Post on 21-Jan-2015
description
Partnership for Solutions to Health Care Reform
• June 2013
2April 10, 2023
2014
Implementation of the
Affordable Care Act
3April 10, 2023
Shared Responsibility for Access
•
3
2014
Individual Mandate
Exchanges
Tax Credits and Subsidies
Employer Penalty
4April 10, 2023
2014 Market Reforms
Fundamental Shift in the Pricing Models for Individual and Small Market(<50)
No Medical Underwriting
Pricing Based on Geography, Age(3-1), Tobacco(1.5-1)
Pricing Changes will proceed even if Public Exchanges not ready
Individuals will have Access to Options across multiple Carriers
How will the Availability of Coverage Shift the “Social Contract” employers have historically entered into with employees for providing health care?
5April 10, 2023
Individual Mandate U.S. citizens and legal residents must have health
insurance (minimum essential coverage) or pay a tax
Tax is the greater of:
• 2014: $95 per adult ($285/family) or 1% household income
• 2015: $325 per adult ($975/family) or 2% household income
• 2016: $695 per adult ($2,085/family) or 2.5% household income (adjusted for inflation after 2016)
Tax will not exceed national average cost of Bronze level coverage
Exceptions include:
• Religious beliefs, undocumented workers, financial hardship
Is the penalty strong enough to move the needle?
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6April 10, 2023
Employer OptionsEngagement
Large Employers attempt to reduce unit cost and consumption
OR
Defined Contribution
Cap employer contributions and push cost changes to employees
OR
Disengagement
Push employees into Public Exchanges. Shift in Employer “Social Contract” creating new buyers in the Marketplace
USI Affinity can deliver the Solutions for all Realtors
7April 10, 2023
Public Exchanges Marketplace for individuals and small businesses to shop
for private health insurance coverage
Pennsylvania and many other states have opted not to operate a Public Exchange at this time
Pennsylvania Public Exchange will be operated by Federal Government
HHS confirms Public Exchanges will work with Brokers
Realtors enrolling in the Public Exchanges can be serviced by USI Affinity
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8April 10, 2023
Public Exchanges Public exchanges will offer community rated metallic plans
that will be tightly regulated and priced.
Qualified health plans sold through the Exchange and off Exchange
• Provide essential benefits• The “metallic” plans: Bronze (60%) – Silver (70%) –
Gold (80%) – Platinum (90%)
Subsidies available for qualified individuals and Tax credits for qualified small employers
Initial enrollment period to begin October 1, 2013 (must enroll by December 22, 2013 for January 1, 2014 coverage)
• Will Federal Exchanges be Ready?
• Portion of SHOP Exchanges Delayed until 2015
9April 10, 2023
Federal Poverty Level 2012 Persons in
family/household 100% FPL 400% FPL
1 $11,170 $44,680
2 $15,130 $60,520
3 $19,090 $76,360
4 $23,050 $92,200
5 $27,010 $108,040
6 $30,970 $123,880
7 $34,930 $139,720
8 $38,890 $155,560
For families/households with more than 8 persons,add $3,960 for each additional person
9
2012 FPL for 48 Contiguous States and District of Columbia. Dept. of Health and Human Services http://aspe.hhs.gov/poverty/12poverty.shtml (as visited 11.7.12). See website for information on Alaska
and Hawaii.
10April 10, 2023
Premium Tax Credit Government pays some of the
premium for Exchange-based coverage
• sliding scale depending on income
• based on silver coverage
Available to individuals between 100%-400% of FPL who:
• are not eligible for minimum essential coverage or
• are eligible for minimum essential coverage through an employer, but that coverage is unaffordable or does not provide a minimum value
Small Employer Tax Credits Available in SHOP Exchange
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Triggers the Employer Penalty
Household Income FPL
Initial Premium Percentage
Final Premium Percentage
Up to 133% 2% 2%
133% up to 150%
3% 4%
150% up to 200%
4% 6.3%
200% up to 250%
6.3% 8.05%
250% up to 300%
8.05% 9.5%
300% up to 400%
9.5% 9.5%
11April 10, 2023
Premium Tax Credit Example A
• Mark earns $40,000 a year. He is age 40 and a single adult. He does not have employer coverage available. Mark’s household income is 348% of FPL.
• Mark goes to the Exchange. An estimated premium for Silver coverage is $5,400. Mark must pay 9.5% of his income for the premium, or $3,800. He will receive a $1,600 subsidy (covering 30% of the overall premium).
Example B
– Same as above but Mark makes $20,000 a year (174% of FPL). Mark will have to pay 5.1% of income on health insurance coverage. He will pay $1,019 and receive $4,381 in subsidy. 11
12April 10, 2023
Private Exchanges and Market Plans offered off Public Exchange will be similar to Public
Exchange. Must Fit Metallic Plans Different Delivery Systems/Networks
Individual and Group Plan Designs will be Similar Individual vs. Group Pricing?
Medical carriers are rolling out their Defined Contribution Solutions combination of Paper and online.
13April 10, 2023
Access for Realtors Sole Practitioners – Individual Plans
• Public Exchange and Off Exchange
Groups – 1 to 50• Public SHOP Exchange – One Carrier, One Plan to Qualify
for Tax Credits• Traditional Plans or Defined Contribution
Groups – 50+• Traditional Plans, Private Exchanges and Self Funding
USI Affinity can deliver the Solutions for all Realtors
14April 10, 2023
Realtors Exchange
USI Affinity offers Realtors the Access, Advice and Advocacy they need to save money, prepare for Health Care Reform and get the most of their benefits.
Access to Unique Products and Services,
Advice on Benefits Design, Compliance and Funding Options
Advocacy to help resolve issues from administration and claims to complex clinical questions
15April 10, 2023
USI Affinity – Partnership with Realtors USI Affinity is currently servicing in excess of $225 Million in
Benefits Premium. This gives USI Affinity the necessary leverage in the marketplace to deliver solutions to the Realtors.
Potential to offer Unique Solutions on Carrier Exchange
USI has invested in a team of ERISA attorneys focused exclusively on Employee Benefits and Health Reform. This investment is there to bring your members the most up to date information on Health Care Reform
• USI Affinity field staff is backed up by a paperless call center which handled more than 20,000 calls in 2012 and is scalable to handle increased volumes in 2014. The advocacy provided to members will be a differentiator as competitors move to strictly online solutions. USI Affinity will offer a balance of technology and personal service.
16April 10, 2023
Questions
855-874-0267
benefits@usiaffinity.com