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YOUR HEALTH YOUR BUSINESS. Health Care Reform Law What Does Health Care Reform Mean to You? -My Options -What About Pre-Existing Conditions When Does.

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Presentation on theme: "YOUR HEALTH YOUR BUSINESS. Health Care Reform Law What Does Health Care Reform Mean to You? -My Options -What About Pre-Existing Conditions When Does."— Presentation transcript:


2 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?

3 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

4 Timeline of Key Elements: The Patient Protection and Affordable Care Act & 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

5 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

6 Preventing the 3 Types of Risk 1.Lost Income 2.Uncovered Medical Cost 3.Non-Medical Costs Associated with Accident or Illness

7 Major Medical Solutions Who can qualify for Major Medical? Why do I want Major Medical? – Health Care Law Requirement – Peace of Mind

8 Major Medical Solutions BENEFITS: 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

9 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.

10 Dental Solutions Brighton 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

11 Dental Solutions Example Savings… Actual Dental Visit – single member ProcedureBilledDiscountPaid X-Rays$ %$19.00 Limited Oral Evil$ %$24.00 Filling – Resin (2)$ %$80.00 Filling – Resin (3)$ %$ TOTALS:$ %$227.00

12 Indemnity Solutions For 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

13 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

14 Disability Solutions RISK PREVENTION How do You Qualify and How Much? Why You Need it?

15 Life Insurance Solutions Preparation and Peace of Mind through Proper Planning- Why YOU Cannot Live Without This Benefit!! 1. Mortgage Protection 2. Income Replacement 3. Final Expenses 4. College Funding

16 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?

17 International Insurance Solutions Worldwide Coverage for Non - U.S. Citizens and Expatriates Hospitalization Surgery Outpatient Rx Coverage Emergency Room Accident Emergency Medical Evacuation Transplants Child Wellness Maternity Global Term Life Insurance Global Daily Indemnity

18 How Can Insurance Help To Support Your Team? Take Risk Out of Equation for You Protect Your Family Income Support Your Team Members

19 Contact Information Brighton Health Solutions Troie Battles – Managing Partner

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