Countdown to 2014: HEALTH CARE REFORM WHAT YOU NEED TO KNOW

Transcription

1 Countdown to 2014: HEALTH CARE REFORM WHAT YOU NEED TO KNOW Coordinated by: -The Affordable Care Act- -Employer Notification- Monday, September 9, 2013 Registration 8:15 a.m. 8:45 a.m. Welcome 8:45 a.m. 9:00 a.m. ACA Presentation 9:00 a.m. 9:45 a.m. Employer Notification Presentation 9:45 a.m. 10:15 a.m. Open Panel Discussion 10:15 a.m. 11:00 a.m. Continental Breakfast Bart Carrigan - President, AGC of Michigan Mike Nystrom - Executive Vice President, MITA Kirk Roy - Vice President, BCBSM Office of National Health Reform Edward C. Hammond - Attorney, Clark Hill PLC Derek L. Watkins - Attorney, Sachs Waldman Question & Answers If you wish to obtain a copy of the material presented today, please Heather Obrecht White at heather@association-benefits.com

2 National Health Reform: Overview and Actions September 9, 2013 Kirk Roy, Vice President, National Health Reform The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary and efforts will be made to present and update accurate information. This overview is intended as an educational tool only and does not replace a more rigorous review of the law s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

3 Outline of Today s Discussion A Reform Overview 1. General provision 2. Impact on Health Insurance Environment 3. Individual subsidies B Employer Plan Sponsor Impacts 1. Small versus Large Businesses 2. Benefits 3. Taxes 4. Premium Rates 5. Employer Mandate C Options and Approaches 1. Employer Profiles 2. Options and Levers 3. Key Takeaways 1

4 A1 Reform Provisions That Impact the Ecosystem Reform Provisions Medicaid expansion Subsidies for individuals Insurance reforms (Benefits, rating, Issuance, pre-existing exclusions) Penalties for not having or offering coverage Health insurance marketplaces Funding (fees and taxes) Medicare and Medicare Advantage payments, reimbursement and quality 2

5 A2 The Reform Environment and Stakeholder Impacts Coverage landscape pre and post-reform Percent of lives, 2010 and million million Small group Large group Administrative services only Individual Medicare Advantage Medicare & Medigap Medicaid Uninsured Total growth Percent -10 to to Group-sponsor challenges and decline in group coverage Individual and consumer market growth Financial challenges for provider community Price sensitivity and commoditization Administrative complexity and compliance risks 3

6 A3 Subsidies for Individual Insurance Who is eligible for a subsidy? Premium subsidy Individual purchasers: % of federal poverty level Single: $11,490 to $45,960 Family of four: $23,550 to $94,200 Not if other minimum essential coverage is available Must purchase coverage on ACA Marketplace Subsidy generally = second lowest cost silver plan premium Max payable Limit on Premium: Applies to: Maximum Payable (% of income): 2% to 9.5% Sliding scale: 100% to 400% FPL Costsharing subsidy Cost-Sharing Change: Out-of-pocket limit and potentially other cost sharing reduced to reach specified AVs Applies to: % FPL, 94% AV 151%-200% FPL, 87% AV 201%-250% FPL, 73% AV 4

7 A3 Individual Subsidies Illustrative Examples Single Individual Household Income Personal Share of Premium Government Share of Premium $13,000 $260 $3,940 $20,000 $1,020 $3,180 $32,000 $2,840 $1,360 $50,000 $4,200 - Family of Four Household Income Personal Share of Premium Government Share of Premium $27,000 $540 $11,460 $41,000 $2,095 $9,905 $65,000 $5,720 $6,280 $100,000+ $12,000-5

8 B1 Employer Impacts Small Versus Large Today Small Employer: Less than 50 Full- Time Employees seeking Health Coverage Small Employer: Less than 50 Full- Time Equivalents based monthly average at 30 hr/week standard Small Employer: Less than 100 Full-Time Equivalents based monthly average at 30 hr/week standard Small Versus Large designation impacts benefit requirements, taxes, premium rates and employer mandate applicability 6

9 B1 Employer Impacts - Counting Full Time Employees working 130 hours or more in a month + Total part-time hours in a month/ 120 = Total Full Time Equivalents for the calendar month (FTEs) The FTE count is determined based on the average of each monthly calculation across the preceding calendar year. Employer adds the 12 monthly calculations and divides by 12, then rounds down to the nearest whole number. Example 1: Rhonda s Wholesale has 36 full-time employees and 15 part-time employees, who each work 96 hours per month. 36 Full Time Employees + 12 Full-time equivalents based on 1,440 part-time hours (1,440/120 = 12) = 48 Total Full Time Equivalents (FTEs) Example 2: Tim s Sporting Goods has 40 full-time employees and 25 part-time employees, who work 96 hours per month. 40 Full Time Employees + 20 Full-time equivalents based on 2400 part-time hours (2,400/120 = 20) = 60 Total Full Time Equivalents (FTEs) 7 Tim has 40 fulltime employees However, 25 part time employees count for 20 FTEs As a result, Tim has 60 FTEs, which is defined as a large group in 2014

10 B1 Employer Impacts (2014) Small Versus Large Impacts Small Employer Large Employer Benefits Required Must cover essential benefits Cost-sharing at metal levels Out-of-pocket requirements Out-of-pocket requirements ACA Taxes Approx 5% (4% for HMO) Approx 4% (3% for HMO) Self- Funded 2-3% Premium Determination Age (3:1), Geography, Tobacco No industry, size or experience No change in structure, still experience rated Employer Mandate Requirements No employer mandate payment Minimum essential coverage Affordability threshold $2,000 per full-time employee Administration Reporting and notices 90-day limit on waiting period Reporting and notices 90-day limit on waiting period Automatic Enrollment 8

11 B2 Additional Benefit Requirements (Large and Small Employers) Coverage Requirements Additional preventive services without cost-sharing and updated rules for past preventive services Coverage of clinical trials No waiting period greater than 90 days Out-of-Pocket Maximum Benefits subject to a true out-of-pocket maximum The out-of-pocket maximum is limited to $6,350/$12,700 (single/family) All types of cost-sharing apply (deductible, coinsurance, co-pays) Cost-sharing on covered service defined by essential health benefits include (hospital, professional, pharmacy, mental health, etc.) One year safe harbor for carve outs ensure each maximum is less than statutory amount Benefit requirements go into effect for the first plan year on/after January 1,

12 B2 Benefit Requirements (Small Employers) Must cover essential benefits Cost-sharing (deductibles, coinsurance, co-pays) must average to metal levels: Approximate Deductible Bronze 60% $2,500-3,000+ Silver 70% Gold 80% Platinum 90% $1,500-2,500 $500-1,500 $ Most current plans do not fit into these metal level plans benefit levels will change for most small employers 10

13 B3 ACA Fees and Taxes When How Much Individual Group Insured ASC Medicare Medicaid Comparative Effectiveness Jul 2013 $1 - $2 PMPY Federal Insurance Premium Tax % of insured premium stoploss Reinsurance Fee 2, $5.25 PMPM High Cost Health Plan Excise Tax variable group Marketplace Fee % small Risk Adjustment $0.96 Fee 6 PMPY 1 Federal Insurance Premium Tax levels are 50% lower for HMOs 2 Reinsurance fees based on 2014 levels, then phase out completely by Individual market is charged a reinsurance fee but then receives net proceeds of collected fees through reinsurance payments (which will be reflected in lower premiums) 4 HCHP Excise Tax based on 40% of the amount beyond specified cost thresholds 5 HHS anticipates collecting user fees by deducting the user fee from Exchange-related program payments Newly established fee to pay for administrative expense of running the federal risk adjustment program. 11 small

14 B4 Premium Determination All insured groups Rate Increase driver Rate Decrease driver Trend (nonreform related) Taxes & Fees +4-5%* Small groups only Industry factor and group factor limit No industry factor may partially offset CCF limit removal impact Rate band compression Increase for younger groups (3:1 age) Member level rating Potential increase for families with older / more dependents Other factors Benefit changes Risk adjustment ~8%* The CHANGE in premium rates for small employers will depend on each company s starting point (ranging from 20%+ reduction to 20%+ increase just due to reform changes) 12

15 B Cost Impacts Benefit Impacts (especially Out-of-Pocket Maximum Fees and Taxes Total (Large Groups) Additional Impact for Small Groups Essential Benefits Metal Level Rate Factor Compression Member Level Rating Total (Small Groups) 1 3% 1 4% 2 7% % % Cost impacts depend on particular circumstances and current benefit levels. 13

16 B5 Employer Mandate Requirements (Delayed 2015) Requirement: Beginning in 2015, employers with more than 50 full-time equivalent (FTEs) workers are subject to a penalty ($2,000 per employee) unless they offer minimum essential coverage that meets minimum value and affordability standards to their fulltime employees Minimum value and affordability standards Minimum value: Benefit coverage provides at least 60% actuarial value Affordability: Employee contribution for self-only health coverage does not exceed 9.5% of household income Example: 100 full-time and 50 part-time employees (125 FTEs) Penalty for not offering coverage: (100-30) * $2,000 = $140,000 Note: Employer mandate is not tax deductible 14

17 C1 Employer Profiles Business Strategy and Workforce Objectives ` Benefits Premiums Penalties Subsidies Match current benefits Modest disruption Larger premium decrease Typical/ no impact No or low employer mandate penalty High subsidy eligibility Split work force Major disruption Larger premium increase Large employer penalty Low subsidy eligibility Options and Optimization 15

18 C2 Core Options Maintain Group Sponsored Coverage Modify Group Sponsored Coverage Modify Funding Approach Cease Group with Transition Support Cease Group Sponsorship Accept benefit and cost changes Substantial benefit modifications to manage cost Self-funding or defined contribution Avoid some ACA costs Shares cost differently with employees Pay penalty Some employees eligible for subsidies Assistance with process and picking new plans Pay penalty Some employees eligible for subsidies Low workforce disruptions Avoid Employer Mandate payments Moderate workforce and administrative disruption Avoid Employer Mandate payments Moderate workforce and administrative disruption Avoid Employer Mandate payments High workforce disruption High workforce disruption 16

19 C2 Other Key Considerations Workforce subsidy eligibility for individual market Employer mandate penalty amounts and cost of avoidance Employee payroll contribution levels as a function of household income Workforce structure (employee classes) Workforce structure (full-time vs part-time) Tax impact of coverage changes Employer Mandate not tax deductible Employer-sponsored coverage is tax deductible Individually purchased plans are paid post-tax 17

20 C2 Communication and Notification Requirements Summary of Benefits and Coverage Continue to provide summary of benefits and coverage Required upon renewal, enrollment and upon request Exchange Notification Plan sponsors are required to send a standard government notice to all plan participants Notice includes awareness of exchanges, open enrollment periods and notice that enrollment on exchange may result in loss of employer sponsored plan Minimum Essential Coverage Plan sponsors are required to notify participants where the current plan meets the minimum essential coverage requirement This requirement can be fulfilled by inclusion of these statements on the Summary of Benefit and Coverage 18

21 C2 A Word on Plan Year NHR Required Effective Date The 2014 benefit requirements and insurance rules apply for plan years on or after 1/1/2014 Market Response Many group plan sponsors are seeking to adjust their plan year to their advantage Many are redefining their plan year as Dec (2013) to defer compliance requirements for one year Others who may benefit from insurance and rate setting reform may seek to pull their plan year forward to 1/1/2014 Insurers are providing options for policyholders to purchase December policy year plans during 2013 to defer their impact from NHR requirements Legal Note on Plan Years A change on policy year is required to be for a legitimate business purpose 19

22 C2 Key Takeaways Know the options for you and your employees Be aware of workforce restructuring dynamics, employee contribution structures and general employer strategies Negotiate flexibility for a changing regulatory environment Be clear about your business objectives and which options put you on the best path Start now think these options through with your insurance, tax and financial advisors 20

23 QUESTIONS? 21

24 PRESENTATION #2 ED HAMMOND

25 HEALTH CARE REFORM AND KEY MULTIEMPLOYER GROUP HEALTH PLAN ISSUES Presented by Edward C. Hammond September 9, 2013

26 Marketplace Notice Employers are required to provide notice of Health Insurance Marketplace (formerly referred to as the Exchange ). Recently issued FAQs say multiemployer plan can issue notices, but employer still responsible for them. Notice must be provided to existing employees no later than October 1, After October 1, 2013, notice must be given to any new employee within 14 days of hire date. By hand or first class mail is safest. Model notices available: For employers who offer a health plan to some or all employees: For employers who do not offer a health plan: Copyright Clark Hill PLC

27 Marketplace Notice Need to get assistance from multiemployer plan to complete information that goes into the notice. Consider communication campaign to avoid confusion: Employers are required to provide this notice. This is just to provide information about exchanges. These notices do not mean you will lose plan coverage or that you have to sign up for exchange coverage. COBRA election notices must also be updated. Copyright Clark Hill PLC

28 Employer Shared Responsibility Provisions IMPORTANT!! Employer Shared Responsibility provisions were originally scheduled to take effect January 1, 2014, but on July 2, 2013, the government announced a one-year delay in the enforcement and assessment of employer shared responsibility payments. No payments will be assessed until January 1, Copyright Clark Hill PLC

29 Employer Shared Responsibility - Overview Only applicable large employers ( ALEs ) are subject to Employer Shared Responsibility provisions. Does not mandate coverage. Proposed regulations issued; expect more/final guidance to be issued within the next year. 5

30 Shared Responsibility Penalty Relief for Multiemployer Plans through 2014 Before the employer mandate was postponed, transition guidance provided that employers were not subject to the Shared Responsibility penalties for bargained employees in 2014 if: Employer is required by CBA to make contributions to multiemployer health plan on behalf of employees that satisfy plan eligibility; Coverage is offered to full-time employees (and their dependent children); and Coverage is affordable and provides minimum value. Not sure how or if this transition rule will be adjusted for 2015, but may be prudent to verify affordability and minimum value. Copyright Clark Hill PLC

31 90 Day Waiting Period Guidance Effective for plan years beginning January 1, Allows plan sponsors to establish a waiting period after eligibility satisfied. Does not specifically address multiemployer plans. There is guidance for variable hour employees, where it cannot be determined at start whether employee will be eligible; no guidance for coverage based on projects completed, earnings or other non-hour standards. 90 days means 90 days (not three months). Copyright Clark Hill PLC

32 Collective Bargaining Agreements What does your CBA say? Does it include a health care related reopener? When negotiations begin, consider adding provisions that offer flexibility for employer to be able to deal with health care costs, employer mandates and future guidance. 8

33 Legal Disclaimer This document is not intended to give legal advice. It is comprised of general information. Employers facing specific issues should seek the assistance of an attorney. Copyright Clark Hill PLC

34 Thank You! Edward C. Hammond Copyright Clark Hill PLC

35 Countdown to 2014: HEALTH CARE REFORM WHAT YOU NEED TO KNOW Coordinated by: -The Affordable Care Act- -Employer Notification- Monday, September 9, 2013 Registration 8:15 a.m. 8:45 a.m. Welcome 8:45 a.m. 9:00 a.m. ACA Presentation 9:00 a.m. 9:45 a.m. Employer Notification Presentation 9:45 a.m. 10:15 a.m. Open Panel Discussion 10:15 a.m. 11:00 a.m. Continental Breakfast Bart Carrigan - President, AGC of Michigan Mike Nystrom - Executive Vice President, MITA Kirk Roy - Vice President, BCBSM Office of National Health Reform Edward C. Hammond - Attorney, Clark Hill PLC Derek L. Watkins - Attorney, Sachs Waldman Question & Answers If you wish to obtain a copy of the material presented today, please Heather Obrecht White at heather@association-benefits.com