Presented by: Sandy Walters Executive Vice President & Senior Consultant Kelly & Associates Insurance Group

1. How the Exchanges / Marketplace Will Effect Your Business & The Latest Updates of ACA Presented by: Sandy Walters Executive Vice President & Senior Consultant Kelly & Associates Insurance Group

2. Two Employer Rules for Large Group • Avoid $2,000 penalty by offering any plan • Avoid $3,000 penalty by either • - Offering qualified and affordable plan • - Having employee take any plan

3. Counting Employees Variations in Counting: • If an employer fails to provide its full-time employees (and their dependents) the opportunity to enroll in “minimum essential coverage,” and • One or more full-time employees enrolls for coverage in an exchange and qualifies for a premium tax credit or cost-sharing reduction, then • Employer penalty = $2,000 for each of its full-time employees in the workforce

4. Employee Rules • Must have qualified coverage if affordable (less then 8% of family income ) • Can only receive either subsidy if  • - Income under 400% poverty level • - Not offered qualified and affordable plan from any size employer  • - Does not participate in any other plan • - Not eligible for Medicaid

5. 2013 Poverty Guidelines for 48 Contiguous states and DC For families/households with more then 8 persons, add 4,020 for each additional person

6. Salary-Hours-Max Contribution

7. DC Coverage Assistance Options in 2014 400% Approximate Income Levels as a Percent of Poverty 300% 250% 200% 133% 100%

8. Exchanges

9. Medicaid Expansion

10. Exchange: Pros & Cons • Pros SHOP • Tax Credit • Employee Choice

11. Tax Credit • Under 25 Employees • Under 50K Average Salary • Contribution must be at least 50% • Max Credit - Under 11 Employees & Under 25K Salary

12. Employer Choice vs. Employee Choice

13. Exchange: Pros & Cons • Cons SHOP • Work with Government Entity • Same Plans Outside the Exchange at Same Price • Limited Plans • Strict Participation Rules in Shop • Disclosure of Info to Government • Higher Probability of Data Theft

14. Exchange: Pros & Cons • Pros of Individual Coverage • Subsidy

15. Exchange: Pros of Individual Exchange • Subsidy • Family Income Under 400% Poverty Level • No Group Qualified Affordable Single Coverage Available • Family Income Under 250% Poverty Level

16. Exchange: Pros & Cons • Cons Individual • Lose Pretax Savings • Employers Contribution

17. DC Health Link – Who Has AccessDC Residents, Lawfully Present

18. DC Residency Requirements Individuals & Families • Persons under age 19 or one who is homeless can self-attest to residency • Otherwise, documentation such as a lease , deed or letter from roommate can prove residency • Moving our of DC would cause loss of eligibility for DC Health Link plan • 30 days to inform DC Health Link of change in residency • Plan eligibility can continue until end of month following month of reported change. • Premium payment required for that month. Small Businesses • No check on individual’s legal status or residency for small business enrollees

19. Choice of Plans

20. Transition to One Marketplace DC Health Link

21. Premium Calculation • DC will not permit a surcharge for tobacco users • Each employee will have a different premium based on his/her age • Family premiums will be a total of each family member’s age rate • Family premium – tour premium plus spouse/partner’s premium + child(ren)’s premium • Up to 3 children under age 21 included in family premiums

22. Employer Contributions DC Health Link will allow a small employer to select its contribution level • Select one plan to base contributions on, the “reference plan” • Select a Percentage to contribute for employees and dependents to enroll in reference plan • The contribution remains fixed based on the reference plan. Employees enrolling in any other allowed plan will pay the difference in premium to “buy-up” or “buy-down”

23. Counting Employees To calculate the number of “full-time equivalent (FTE)” employees: • Count all employees who worked on average 30 hours per week or more • Count the number of hours worked on average by part-time employees and divide by 30, rounding up to the next higher number for any fractions • Add the two numbers together Note: Count all employees, not just those that are eligible for health benefits. For example: SmallCo has 20 full-time employees working 30 hours per week and 4 part-time employees working 15 hours per week • Full-time employees 20 • Part time hours divided by 30 2 • Total full-time equivalents 22

24. Sample On and Off Exchange • Individual Coverage 50% and 75% Paid by Employer • Annual Income $30,000 • Monthly Income $2,500 • Hourly Income $14.42 • Individual Coverage • Monthly Premium $300

25. Sample On and Off Exchange

26. Questions