKOTA

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1 HEALTH CARE REFORM DOCUMENT FROM THE WEBSITE OF BLUE CROSS BLUE SHIELD OF NORTH DAKOTA Frequently Asked Questions I ve heard the federal government launched a new website called Healthcare.gov. How can it help me? Healthcare.gov launched on July 1, It allows you to see all the health insurance options available in your area for your specific situation and compare features. Healthcare.gov provides a preview of the state exchanges that will launch in The exchanges will take the concept a step further by allowing consumers to not just compare health insurance features and prices, but also to purchase health insurance online right from the site. What is the CLASS Act and how does it affect me? October 2011 update: The U.S. Department of Health and Human Services announced that it is halting plans to implement the CLASS Act. The CLASS Act (Community Living Assistance Services and Support Act) is a provision of the health reform bill dealing with long-term care insurance. It will create a long-term care program that will be available to adults who meet certain eligibility requirements. Employers will offer the program to employees as a payroll deduction; however, neither employers nor employees will be required to participate. Special rules will be created by the U.S. Department of Health and Human Services for individuals who wish to participate, but whose employer does not make the program available through payroll deduction. If an employer does make the program available, employees must opt out if they do not want to participate. I've heard health reform allows my children to be covered by my health insurance policy up to the age of 26. When can my children be added to my policy? BCBSND has elected to adopt early some key provisions of the Patient Protection and Affordable Care Act (PPACA). As a result, effective June 1, 2010, dependent children up to the age of 26 may remain on their parent's health plan through the month of their 26th birthday. We believe early adoption of this important provision best serves our customers and implements health reform legislation in the most convenient, efficient manner. If you have an eligible dependent child younger than age 26 who lost coverage before May 31, 2010, they can be added during the annual enrollment period established by your employer or because of a special employee enrollment event, such as marriage, birth or adoption. You will need to complete the application at your place of employment if you have employer group insurance. The changes apply to individual health plans and fully insured group plans. The mechanics of these changes are a little different for individual versus group health plans. What is an "eligible dependent child"? A child is eligible to remain on a parent's health insurance plan until age 26 regardless of marital status, financial dependency, residency, student status, and employment status. Coverage can be

2 denied to an eligible adult child up to age 26 is if the parent's plan is part of a grandfathered group health plan that can deny coverage based on an adult child's eligibility to enroll in another group health plan for plan years beginning before January 1, How does health reform affect pre-existing conditions for children? BCBSND has also decided to implement early the provision of the Patient Protection and Affordable Care Act (PPACA) that eliminates waiting periods for pre-existing conditions for members younger than age 19. BCBSND implemented this new provision effective June 1, How will COBRA change under the new law? How long will I be able to continue on my employer s plan? COBRA regulations have not changed as a result of the new health care reform law. A terminated employee is still eligible for a continuation period of up to 18 months. As the owner of a small business with fewer than 50 employees, if I provide health care coverage to my full-time employees, am I required to also provide it to my part-time employees? For a company with fewer than 50 employees, there is no mandatory requirement that the employer provide health insurance to any employees, full-time or part-time, now or in the future. Does the new health reform law apply to vision and dental care? Many details about health reform are unknown at this time. From the information we have now, we are uncertain how vision and dental care will be affected by health reform. Under health reform, certain services will be defined by the U.S. Department of Health and Human Services as "essential benefits," but we do not know at this time whether vision and dental will be included in that definition. As details are worked out, there may be differences between adults and children in regard to vision and dental coverage. Information on this site will be updated as we learn more. How soon will the changes take place? Health care reform will be implemented over time - some provisions begin in September 2010, six months after the law was signed (or when your health insurance plan renews, whichever is later); others are not fully realized until Many of the provisions begin in Will my premium go up? Based on the information we have, health care reform is likely to push premiums up. The timing of any increase will depend on when certain cost-inflating provisions of the law go into effect. Beginning in 2014, some individuals may be eligible for premium credits or reductions on costsharing based on their incomes. Will health care reform help me pay for my health insurance? Beginning in the 2010 tax year, small businesses (25 or fewer employees and average wages less than $50,000) may be eligible for tax credits to help them pay for part of their employees' health insurance coverage.

3 Beginning in 2014, individuals who do not get health insurance through their employer may be eligible for subsidies to help offset the cost of health insurance. What will be the impact on North Dakota? Health care reform will have a significant impact on North Dakotans and all Americans. Medicare reimbursements. Especially advantageous to North Dakota, health reform increases the payments Medicare makes to doctors and hospitals in more rural states like North Dakota the so-called frontier amendment. This should take some of the burden off private insurance to subsidize the shortfall in Medicare payments. Medicaid expansion. Health reform expands Medicaid, which is a shared state and federal program. Right now, the federal government will cover the state s increased share. However, the federal government may not cover the state's increased share indefinitely. Individual mandate. On a more individual level, we expect the mandate that everyone is to be covered by health insurance by 2014 will greatly impact North Dakotans. We believe this is one of the provisions of the law that will drive up premiums in the state because many North Dakotans will likely be covered by richer benefits than they currently receive. Health insurance exchanges. Relevant to individuals and small businesses, the health insurance exchanges that health reform will create by 2014 will allow North Dakotans who are not covered by their employer to purchase qualified health insurance. There are many more provisions of the health reform legislation that will affect North Dakota. How will health reform affect North Dakota's doctors and hospitals? Before health care reform, doctors and hospitals in sparsely populated rural states received far lower Medicare payments for identical procedures than doctors and hospitals in more urban states. The so-called "frontier amendment" in the health care reform legislation will raise the amounts paid by Medicare to doctors and hospitals in sparsely populated rural states. The frontier amendment will have a positive effect on North Dakota's doctors and hospitals, and should take some of the burden off private insurance to subsidize the shortfall in Medicare payments. Will North Dakota still have an insurance commissioner or will everything be handled on a federal level? North Dakota will continue to have an insurance commissioner, although some of the state's insurance laws may change to match provisions dictated by the national health care reform law and federal regulations. Do I need to sign any paperwork to make the health reform changes effective? At this time, we are not aware of any paperwork that you will need to sign. The provisions will take place over a number of years. We will inform you of any paperwork should it become necessary, but it is likely these changes will be automatic.

4 What is the exchange? A health insurance exchange is a web-accessible marketplace where individuals and small groups can compare and shop for private insurance. The exchange will also determine an individual's eligibility for government programs (such as the Children's Health Insurance Program (CHIP) and Medicaid) and for premium subsidies and cost-sharing reductions. Will my plan change? For new health insurance plans, it appears benefits will be richer, cost shares will be lower, annual limits will be minimal, and lifetime and annual limits on essential benefits will be eliminated. However, as a result of these enhanced benefits, we expect premiums will increase, which may be offset by subsidies for some people who buy their own insurance. If I am covered through my employer, am I eligible for a health insurance subsidy? Generally, no. Only people who buy their own insurance (those not covered through their employer) are eligible for subsidies. Based on income and the amount the employee pays for their share of the premium in group coverage, some people may be eligible for a "Free Choice Voucher," which permits that person to use the employer's share of the premium to purchase a product from the new exchange. Details on that provision of health care reform are unclear at this point. Will my plan cover all the expenses for preventive services? Will I have to pay out of my pocket for these services? For plans that must conform to the provisions of health care reform, certain preventive services will be covered with no out-of-pocket expenses for the insured person. The U.S. Department of Health and Human Services will be defining by regulation which preventive services are covered in this manner. Will my plan still have out-of-pocket costs (deductible, coinsurance and copay)? Generally, yes, but some provisions of health care reform affect this aspect of insurance coverage. With the exception of grandfathered plans, health care reform imposes an annual $5,950 limit for out-of-pocket costs for individuals and $11,900 for most families. Some individuals may be eligible for cost-sharing limitations based on income. I own a small business. Will I be required to buy health coverage for my employees? If your business has fewer than 50 employees, you will not be required to provide your employees with health insurance. As a small business owner, what help can I get paying for my employees' health insurance premiums? Under health care reform, small businesses may be eligible for a tax credit of up to 35 percent of the employer's contribution to health insurance premiums if the employer pays at least 50 percent of the premium cost for the years 2010 through Beginning in 2014, that tax credit will increase to 50 percent, but is available for only two years thereafter.

5 I am currently uninsured or buy my own insurance. How do I find out if I'm eligible for subsidies to help me pay for health insurance? The details of this program have not been developed yet. But, generally, people with incomes between 133 percent and 400 percent of the federal poverty level will be eligible for the health insurance subsidies beginning January 1, Generally, the subsidies will only be available to individuals who do not have health insurance through their employer. How do I learn more about the temporary high-risk insurance pool for people who ve been rejected by insurers or have been uninsured for at least six months? A federally funded high-risk insurance program called the Pre-Existing Condition Insurance Plan launched on July 1, It will run until 2014, when insurers are required to offer coverage to anyone, regardless of health condition. I belong to a union. Are the so-called Cadillac plans going to be affected? None of the health insurance plans currently offered by Blue Cross Blue Shield of North Dakota fit the definition of "Cadillac plan" as defined by the health care reform legislation. As health care reform is implemented, the benefits included in our plans may change. Whether any future plans will qualify as "Cadillac plans" is undetermined at this point. I am an employer and I want to keep my current plan. Can my plan be grandfathered or do I need to make changes to conform to health reform? Your current plan can be grandfathered in under health care reform. However, in the next several years, more components of the law will be implemented and it is possible your plan may change. How will health reform affect my flexible spending account? Contributions to an individual's medical flexible spending account are scheduled to be reduced from $6,000 to $2,500 annually starting in 2013.

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