CBIZ HEALTH REFORM WHITEPAPER: THE IMPACT OF HEALTH REFORM ON YOUR BUSINESS
YOUR HEALTH YOUR BUSINESS. Health Care Reform Law What Does Health Care Reform Mean to You? -My...
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Transcript of YOUR HEALTH YOUR BUSINESS. Health Care Reform Law What Does Health Care Reform Mean to You? -My...
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YOUR HEALTH
YOUR BUSINESS
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Health Care Reform Law
• What Does Health Care Reform Mean to You?- My Options- What About Pre-Existing Conditions
• When Does It Take Effect?
How can Brighton Health Solutions Help
Me?
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The Patient Protection and Affordable Care Act of 2010
March, 2010: President Obama Signed Into Law Landmark Health Care Reform Legislation
March 23, 2010 – “Today, after almost a century of trying. Today, after over a year of debate. Today, after all the votes have been tallied, health insurance reform becomes law in the United States of America…We are a nation that faces its responsibilities and faces its challenges. Here in this country we shape our own destiny…That's what makes us the United States of America.”
– President Obama
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Timeline of Key Elements: The Patient Protection and Affordable Care Act
2010 2011 20142012 2013 2015 & Beyond
• New federal rate review process established
• Insurance market reforms begin, including:
• Children may stay on parents’ policies until age 26 and no pre-ex exclusions for children until age 19
• Lifetime benefit limits prohibited
• Rescissions prohibited except for fraud
• Limited small business tax credits established
• Part D rebate for beneficiaries in the gap
• Temporary high risk pool created
• Statutory Medicaid drug rebates to states for drugs provided in managed care
• Funds for Community Health Centers
• MLR mandated: 85% for large group and 80% for small group and individual (non-group)
• Uniform coverage documents and standard definitions developed
• HSAs & FSAs limited • Discounts in Part D
“Donut Hole”• Annual fee on
pharmaceutical manufacturers begins
• Physician Quality Reporting Initiative bonuses
• Coverage for preventative services in Medicaid begins
• Reimbursement rates for primary care increased
• Medicare Advantage phase-in of capped FFS rates begins
• Quality bonus begins to be phased-in for Medicare Advantage plans
• Plans to merge Medicare incentives for physician quality reporting and for meaningful use of electronic medical records
• State Medicaid plans are required to pay primary care providers at Medicare rates
• Deduction for expenses allocable to the Part D subsidy for “qualified prescription drug plans” is eliminated
• High earner tax begins
• FSA contributions limited
• Annual fee on medical device sales begins
• Public reporting of physician performance information begins
• Annual insurance industry tax begins
• Insurance market reforms continue, including:
• Exchanges established• Guarantee issue
requirements • Standardized
minimum benefit offerings
• Prohibitions on annual limits, pre-existing condition exclusions, and rating based on health status
• MLR for MA and coding intensity changes go into effect
• Medicaid expansions become effective
• Individual and employer responsibility requirements begin
• Independent Payment Advisory Board presents first proposals
• Physician value-based payment program to promote quality for Medicare beneficiaries created in 2015
• States have flexibility to provide CHIP eligible's coverage in the Exchanges in 2015
• High-value plan excise tax begins in 2018
• “Donut hole” closed by 2020
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How Does Insurance Help My Lifestyle?
• Success is built and sustained by being Healthy.
• How much do I want to Risk with my Health and My Family?
• How Much do my Team Members Risk?
• Fact: Half of All US Bankruptcies stem from a Medical Crisis
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Preventing the 3 Types of Risk
1. Lost Income
2. Uncovered Medical Cost
3. Non-Medical Costs Associated with Accident or Illness
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Major Medical Solutions
• Who can qualify for Major Medical?
• Why do I want Major Medical?– Health Care Law Requirement– Peace of Mind
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Major Medical SolutionsBENEFITS:• Hospital inpatient room and board including intensive and cardiac care
• Hospital medical and surgical services and supplies
• Physicians' diagnostic, medical, and surgical services
• Other medical practitioners' services
• Nursing services including private duty service outside the hospital
• Anesthesia and anesthesiologist services
• Outpatient services
• Ambulance service to and from a hospital
• X-rays and other diagnostic and laboratory tests • Radiological and other types of therapy• Prescription drugs • Blood and blood plasma • Oxygen and its administration • Convalescent nursing home care • Home health care services
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Dental Facts
• General StatisticsGeneral Statistics • Approximately 130 Million Americans lack dental coverage – nearly
triple the number without health insurance. (Managed Dental Care, August 2008)
• Research is pointing to associations between chronic oral infections and heart and lung diseases, stroke, and low-birth-weight, premature births.
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Dental SolutionsBrighton Health Solutions works with
Partners that:• Provide an affordable way to reduce dental care costs
without restricting access to care – only $8 per month
• Provide no restrictions, limitations, or maximums
• Guaranteed Issue
• Have Discounts that range from 20% to 60%*
• Are Available at 98,000+ participating locations nationwide
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Dental SolutionsExample Savings…Example Savings…
Actual Dental Visit – single member
Procedure Billed Discount Paid
X-Rays $37.00 49% $19.00
Limited Oral Evil $58.00 59% $24.00
Filling – Resin (2) $143.00 44% $80.00
Filling – Resin (3) $210.00 51% $104.00
TOTALS: $448.00 49% $227.00
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Indemnity SolutionsFor those who cannot afford Major Medical
or cannot Qualify for Major Medical
• Guarantee Issue• Pays in addition to any coverage• Covers all pre-existing limitations
(including pregnancy)• First Dollar Benefits • No deductibles• No co-pays
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Indemnity Solutions
BENEFITS• Guarantee Issue
• No Pre-ex
• No annual benefit maximums
• Assignable benefits
• Pays in addition to any other coverage
• Benefits apply regardless of where care is given
• National PPO Network included for claim discounts
• Telemedicine Services
• 24 Hour Nurse Line Assist
• Patient Advocacy
• Prescription Drugs benefits
• Dental Discount Program
• Insured Vision Program
• Lab & Imaging Discount Benefit
• Adult Wellness Plan
• Accident Medical benefit & AD&D with no annual limits
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Disability Solutions
RISK PREVENTION
• How do You Qualify and How Much?• Why You Need it?
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Life Insurance SolutionsPreparation and Peace of Mind through Proper Planning-
Why YOU Cannot Live Without This Benefit!!
1. Mortgage Protection2. Income Replacement
3. Final Expenses4. College Funding
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International Insurance Solutions
Insurance helps to offset deductibles that your International Team Members have with their
current health programs.
• Who Qualifies?• Why You Need it?
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International Insurance SolutionsWorldwide Coverage for Non - U.S. Citizens and Expatriates
Hospitalization
SurgeryOutpatient
Rx CoverageEmergency Room Accident
Emergency Medical EvacuationTransplants
Child WellnessMaternity
Global Term Life InsuranceGlobal Daily Indemnity
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How Can Insurance Help To Support Your Team?
• Take Risk Out of Equation for You• Protect Your Family Income
• Support Your Team Members
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Contact Information
Brighton Health Solutions877-261-4491801-261-2600
www.brightonhealthsolutions.comTroie Battles – Managing Partner