“Making Hay in the ACA”

1. “Making Hay in the ACA” “what is in it for me?” Call 1-866-309-0557 Access Code *1291180*

2. During a live webinar For the courtesy of all participants, please: • Place your phone on mute • Either press *6* • Or press the mute button on your phone device • To unmute, press *6* or the unmute button on your phone device • Do not place you phone on hold at anytime • Either remain on mute or hang up if you need a break

3. Agenda • Important resources to help you and your prospects • Health Insurance Marketplace Certification • BCBSTX Certification • 2014 BCBSTX ACA plans & agent commissions • Using tax subsidies to prospect and grow your clientele

4. Agenda Continued • SHOP Exchange Update • Small Group Health Insurance Tax Credits (HITCs) • Using HITCs to get more small group health insurance • Early renewal strategies • Marketing tips

5. Disclaimer • This presentation is tailored for independent health insurance agents in the state of Texas that intend to write BCBSTX in the HIMs. 09-27-13

6. Valuable ACA Resources All located in our Health Care Reform section at www.TheBrokerageInc.com

7. Resources at www.TheBrokerageInc.com

8. Scroll down to “Health Care Reform”, where ACA related resources may be found.

9. Visit www.AskBlueInsurance.com

10. www.Medicare.gov

11. https://www.healthcare.gov/(available in Spanish)

12. CuidadoDeSalud.gov

13. Hola? • 9-26-13: The Spanish version of www.healthcare.gov will not be able to accept new HIM enrollments “for a few weeks” • 10-25-13: Spanish online enrollment is not going to happen…this year • An estimated 10 million Latinos are eligible for coverage, and 4 million of them speak Spanish primarily. • The state of Texas is 40%+ Latino

14. Use www.CMS.gov for YouTube video learning

15. Registration Process for Agents / Brokers • Note: the agent distribution channel did not create the problems…but we must deal with them. • Know that we would like to help you register, but we cannot do anything to fix the volume or technology challenges. • If you need assistance, call 855-267-1515. • The certification process is beginning to work now.

16. Getting set up to market on the HIMs Four step process: • Register at the CMS Enterprise Portal (Part 1) • Complete your certification at The Health Insurance Marketplace website • Register to accept applications in the HIMs (Part 2) • Complete the BCBSTX required certification

17. Step One: Register to certify

18. https://www.regtap.info/uploads/library/AB_slides_092713_5CR_092613.pdfhttps://www.regtap.info/uploads/library/AB_slides_092713_5CR_092613.pdf

19. Certify https://marketplace.medicarelearningnetworklms.com

20. Step 3: Register to enroll people in the HIMs

21. Step 3 - Setting Up Your FFM Account • You create your FFM UID (Federally Funded Marketplace User ID) when you create your account on the CMS Enterprise Portal during the agent/broker registration process. • If you forget your FFM User ID or password information, click on the "Forgot my User ID/Password" link on the CMS Enterprise Portal log-in web page at https://portal.cms.gov/. 

22. www.bcbstx.com/producer Step 4: Get certified with The Blues

23. The message is simple: Right now, nothing is required by Federal law for you to own. On January 1, 2014, that changes. You will then be required by law to own a qualified health insurance. If you cannot afford a QHP, you will be subsidized. If you choose not to own a QHP, you will be penalized. If you need help, I will help you.

24. Simplify the message – use the Government sources!

25. Marketing tips • Know how to calculate subsidies • Know how to complete a HIM application • Hint: no health questions, more qualification questions • Find the Health Insurance Marketplace applications for a QHP at www.TheBrokerageinc.com in the HCR Resources section • Know how to calculate Health Insurance Tax Credits for groups of 2-25 Use HITCs to prospect small groups of 2-25 lives

26. Health Insurance Marketplace (Short Form)

27. HIM (Short Form)

28. HIM (Short Form)

29. Who are the 50M uninsured? And how do I get quotes and sign them up?

30. Individuals Eligible for Premium Tax Credit, by Income

31. Individuals Eligible for a Premium Tax Credit, by Employment Status

32. Individuals Eligible for a Premium Tax Credit, by Age

33. How do you get a health insurance quote?

34. You will end up at the Kaiser website

35. www.kff.org – Subsidy Calculator

36. Enter demographic info & click “submit”

37. Instant results

38. Subsidies are based on the 70% Actuarial Value Plan or “The Silver Plan” • 70% AV Plan Premium $11,450 • Minus the subsidies - $ 8,085 • Net premium cost to family = $ 3,365 per year Total Family Premium is $280 per month

39. 60% AV Plan or “The Bronze Plan” • 60% AV plan premium $9,490 • Minus the subsidies - $8,085 • Net premium cost to family = $1,405 per year Total Premium is $117 per month

40. ACA “MOOP” (Max Out of Pocket) • $6,350 for an individual • $12,700 for a family • Same as the MOOP of an HDHP (high deductible health plan) • Bronze or Silver plans have the same max out of pocket • If you only make $50K per year, how can you pay this MOOP? • Add a supplemental health plan

41. Sales Idea: “The Combo Plan” “Bronze Plan” and “Active Care” • Bronze Premium $117 • Active Care Premium $153 • Total Family Premium $270 per month $10 less per month than The Silver Plan at $280 per month, but the supplemental health plan helps offset the $12,700 MOOP.

42. What is Active Care? • New supplemental health product • combines Critical Illness, Cancer, Heart Attack, Stroke, ESRD, and Accident benefits into one product • Simplified underwriting • May be list billed • Agent commission is 50% • Contact Belynda@TheBrokerageInc.com for complete details • Visit http://thebrokerageinc.com/insurance-products/critical-illness/

43. Let’s review these numbers again… 6% commission is paid by BCBSTX for years 1-3, and 4% level after that.

44. Which plan is best suited for the family? • The Silver Plan costs $280 per month • The Bronze Plan / Active Care plan costs $270 per month • The Combo Plan saves the family $10 per month in total premium • The Combo Plan offers better protection to the family • The Combo Plan pays the agent 54% more commission!

45. <250% Federal Poverty Level =CSR or Cost Sharing Reductions • Similar to the Medicare Savings Plan (Low Income Subsidy), a person at or below the 250% FPL is eligible for cost sharing on the Silver Plan • Think of how the “low income subsidies” work within the “Medicare Savings Program” • How might this impact your recommendations? • Should they even consider a supplemental plan(s)? • Or should they consider less of a supplemental benefit plan(s)?

46. 2014 BCBSTX HIM Plans • Rx Benefits • The Gold Plan On Exchange & The Gold Plan Off Exchange • The Silver Plan On Exchange & The Silver Plan Off Exchange • The Bronze Plan On Exchange & The Bronze Plan Off Exchange

47. 2014 BCBSTX Individual Plans Rx Benefits Structure • Benefit Structures • Drug Card • Coinsurance after Medical Deductible • Formulary • Standard Formulary on PPO Network • Generics Plus formulary on narrow networks • Generics Plus is essentially a leaner version of the standard formulary and includes non-specialty and specialty drugs for all major therapeutic categories • 5-Tier Drug (2-tier Generics) • Drives utilization towards Generic drugs

48. On Exchange – Gold

49. On Exchange – Silver

50. On Exchange – Bronze