Eugenie Guillot Sales Director Coventry Health Care Public Domain Health Care Reform What You Should Know Introduction 2012 – Recap 2013 and 2014 – FSA Limits – Health Insurance Marketpla ce – SHOP – Essential Health Benefits – Actuarial Value – Employer Shared Responsibi lity – ACA Fees & Taxes – Community Rating 2015-2018
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Eugenie Guillot Sales Director Coventry Health Care Public Domain
Eugenie Guillot Sales Director Coventry Health Care Public Domain. Health Care Reform What You Should Know. Introduction 2012 – Recap 2013 and 2014 – FSA Limits – Health Insurance Marketplace – SHOP – Essential Health Benefits – Actuarial Value - PowerPoint PPT Presentation
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Coventry Health Care is your partner in navigating health care changes associated with the Affordable Care Act (ACA). We are pleased to partner with the Jefferson Chamber of Commerce to assist business owners in understanding the impact this law will have on their business and employees.
Timeline of Changes Affecting Group Commercial Market
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2012 2013 2015 2016 2017 20182014
Women’s Preventive Services, Medical Loss Ratio (MLR), SBCs, W-2 Reporting
FSA Limits, Partnership Exchange Deadline, Final exchange Rules, PCORI Fee, Electronic Health Transaction Rules
Waiting Period Limitation Rules, Employer Coverage Mandate, Health Exchange Established, Essential Health Benefits, Health Benefit Standards, Subsidies for Individuals, Insurance Market Rules, Health and Wellness Rewards, Annual Health Insurance Industry Fee, State Risk Pool Requirement, Transitional
Reinsurance Fee, Risk Corridor Program Established, Risk Adjustment Program and Fee, Small-Group Participation in State Exchanges
• Health insurers report MLRs to the federal government by June 1 each year– MLR is the percentage of premiums spent on medical care– If a health insurer does not meet a minimum MLR threshold, a
rebate payment is due to policyholders– The MLR threshold is 85% for large groups and 80% for small
groups and individual policies • Health insurers must issue rebates by August 1 each year if
they do not meet the required threshold in the specified market
• In initial year, open enrollment will be six months: October 1, 2013, through March 31, 2014
• In following years, open enrollment will be from October 15 through December 7
• Assistance available for individuals– Premium tax credits
– Cost-sharing subsidies
Beginning in 2014, individuals and small businesses with up to 50 employees can purchase insurance through a health insurance marketplace. In 2016 businesses with up to 100 employees can also participate.
The ACA requires non-grandfathered small-group and individual plans both inside and outside health insurance marketplaces for plan years beginning on or after January 1, 2014, to cover a set of health services and benefits called the Essential Health Benefits Package. These include: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use
disorder services, including behavioral health treatment
Prescription drugs Rehabilitative and habilitative
services and devices Laboratory services Preventive and wellness services
and chronic disease management Pediatric services, including oral and
vision care
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Visit www.CHCLA.com for more information on essential health benefits.
• Minimum value definition: A health plan that covers at least 60% of the total allowed cost of benefits that are expected to be incurred.– IRS and HHS have developed a calculator for employers to
use to help determine if the coverage they offer their employees meets the definition of minimum value.
• Affordable coverage definition: When an employee’s share of the premium for employer-provided coverage costs the employee 9.5 percent or less of their wages.
Beginning on January 1, 2014, rates may vary only based on the following:
Whether the plan or coverage covers an individual or family Rating area Ageo Rate must not vary by more than
3:1 for like individuals of different age who are age 21 and older
o Variation in rate must be actuariallyjustified for individuals under age 21, consistent with a uniform age rating curve. A state may use a narrower ratio with approval by CMS.
Tobacco use, except that such rate shall not vary by more than 1.5:1 for like individuals who vary in tobacco usage. A state may use a narrower ratio with approval by CMS.
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Total premium for a family is determined by adding the premium
for each member:
Rate for 50-year-old adult who smokes
+Rate for 48-year-old adult nonsmoker
+Rate for 16-year-old minor
Visit www.CHCLA.com for more information on issues affecting employers.
• Insurance Payment Advisory Board January 15, 2015– Independent Payment Advisory Board created to submit
recommendations to Congress to slow growth in national health expenditures• Recommendations to reduce Medicare spending in 2014
• State health choice compacts allowed January 1, 2016– States permitted to form health care choice compacts– Allow insurers to sell policies in any participating state
• Large-group participation in state health insurance marketplace January 1, 2017– States may allow employers with more than 100
employees to be part of state health insurance marketplace by purchasing coverage through the Exchange
• Cadillac excise tax 2018 plan year– A 40 percent excise tax imposed on “Cadillac” health
plans when value of coverage exceeds $10,200 for individual and $27,500 for families.
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Visit www.CHCLA.com for more information on health care reform.
The information contained in this presentation does not constitute legal advice. The law changes very rapidly and, accordingly, Coventry recommends that you seek advice from your legal counsel and/or
tax advisor as it pertains to you and your business. Nothing that you read or is provided in this document should be used as a substitute for the advice of competent legal counsel.