Individual Health Insurance Marketplace Overview

"Helping individuals compare standard individual health insurance options"

The ZaneHRA Software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, check out our Software.

Employers use ZaneHRA to open and manage their own stand-alone HRA or defined contribution health plan completely online, electronically enroll participants and print welcome kits, and monitor expenses and reimbursements in real-time.

Employees obtain their own individual health policies from a designated health insurance broker (see below), submit premium and medical expenses online, via fax, or mail, and receive same-day reimbursement via check, payroll addition, or direct deposit. Zane Benefits does not sell health insurance.

Insurance Professionals partner with Zane Benefits and use ZaneHRA to provide clients with a cost-saving health benefits option. Insurance brokers earn compensation on ZaneHRA referrals and retain 100% of the health insurance compensation from carriers. ZaneHRA is distributed by leading health insurance carriers, agencies, brokers, and accountants.

DISCLAIMERThe information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state. www.ZaneBenefits.com

For additional resources on Health Care Reform, visit

www.zanebenefits.com/blog

Agenda

1. What is the Individual Health Insurance Marketplace?

2. Advantages of the Individual Health Insurance Marketplace

3. Individual Health Insurance Costs in 2014

4. Why the Marketplace Matters to You

5. Accessing the Individual Health Insurance Marketplace

What is the Individual Health Insurance Marketplace?

What is the Individual Health Insurance Marketplace?

Earlier this year, the government re-branded health insurance exchanges as Health Insurance Marketplaces.

The Individual Health Insurance Marketplace is the ACA's health insurance exchange ("AHBE") for individuals, which provides:

1. Individual Plan Standardization (standardizes individual health insurance products within specific metal tiers)

2. "Unbiased" Individual Plan Comparison (allows individuals to compare all plans in one "unbiased" place)

3. Tax Credit Administration (determines tax credit eligibility/amount and facilitates advanced payment)

"Helping individuals compare standard individual health insurance options"

Understanding How the Health Insurance Marketplace Works

Step 1: Individual goes to his or her state's Individual Health Insurance Marketplace website (e.g. www.coveredca.com).

Step 2: Individual completes 1 of 2 applications:i. Application for Insurance with Tax Credit (e.g. sample).ii. Application for Insurance without Tax Credit (e.g. sample).

Step 3: Individual health insurance marketplace displays all available plan options within metallic tiers and displayed cost will factor in tax credit.

Step 4: Individual selects plan.

Step 5: Individual health insurance marketplace bills individual for his or her portion of premium (i.e. the total premium minus tax credit) and forwards payment to the carrier

Advantages of the Individual Health Insurance Marketplace

Advantages of the Individual Health Insurance Marketplace

The Individual Health Insurance Marketplace will have the following 4 key advantages

1. Choice

2. Portability

3. 1 Stop Shop / Convenience

4. Tax Credits

#1 Choice

Individuals will be able to choose the health insurance plan that best fits their families' needs based on standard metallic levels:

Within each metallic level, Individuals will be able to choose different combinations of:

● co-pays● deductibles● co-insurance● networks

#2 Portability

Individual health insurance is not tied to employment, meaning they will be able to take their health insurance with them when they switch jobs.

This is a major advantage over traditional employer-sponsored health insurance.

Portable Memory Analogy

#3 1 Stop Shop / Convenience

1 Website and 1 Application gets individual access to:

● All available plan options, and● Premium tax credits.

Best of all, it will be "unbiased" (unlike sites like ehealthinsurance.com).

#4 Tax Credits

SPECIAL INCENTIVE: Massive tax credits* will be available for households earning up to 400% of the FPL (majority of Americans).

Individuals can only access the premium tax credits through the INDIVIDUAL health insurance marketplace.

(Requires Your Employer to Drop Coverage)

Household Income & Size are Key Variables for Individuals

Tax credit calculator coming soon at

http://navigator.zanebenefits.com

Household Size 100% of FPL 400% of FPL Premium Cap Range

1 $11,490 $45,960 $0 - $363.85 / mo

2 $15,510 $62,040 $0 - $491.15 / mo

3 $19,530 $78,120 $0 - $618.45 / mo

4 $23,550 $94,200 $0 - $745.75 / mo

5 $27,570 $110,280 $0 - $873.05 / mo

6 $31,590 $126,360 $0 - $1,000.35 / mo

7 $35,610 $142,440 $0 - $1,127.65 / mo

8 $39,630 $158,520 $0 - $1,254.95 / mo

2013 FPL Guidelines

Average Group Single Premium in 2011 was:

$435.17

Average Employee +1 Premium in 2011 was:

$860.75

Average Group Family of 4 Premium in 2011 was:

$1251.83

Individual Health Insurance Costs in 2014

Individual Health Insurance Costs in 2014

Actual individual health insurance premiums are TBD.

BUT, you can estimate your costs using a tax credit calculator.

For example, see Cover California Cost Estimator

Why the Marketplace Matters to You

Why the Health Insurance Marketplace Matters to You

1. Employees

If your firm does not offer health insurance, you may be eligible for a tax credit starting in 2014.

If your firm does offer health insurance, you may be able to get equivalent individual health insurance for less money (with portability).

2. Employers

Individual Insurance + Defined Contribution = BETTER BENEFITS FOR LESS?

3. Insurance Brokers

New solutions to offer employers, employees and individuals.*

*Many states (e.g. NY, WA) are allowing commissions to be paid directly from carrier.

Individual Insurance + Defined Contribution Link to Health Insurance Marketplace

Accessing the Individual Health Insurance Marketplace

Accessing the Individual Health Insurance Marketplace

You can only access coverage during designated Enrollment Periods

● Initial Enrollment Period, October 1st, 2013 - March 31st, 2014● Annual Enrollment Periods, October 15th - December 7th● Special Enrollment Periods, similar to cafeteria plan rules

Why Enrollment Periods?

Annual enrollment periods ensure that individuals and families don’t wait until they get sick to enroll in coverage.

Summary/Next Steps

Summary

Summary

● Starting in 2014, the Individual Health Insurance Marketplace will allow individuals to compare/purchase standard individual plans.

● The Marketplace facilitates the calculation and advanced payment of an individual's premium tax credit (if applicable).

● Employees are only eligible for the premium tax credit if employer drops coverage.

● Employers, Employees and Insurance Brokers need to understand the Marketplace because it may be a better solution than group health insurance.

The ZaneHRA Software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, check out our Software.

Employers use ZaneHRA to open and manage their own stand-alone HRA or defined contribution health plan completely online, electronically enroll participants and print welcome kits, and monitor expenses and reimbursements in real-time.

Employees obtain their own individual health policies from a designated health insurance broker (see below), submit premium and medical expenses online, via fax, or mail, and receive same-day reimbursement via check, payroll addition, or direct deposit. Zane Benefits does not sell health insurance.

Insurance Professionals partner with Zane Benefits and use ZaneHRA to provide clients with a cost-saving health benefits option. Insurance brokers earn compensation on ZaneHRA referrals and retain 100% of the health insurance compensation from carriers. ZaneHRA is distributed by leading health insurance carriers, agencies, brokers, and accountants.

DISCLAIMERThe information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state. www.ZaneBenefits.com

For additional resources on Health Care Reform, visit

www.zanebenefits.com/blog