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Healthcare Reform Benefit Consultants Northwest Plan Administrator “ Knowledge is Power in Benefit Management ” Quality Service Integrity Knowledge Support.

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Presentation on theme: "Healthcare Reform Benefit Consultants Northwest Plan Administrator “ Knowledge is Power in Benefit Management ” Quality Service Integrity Knowledge Support."— Presentation transcript:

1 Healthcare Reform Benefit Consultants Northwest Plan Administrator “ Knowledge is Power in Benefit Management ” Quality Service Integrity Knowledge Support Presented by: Introducing Call Center

2 Quality Service Integrity Knowledge Support Table of Contents Page 1Small Business Tax credit Page new taxes Page new taxes Page new taxes Page new taxes Page 6Penalties Page 7What is in effect now Page 8Small Group Page 9Large Group Page 10Metallic Plans Page 11State Exchanges Page 13Essential Health Benefits “ Knowledge is Power in Benefit Management ” Healthcare Reform The following organizations provided information for this presentation:  Heritage Foundation  Washington State OIC  Healthcare.gov  NFIB  NAHU  HHS PPACA was signed on Jan 5, 2010 Supreme Court ruling June 28, 2012 Timeline is found on

3 Healthcare Reform Quality Service Integrity Knowledge Support Small Business Tax Credit 2010 first year credit available Government says 4 Million businesses qualify but less than 10% have applied. Are you one of them? Less than 25 Full Time Employees and $50,000 average wage Credit is up to 35% of Premium Cost 50% of premium cost in 2014 “ Knowledge is Power in Benefit Management ”

4 Quality Service Integrity Knowledge Support What Were The New Taxes % tax on Indoor Tanning Services $2.7 Billion Repeal special deductions for the Blues $ 400 Million Exclude Bio Fuel Producer Credit $24 Billion Increase corporation taxes by disallowing certain activities that lower tax liability $4.5 Billion “ Knowledge is Power in Benefit Management ” Healthcare Reform

5 Quality Service Integrity Knowledge Support What Were The New Taxes 2011 Impose annual fee on drug manufacturers $27 Billion Reduce allowable prescriptions allowed under HSA and FSA (OTC Drugs) $5 Billion Increase penalty for HSA/FSA disallowed purchases from 10% to 20% $1.4 Billion “ Knowledge is Power in Benefit Management ” Healthcare Reform

6 Quality Service Integrity Knowledge Support What Are The New Taxes 2013 Increase payroll taxes plus investment income to AGI (2.9% to 3.8%) $210 Billion 2.3% excise tax on medical devices $20 Billion Raise floor for medical deductions to 10% $15 Billion Eliminate corp deduction for retiree Rx $4.5 Billion Increase taxes on health insurance companies $ 600 million “ Knowledge is Power in Benefit Management ” Healthcare Reform

7 Quality Service Integrity Knowledge Support What Are The New Taxes 2014 Mandate coverage for individuals $65 Billion Annual fee on health insurance providers $60 Billion Limit FSA to $2,500 $13 Billion 40% Tax on Cadillac health plans (2018) $32 Billion Total New Taxes over 10 years $503 Billion “ Knowledge is Power in Benefit Management ” Healthcare Reform

8 Quality Service Integrity Knowledge Support Penalties / Taxes Mandate coverage for individuals in 2014 if no coverage: tax is $95 or 1%, increases to $695 or 2.5% in Small Business (50 or less FTE) no mandate, but if you provide coverage must have the 10 Essential Health Benefits. (Bronze level plan) Large business (over 50 FTE). $40,000 plus $2,000 per employee over 50 if no coverage. If employer provides coverage it must cost the employee less than 9.5% of wages and be at least a Bronze level of benefits. “ Knowledge is Power in Benefit Management ” Healthcare Reform

9 Quality Service Integrity Knowledge Support What is in effect now? No out of pocket for Preventive No lifetime caps Must cover Child’s Pre-existing condition Children up to age 26 can stay on parent’s plans Small Business tax Credit Federal medical loss ratio standards Federal review of unreasonable rate increases Expanded coverage for early retirees “ Knowledge is Power in Benefit Management ” Healthcare Reform

10 Quality Service Integrity Knowledge Support Small Group Employers 50 FTE or Less Small Business Tax Credit Limits on HSA/ FSA No out of pocket for Preventive No lifetime caps Must cover Childs Pre-existing condition Children up to age 26 can stay on parent’s plans Federal medical loss ratio standards 80% Emergency Services in and out of network benefits must be the same “ Knowledge is Power in Benefit Management ” Healthcare Reform

11 Quality Service Integrity Knowledge Support Large Group 51 FTE or More Mandate coverage at the Bronze level No out of pocket for Preventive No lifetime caps Must cover Child’s Pre-existing condition Children up to age 26 can stay on parent’s plans Federal medical loss ratio standards 85% Penalty approx $2,000 per employee for no coverage 40% tax on Cadillac Plans paid by insurer/employer “ Knowledge is Power in Benefit Management ” Healthcare Reform

12 Quality Service Integrity Knowledge Support Metallic Plans Platinum 90% actuary value Gold 80% actuary value Silver 70% actuary value Bronze 60% actuary value Actuary value means: The percentage the insurer is expected to pay in claims. The remainder is paid by the insured. On July 10, 2012 Jeff Roe, CEO of Lifewise Insurance, stated that most small business plans today are at the 40% to 45% actuary value. “ Knowledge is Power in Benefit Management ” Healthcare Reform

13 Quality Service Integrity Knowledge Support State Exchanges Each state will have an exchange, if states do not set one up the Feds will Web based site that will compare plans within a state Insurers must offer plans within and outside of the exchange Subsidies are received through the exchange Businesses can compare products through the Small Business Health Options Program (SHOP) Individuals can compare like products “ Knowledge is Power in Benefit Management ” Healthcare Reform

14 Quality Service Integrity Knowledge Support It is the law of the land In less than 18 months all Americans are required to have health insurance It is an individual mandate Companies over 50 employees will be fined if not offering insurance at the Bronze level States will have exchanges for you to shop for coverage BCNW and ASA will be there to help you through this transition of Healthcare Reform “ Knowledge is Power in Benefit Management ” Healthcare Reform

15 Quality Service Integrity Knowledge Support Essential Health Benefits Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care “ Knowledge is Power in Benefit Management ” Healthcare Reform


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