1. ACA Simplified The Affordable Care Act (PPACA) was signed into law on March 23, 2010— putting in place measures to improve access to affordable health care. Starting January 1, 2014: Most Americans will have to purchase health insurance or pay a penalty: $95 or 1% of Income for 2014 – assessed on annual tax filing. Large employers (51 or more employees) may be subject to penalties if they don’t provide insurance – Postponed until 2015 Insurance companies will need to modify their plan offerings to meet certain requirements of the ACA – QUALIFIED HEALTH PLANS Every state must have a Health Benefit Exchange, where individuals and small businesses can shop for health coverage. An Exchange is an On-line Digital Marketplace where consumers can go to shop for insurance. New York will have two Exchanges: an Individual Exchange (for Individuals and Sole Proprietors) and a Small Business Health Options Program (SHOP) Exchange (Businesses 2-50 employees)

2. Important Exchange Dates October 1, 2013: Open enrollment begins January 1, 2014: Effective date for plans offered in the exchange and for penalties for non-compliance March 31, 2014: Open enrollment ends

3. Small Business Compliance May purchase insurance through a broker or directly from an insurance carrier May purchase coverage through NY’s SHOP exchange Allow employees to shop the individual exchange

4. Premiums & Benefits Plans sold in the exchange must offer a minimum set of essential benefits Plans will be offered in platinum, gold, silver & bronze tiers in the exchange Premiums must be the same for identical polices whether sold in the exchange or off the exchange Policies sold off the exchange may include enhanced benefits such as wellness programs

5. Qualified Plans Guaranteed issue No pre-existing conditions exclusions No lifetime caps on coverage Dependent coverage through age 26 (NY requires dependent coverage through 30) Preventive care Women’s health care

6. Qualified Plan Benefits Qualified plans must include: Ambulatory patient services Emergency room services Hospitalization Maternity and newborn care Mental health and substance use disorders Prescription drugs

7. Qualified Plan Benefits continued Rehabilitative and rehabilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care

8. Metal Tiers Plan tiers are based on the % of costs covered: Bronze is 60% Silver is 70% Gold is 80% Platinum is 90%

9. Deductible/Out-Of-Pocket Max Out-of-pocket maximum amounts may not exceed established limits; adjusted annually. Deductibles generally can not exceed established limits of $2,000/single or $4,000/family

10. Premium Assistance Individuals whose income is 139-400% of the FPL may obtain a tax credit that can be applied to the premium of any level plan purchased in the exchange Employers with fewer than 25 FTE’s may earn tax credits of up to 50% of premiums for 2014 and 2015 (35% for NFP employers)

11. Penalties 2014: The greater of $95/adult & $47.50/child up to $285/family or 1% of taxable income 2015: The greater of $325/adult & $162.50/child up to $975/family or 2% of taxable income 2016: The greater of $695/adult & $347.50/child up to $2,085/family or 2.5% of taxable income

12. NY Exchange Plans Affinity Health Plan Today’s Options of NY BC/BS of Western NY BSNENY Capital District Physicians Health Plan Emblem Health Empire BC Empire BC/BS

13. NY Exchange Plans continued Excellus Fidelis Care Health First Health Republic Independent Health Market Plus MVP North Shore LIJ Care Connect

14. NY Exchange Plans continued Oscar United Healthcare United Healthcare Oxford Univera

15. For More Information 1-855-355-5777 www.healthbenefitexchange.ny.gov