Agenda Components of Reform to Consider Requirements of a small - - PowerPoint PPT Presentation

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Dec 28, 2022 226 likes •423 views

Agenda Components of Reform to Consider Requirements of a small employer Requirements of a large employer The Exchanges What do they mean? Do we Pay or Play? Changes Already in Effect Rate Review (2010) Grandfathering

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Agenda

Components of Reform to Consider Requirements of a small employer Requirements of a large employer The Exchanges – What do they mean? Do we Pay or Play?

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SLIDE 4

Changes Already in Effect

Rate Review (2010) Grandfathering (2009) Small business Tax Credits (2010) “Patient Bill of Rights” (2010) Network access – PCP Choice Independent appeals process No pre-ex for kids <19 Coverage for dependents up to age 26 100% coverage for wellness/prevention No Rescissions No Annual and lifetime limits Medical Loss Ratios – MLR (2010) Defines “maximum” insurance company profits 15% Large groups 20% small groups Requires refunds to groups is profit is too high

SLIDE 5

2013 – We’re Already Here

Limits on Health FSA Accounts
Increases in Medicare Payroll Taxes
Increases in Medicare Contribution Tax
Mandatory Form W-2 Reporting (100+ ee’s)
Health Care Exchange Notices

SLIDE 6

Coming Soon to a Policy Near You

Guaranteed Issue - Insurers must issue a policy to any applicant, regardless of health

condition. No pre-existing condition

limitations. Community Rating – Everyone is charged essentially the same amount for insurance. Variations for geography, smoking and age (3:1), was 7:1.

SLIDE 7

The Individual Mandate

The Individual’s Penalty

For not having “minimum essential coverage” Not more than the price of the lowest coverage option Some exceptions

SLIDE 8

Bad News for Insurance Rates

Bracing for rate double digits increase in 2014. (20%-60%) What’s gives? It’s the policymakers. It’s ObamaCare… Premium hikes are a consequence of policies. Premiums will rise because, in the end, everything has a price. Prohibition of traditional underwriting is a major and costly provision. Washington can try to force health plans to price insurance below cost, but then health plans will lose money and move out of markets. To keep the insurers whole, and accommodate the new rules, the cost of insurance must go higher. That re-pricing is what’s coming this fall.

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Preparing for 2014

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Discrimination

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SLIDE 11

What is a FT Employee?

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PPACA & the Small Employer

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A Large Employer = 50+ FTEs

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Large Employer Unaffordable Coverage Penalty

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Calculating Safe Harbor Limits

Employee Only Rate $325.00

Hourly Wage 80% 70% 60% 50%

6.54%

9.80% 13.07% 16.34%

6.13%

9.20% 12.27% 15.34%

5.78%

8.67% 11.56% 14.45%

5.46%

8.20% 10.93% 13.66%

5.18%

7.77% 10.36% 12.95%

4.93%

7.39% 9.85% 12.32%

4.69%

7.04% 9.39% 11.74%

4.48%

6.73% 8.97% 11.21%

4.29%

6.44% 8.58% 10.73%

4.12%

6.17% 8.23% 10.29%

3.95%

5.93% 7.91% 9.88%

3.80%

5.70% 7.60% 9.51%

3.66%

5.49% 7.33% 9.16%

3.53%

5.30% 7.07% 8.83% Employer Contribution

SLIDE 16

2014 Safe Harbor Limits

Employee Only Rate $455.00

Hourly Wage 80% 70% 60% 50%

9.15%

13.73% 18.30% 22.88%

8.59%

12.88% 17.18% 21.47%

8.09%

12.14% 16.18% 20.23%

7.65%

11.48% 15.30% 19.13%

7.25%

10.88% 14.51% 18.13%

6.90%

10.34% 13.79% 17.24%

6.57%

9.86% 13.15% 16.43%

6.28%

9.42% 12.56% 15.70%

6.01%

9.01% 12.02% 15.02%

5.76%

8.64% 11.52% 14.40%

5.53%

8.30% 11.07% 13.83%

5.32%

7.98% 10.65% 13.31%

5.13%

7.69% 10.26% 12.82%

4.95%

7.42% 9.89% 12.37%

4.78%

7.17% 9.56% 11.95%

4.62%

6.93% 9.24% 11.55%

4.47%

6.71% 8.95% 11.18%

4.33%

6.50% 8.67% 10.84%

4.20%

6.31% 8.41% 10.51%

4.08%

6.12% 8.16% 10.20%

3.97%

5.95% 7.93% 9.92%

3.86%

5.79% 7.71% 9.64% Employer Contribution

** Represents 40% increase in 2014

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The Exchanges

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2014…Decisions…Decisions Pay or Play?

How will this change your business? We can help to answer some big questions for you… 1.Is my plan as it is today in compliance? 2.What is the real net cost of my plan today? 3.What will it cost me if I cancel my plan and send my employees to the exchanges? 4.What penalties am I subject to based on my plan today? 5.How much will it cost me to make the changes necessary to get into compliance?

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