Understanding the Impact of Health Care Reform on Your Plan

Transcription

1 Understanding the Impact of Health Care Reform on Your Plan

2 Overview 2 The Objective Health Care Reform Overall Update Small Group Requirements Choices for Small Groups New Plans, New Features Questions?

3 The Objective 3 Minimize impact on you & your employees provide options to meet your needs

4 Health Care Reform Update: Delayed Until 2015: Health insurance coverage reporting (employer contributions) Employees working 30+ hours are considered full-time and could be subject to penalty Penalties for large groups (50 or more employees) if they don t provide coverage; look-back period

5 Health Care Reform Update: What Still Impacts You in 2014? Out-of-Pocket (OOP) Maximum No pre-existing condition limitations Waiting periods limited to 90 days W-2 reporting Individuals must have coverage or pay a penalty

6 Small Group Requirements

7 Small Group Requirements 7 Essential Health Benefits Provider network adequacy type, number, reporting Drug formulary type, number that must be covered State mandated standard plans (allowed to offer other options) Actuarial Value & Metal Plans Named after precious metals (Platinum, Gold, etc.) What the health plan must pay vs. what member pays

8 Essential Health Benefits 8

9 Rx Overview Formulary Options 9 Staying with 3 Tier Formulary Tier 1 = Generics Tier 2 = Preferred Brands Tier 3 = Non-Preferred Brands Small Group Open Formulary On & Off Exchange What you have today Smooth transition since no major changes

10 How Do the Metal Plans Work? 10 All plans must fall within pre-set actuarial value ranges named after precious metals Bronze Silver Gold Platinum Actuarial Value Ranges Allowed for Small Groups by Metal Plan

11 Choices for Small Groups

12 Choices for Small Groups 12 You can: Simply renew; automatically compliant with mandates Choose another plan Go to the SHOP Exchange Rates are the same on & off the exchange All employees must complete new paperwork

13 New Plans, New Features

14 New Plans for Small Groups 14 Due to requirements of health care reform, all small group plans will be retired You will be transferred to new, fully-compliant plan New plan is closest match to current cost sharing HealthyRewards for small groups is replaced by ExerciseRewards with new $600 gym reimbursement

15 Introducing: SimplyBlue Plus 15 More options Low cost Gold & Silver hybrid plans offer first dollar drug coverage, HRA compatible Some hybrid plans have higher deductibles for lower premium ($1,000 - $3,000) HDHP Silver and Bronze packages offer HSA or HRA compatible options Numerous deductible options

16 Moving to SimplyBlue Plus 16 Actuarial value of current plan determined, then your group is moved to closest match for cost sharing Healthy Blue SimplyBlue BlueChoice/HMO Blue SSA Plans SimplyBlue Plus Healthy NY Group HNY Branded EPO* *Pending approval

17 New Plans Fully Compliant 17 All benefits follow model language provided by NYS State mandated plans called standard In-network, out-of-network = separate out-of-pocket maximum All cost shares (copays, coinsurance, deductibles, Rx) accumulate toward the out-of-pocket maximum Accumulating benefits will reset (nothing carried over from the previous product) Non-standards named by metal level and a number (examples: Bronze 2, Platinum 9) Groups transition to new plan at renewal

18 New Plans Available Riders 18 Dependent to 29 Coverage Domestic Partner Coverage (no cost) Family Planning Exclusion* Pediatric Dental Removed** *Group must file for religious exemption ** If stand-alone dental plan is purchased, coverage can be removed

19 New Features for Fitness 19 With $600 Gym Reimbursement Program & ExerciseRewards TM members enjoy: Gym discounts Three one-week free trial memberships to participating fitness facilities Online interactive tools Discounted, family programs offered through many of the facilities in the gym network

20 ExerciseRewards Online 20 Create individualized fitness plans Find your ExerciseRewards facility & try it out for free! Take one of many Ecoaching courses Build a 28-day customized meal plan

21 New Features: Dental & Vision Coverage 21 Adult vision coverage offered on all non-standard plans both on and off exchange Pediatric dental & vision embedded into medical plans Pediatric coverage for kids up to age 19 Uses Excellus BCBS Dental Networks

22 Your Questions?

23 Engaging Your Members Thank you!