jim williams, benefit specialist, lockard and williams ins. svcs

Jim Williams, Benefit Specialist, Lockard and Williams Ins. Svcs.


Steve Dickson, Registered Lobbyist, Strategem, Inc.



Donnie Smith, VP of HR & PR, Rush Health Systems



Donnie Smith, VP of HR & PR, Rush Health Systems

Pam Gregory, Agent, Bottrell Insurance Agency, Inc.


Steve Dickson, Registered Lobbyist, Strategem, Inc. Donnie Smith, VP of HR & PR,

Rush Health Systems Pam Gregory, Agent,

Bottrell Insurance Agency, Inc. Dan Risher, Dir. of HR & Safety, Marshall Durbin

Companies

All new health plans must provide certain preventive services, with no copay or deductible.

Many people will get government subsidies to buy insurance they could not otherwise afford.

If you have a pre-existing condition, you will be able to buy insurance for the same premium people in good health pay.

No lifetime limits on health insurance coverage if you have an expensive, chronic health problem.

As many as 34 million people will become newly insured. Source, National Center for Policy Analysis

Yes Access is the real issue, not health care

coverage, but access. Only 5% of Medical Students are going into Family Practice. Currently, we are 175,000 doctors short of our need—Nationwide. The rural communities will hurt the most. The majority of Medical Students usually stay within a 50 mile radius of where they went to med school.

FNP’s can help out greatly. But you may not be able to see a doctor when

you need help. In Massachusetts, with a similar reform: New patients in Boston wait an average of 63 days to see a family doctor.More people than ever are seeking care at hospital emergency rooms.

Source, National Center for Policy Analysis

Some insurers are already restricting which doctors you can see.

The new law encourages doctors to join Accountable Care Organizations (ACOs).

In an Accountable Care Organization (ACO): You will not necessarily see the same doctor or

nurse on each visit. You will not be allowed to get care from doctors

outside of the ACO, and The ACO will get to keep any money they save by

giving you fewer tests and services.Source, National Center for Policy

Analysis

Pre-PPACA, consumers have the choice to go directly to the carrier for coverage or shop the market place under the counsel of a independent licensed insurance agent.

After 2014, health insurance exchanges will be developed and up-and-running as a new source for obtaining coverage. Currently the Mississippi exchange legislation is dead. If the legislature can not pass authorizing legislation by next year’s session, the federal government will establish the exchange in our state.

The Exchange will be the only source for uninsureds to obtain subsidized coverage. They will also have Navigators whose role is to do outreach to uninsured populations and enroll them into coverage through the exchange.

Agents and brokers have worked in the health insurance market place to assist individuals and business owners to obtain insurance.

They counsel consumers through their decision making process and insure that their clients obtain the best product to meet their needs.

The State licenses insurance producers to assist in the enrollment process of health products and it is a role they will continue to have in the new health insurance market place.

In 2011: The Department of Health and Human

Services will issue standards for plans (including self-funded plans) to follow when describing coverage to enrollees.

The Department of Labor will begin annual studies on self-funded plans using data from 5500s.

Costs for over-the-counter drugs not prescribed by a doctor can no longer be reimbursed through an HRA or health FSA or on a tax-free basis through an HSA or MSA.

In 2011: The tax on distributions from an HSA or MSA

not used for qualified medical expenses is increased to 20 percent.

CLASS program (voluntary long term care) takes effect; employers may facilitate payroll deductions but participation is not mandatory.

In 2012 (or within 24 months from date of enactment):

Plans must begin to report value of employer-sponsored health insurance coverage on W-2s.

Plans must provide a summary of benefits to enrollees using format described earlier.

Plans must provide a 60-day prospective notice of plan changes.

In 2012 (or within 24 months from date of enactment):

Plans must pay $1 per plan participant for the first plan year ending after September 30, 2012 to support comparative effectiveness research. This fee increases to $2 per participant in the following plan year, and then the fee is indexed by the cost of “national health expenditures” after.

In 2013: Subsidies to employers who maintain

prescription drug plans for Medicare Part D eligible retirees will cease to be deductible, which has an immediate impact on employers’ FAS 106 accounting.

Employee salary reduction contributions to FSAs will be limited to $2,500, indexed by the Consumer Price Index.

In 2013: Employers must provide a notice to employees

about the availability of the exchange and how to obtain assistance, and their potential eligibility for premium credits if the employer’s share of costs is less than 60 percent of the allowed total cost of benefits.

Medicare payroll tax increases by 0.9 percent for high income earners (employee portion only). High income earners are joint filers with incomes above $250,000 or others with incomes above $200,000. A new 3.8 percent tax on unearned income for the same filers will also go into effect.

Make voluntary changes to increase benefits. Conform to required legal changes. Adopt voluntarily consumer protections. Change third-party administrators. Lose grandfathered status in one benefit

package but keep it in another. Implement amendments to a plan that were

adopted prior to March 23, 2010 but not effective until after.

Enroll new family members of individuals already enrolled, enroll new employees (whether newly hired or newly enrolled) and their families.

Increase fixed-amount cost-sharing requirements such as deductibles and out-of-pocket limits by no more than medical inflation (CPI-U Medical) plus fifteen percentage points.

Increase copayments by no more than:Medical inflation plus 15 percentage

points, or $5 increased by medical inflation.

Decrease its portion of the premium or other fixed cost of coverage relative to the portion of such cost paid by employees.

Enter a new contract of insurance as long as the change becomes effective on or after November 15, 2010.

Contracts that took effect before November 15, 2010, but after March 23, 2010, will cause the plan to lose grandfathered status.

Increase a percentage cost-sharing requirement (such as coinsurance) above the level at which it was on March 23, 2010.

Decrease its contribution rate toward the cost of any tier of coverage by more than 5 percentage points below the contribution rate for the coverage on March 23, 2010.

For this purpose, contribution rate is defined as the amount of contributions made by an employer compared to the total cost of coverage, expressed as a percentage.

In the case of a self-insured plan, contributions by an employer are calculated by subtracting the employee contributions towards the total cost of coverage from the total cost of coverage.

Eliminate all or substantially all benefits to diagnose or treat a particular condition, or eliminate an essential component for treating a particular condition.

Increase a fixed-amount cost-sharing requirement other than copayments, such as a $500 deductible or a $2,500 out-of-pocket limit, by a total percentage measured from March 23, 2010 that is more than the sum of medical inflation and 15 percentage points.

Increase fixed-amount copayments by an amount that exceeds the greater of: A total percentage measured from March 23,

2010 that is more than the sum of medical inflation plus 15 percentage points,

or $5 increased by medical inflation.

Move enrollees from one plan to another that has fewer benefits or higher cost sharing.

Yes. Since you are limited on the costs you can share with your participants you must effectively manage your plan costs. You must make sure that all the components of your plan (eligibility, wellness, pre-cert/case management, disease management, Rx, reporting, communication, etc) are designed aggressively and working in concert to effectively control your health plan costs.

Probably not. Employers can drop your coverage altogether and pay a fine that costs less than insuring you and your family.

14 million employees will lose their employer plan.

80% of small businesses won’t be able to keep their current plan.

More than 100 million people will be forced into a more costly, more regulated health plan.


More. You can avoid more costly state mandated benefits in favor of benefits specifically designed for your participants and their needs.

The tailored plan design and data capture abilities of self-funded administration should allow your plan to be agile in dealing with the challenges that today’s health care environment presents.

Yes, because of the flexibility that it gives a plan sponsor in dealing with all the pressures faced by a health plan today.

The cost of health care. It doesn’t matter whether you are looking at the costs paid by the plan or the participant, the cost of health care is high. Cost transparency would be a great first step in address this issue.

If EVERYONE, Plan and participant alike, understood the total cost of health care and shared in those cost decisions would be made that would begin to drive health care costs down.

Informing consumers of the costs of their medical services creates a more educated public who makes more responsible cost/benefit choices when choosing their care.

As for carriers, their rates will have to be disclosed and reported to the states in a more transparent process. The argument is there that states will have the opportunity to review rates and approve or disapprove them, forcing carriers to become compliant and competitive with others who wish to do business in that insurance market.

$5,800 for an individual (in 2016) $15,200 for a family of four (in 2016) In the government exchange, the out-of-

pocket premium will be limited to a percent of your income up to about $43,000 ($88,000 for a family).


The government will require you to show them your most recent tax return, revealing your total family income — including any nonwage income as well as your spouse’s income.


More than half of the cost of reform will be paid for by reduced spending on the elderly and disabled on Medicare.

New taxes on drugs and medical devices, such as wheelchairs, pacemakers, artificial joints, etc.

40% tax on “Cadillac” plans. Scores of other items will be taxed, ranging from

tanning salons to the sale of your home, in some cases.


Health insurers will have to raise premiums for everyone.

Employers will have to reduce wages and other benefits.

As many as 700,000 jobs could be lost by 2019.


Medicare Advantage (MA) members will lose $1,267 in Medicare payments in 2014.

One of every two MA members (7.4 million) will lose their plan entirely.

One in seven hospitals may go out of business, and doctors may not take new patients

Medicare will pay for an annual checkup. Deductibles and copayments will be eliminated

for many preventive services. If you are in the prescription drug “doughnut

hole,” you may qualify for a $250 rebate. Eventually (in 2019), the doughnut hole will be

eliminated.Source, National Center for Policy

Analysis

Penalties for employers with more than 50 full-time employees that DO NOT offer coverage to employees: If an employer does not offer its full-time employees (and

their dependents) group health coverage, and one or more full-time employees enrolls for coverage in an exchange and qualifies for a premium tax credit or cost-sharing reduction,

Then the employer would pay a $2,000 annual penalty per full-time employee, except that the first 30 full-time employees are exempt from the calculation. The penalty is assessed monthly and is indexed for inflation.

Penalties for employers with more than 50 full-time employees that DO offer coverage: If the employer offers its full-time employees (and their dependents)

the opportunity to enroll in group health coverage, And one or more full-time employees enrolls in coverage in an

exchange and qualifies for a premium tax credit or cost-sharing reduction because the employee’s family income is less than 400 percent of the federal poverty limit,

And the employee’s share of the premium exceeds 9.5 percent of his or her income,

Or the employer covers less than 60 percent of the allowable costs under the plan,

Then the employer would pay a $3,000 annual penalty (assessed monthly) for each full-time employee who receives a tax credit or cost-sharing reduction. The total penalty is capped at the amount the employer would otherwise have to pay for providing “no coverage” as described above and would be indexed annually.

jim williams, benefit specialist, lockard and williams ins. svcs

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