Health Care Reform

1. Health Care Reform September 18th, 2013

2. Individual Marketplace • Which individuals can purchase insurance on the exchange? • Individuals who do not have access to “minimum essential coverage” or “affordable coverage” through their employer • Individuals who are eligible for either of the two types of financial assistance: • 1.Advance premium tax credits and/or • 2.Cost sharing reductions to out-of-pocket maximums

3. Eligibility

4. Premium Tax Credits Individual Market: • Premium assistance available to individuals who fall between 100% to 400% of the Federal Poverty Level • This premium assistance is only available to individuals who qualify and purchase through the marketplace. • Credit amount is generally equal to the difference between the premium for the “benchmark plan” and the taxpayer’s “expected contribution.” • Benchmark plan = the second-lowest-cost “silver” plan

5. Premium Tax Credits

6. Calculating Premium Caps

7. Cost-Sharing Reductions Individual Market: • The expected contribution is a percentage of the taxpayer’s household income based on a sliding scale (contribution increases as income increases) • Cost-sharing reductions available to individuals below 250% of the Federal Poverty Level – these are reductions limiting the amount people must pay out-of-pocket • This cost-sharing reduction is only available to individuals who qualify and purchase through the marketplace.

8. Cost-Sharing Reductions Individual Market - for a family of four in 2013: 100% of FPL = annual income of $23,052 250% of FPL = annual income of $57,636

9. Actuarial Value • Catastrophic • 60% = Bronze • 70% = Silver • 80% = Gold • 90% = Platinum *Actuarial value is not affordability.

10. Actuarial Value You can check your plan at the CCIIO website using the AV Calculator.

11. Small Group • Premiums are member level rated but capped at three dependents under the age of 21. Once a child turns 21 they will count as another adult.

12. Small Group – Impacts to Premiums Annual Health Insurer Fee Reinsurance Fee Premiums Will Increase to Account for Fees = + Exchange User Fee We have heard from carriers that this will be between 4 & 6%.

13. Small Group – Impacts to Premiums Plan Design Changes • Limit on out-of-pocket maximum (OPM) for Essential Health Benefits to HSA qualified amounts (2014) $6,350 single/$12,700 family • Essential Health Benefit health and drug out-of-pocket payments include: Deductibles, Coinsurance, and Copayments • Small Group deductible limits (2014) $2,000 single/$4,000 family • Essential Health Benefits package effective for plan years on or after Jan. 1, 2014

14. Small Group – Impacts to Premiums

15. Small Group – Impacts to Premiums • Health and Gender No Longer a Factor!!! • No Pre-Existing Conditions!!! • No waiting periods longer than 90 days! • 1st Plan Year following January 1st 2014 • Wellmark is making all groups change 1/1/14

16. Carriers In the Marketplace(aka Exchange) • Sanford • 4 Plan options • Avera • 10 Plan Options • Dakotacare • 2 Plan Options in the marketplace, • Many more in the traditional market Rates will be the same in and out of the marketplace.

17. Carriers outside the Marketplace • Wellmark • 14 Plans offered • Coventry • Assurant • Federated

18. Small Employer Tax Credits Available only inside the SHOP beginning in 2014. So who’s eligible? • Fewer than 25 full-time equivalent employee’s • Pay average annual wages below $50,000 per FTE • Contribute at least one half (50%) of the cost of each of their employee’s health insurance premium • Tax credit in 2014 for for-profit employers: 50% of premiums • Tax credit in 2014 for non-profit employers: 35% of premiums