1. Health Care Reform September 18 th, 2013

2. Individual Marketplace O Which individuals can purchase insurance on the exchange? O Individuals who do not have access to “minimum essential coverage” or “affordable coverage” through their employer O Individuals who are eligible for either of the two types of financial assistance: O 1.Advance premium tax credits and/or O 2.Cost sharing reductions to out-of-pocket maximums

3. Eligibility Year Enrollment Timeframe Time PeriodEffective Date Assigned 2013 Open Enrollment 10/1/2013 –3/31/2014 If applying between 10/1/13 – 12/15/13 = 1/1/14 If applying between 12/16/13 – 1/15/14 = 2/1/14 If applying between 1/16/14 – 2/15/14 = 3/1/14 If applying between 2/16/14 – 3/15/14 = 4/1/14 If applying between 3/16/14 – 3/31/14 = 5/1/14 Special Enrollment Throughout the year Next day effective date, if requested, or any other day up to 60 days of the event in the future. 2014 Open Enrollment 10/15/2014 -12/7/2014 1/1/2015 Special Enrollment Throughout the year Next day effective date, if requested, or any other day up to 60 days of the event in the future.

4. Premium Tax Credits Individual Market: O Premium assistance available to individuals who fall between 100% to 400% of the Federal Poverty Level O This premium assistance is only available to individuals who qualify and purchase through the marketplace. O Credit amount is generally equal to the difference between the premium for the “benchmark plan” and the taxpayer’s “expected contribution.” O Benchmark plan = the second-lowest-cost “silver” plan

5. Premium Tax Credits Income LevelPremium as a % of Income Up to 133% of FPL2% of Income 133 – 150% FPL3 – 4% of Income 150 – 200% FPL4 – 6.3% of Income 200 – 250% FPL6.3 – 8.05% of Income 250 – 300% FPL8.05 – 9.5% of Income 300 – 400% FPL9.5% of Income

6. Calculating Premium Caps Sample Single Household Sample Family of 4 Annual Income Monthly Premium Cap Annual Income Monthly Premium Cap FPLCap% 100%2%$11,200$19$23,000$39 200%6.3%$22,300$117$46,100$242 300%9.5%$33,500$265$69,200$548 400%9.5%$44,700$354$92,200$730

7. Cost-Sharing Reductions Individual Market: O The expected contribution is a percentage of the taxpayer’s household income based on a sliding scale (contribution increases as income increases) O Cost-sharing reductions available to individuals below 250% of the Federal Poverty Level – these are reductions limiting the amount people must pay out- of-pocket O This cost-sharing reduction is only available to individuals who qualify and purchase through the marketplace.

8. Cost-Sharing Reductions Silver Plan Actuarial Value Consumer Max OOP Amount Limits Applicable Population 94%$2,250 Single $4,500 Family 200 – 250% FPL 87%$2,250 Single $4,500 Family 150 – 200% FPL 73%$5,200 Single $10,400 Family 100 – 150% FPL Individual Market - for a family of four in 2013: 100% of FPL = annual income of $23,052 250% of FPL = annual income of $57,636

9. Actuarial Value O Catastrophic O 60% = Bronze O 70% = Silver O 80% = Gold O 90% = Platinum *Actuarial value is not affordability.

10. Actuarial Value Metallic TierMember PaysInsurance Pay Bronze40%60% Silver30%70% Gold20%80% Platinum10%90% You can check your plan at the CCIIO website using the AV Calculator.

11. Small Group O Premiums are member level rated but capped at three dependents under the age of 21. Once a child turns 21 they will count as another adult.

12. Small Group – Impacts to Premiums Annual Health Insurer Fee Reinsurance Fee Premiums Will Increase to Account for Fees + = We have heard from carriers that this will be between 4 & 6%. Exchange User Fee

13. Small Group – Impacts to Premiums Plan Design Changes O Limit on out-of-pocket maximum (OPM) for Essential Health Benefits to HSA qualified amounts (2014) $6,350 single/$12,700 family O Essential Health Benefit health and drug out-of-pocket payments include: Deductibles, Coinsurance, and Copayments O Small Group deductible limits (2014) $2,000 single/$4,000 family O Essential Health Benefits package effective for plan years on or after Jan. 1, 2014

14. Small Group – Impacts to Premiums Pediatric Dental EHBPediatric Vision EHB Diagnostic & PreventativeEye Exam Basic RestorativeFrames Oral SurgeryLenses EndodonticsContact Lenses Periodontics Major Restorative Medically Necessary Orthodontia

15. Small Group – Impacts to Premiums O Health and Gender No Longer a Factor!!! O No Pre-Existing Conditions!!! O No waiting periods longer than 90 days! O 1 st Plan Year following January 1 st 2014 O Wellmark is making all groups change 1/1/14

16. Carriers In the Marketplace (aka Exchange) O Sanford  4 Plan options O Avera  10 Plan Options O Dakotacare  2 Plan Options in the marketplace,  Many more in the traditional market Rates will be the same in and out of the marketplace.

17. Carriers outside the Marketplace O Wellmark  14 Plans offered O Coventry O Assurant O Federated

18. Small Employer Tax Credits Available only inside the SHOP beginning in 2014. So who’s eligible? Fewer than 25 full-time equivalent employee’s Pay average annual wages below $50,000 per FTE Contribute at least one half (50%) of the cost of each of their employee’s health insurance premium Tax credit in 2014 for for-profit employers: 50% of premiums Tax credit in 2014 for non-profit employers: 35% of premiums