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?

5

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

7

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

10

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