Who We Are Formed in 2010 by Luanne Gentilini and Preston Bostrom. Based in Worland, Wyoming with an office in Baker, Montana. Mission statement: “To provide exceptional service to our clients and their employees while responding quickly and efficiently to the ever changing healthcare payer environment.” PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808 Fax: 307-347-2646 www.rockymuntainadministrators.com

The Affordable Care Act The Road So far: 2010 2011 2012 2013 Temporary high risk pool Early retiree reinsurance program (ERRP) Small Business Tax Credit Adult child coverage until age 26 No pre-existing conditions for children until age 19 Rescissions prohibited except for fraud or non-payment Lifetime dollar limits prohibited Annual dollar limits restricted Preventive services with no cost sharing* Pediatricians as PCP’s direct access to OB/GYN’s * ER coverage as in-network – no prior authorization * Initial appeals review standards * Medicare Part D rebate Online consumer information at healthcare.gov Annual rate review process Appeals ombudsman and process documentation* Medical loss ratio: 85% for large group, 80% for small group and individuals HSA/HRA/FSA: limitation for OTC medications Increase penalty for non-qualified HAS withdrawals Small business wellness grants Annual fee on pharmaceutical manufactures begins Discounts on Medicare Part D “donut hole” Non-discrimination rules apply to insurance plans (implementation delayed until regulations are released) * Auto-enrollment for groups with 200+ Full-time employees (implementation delayed until regulations are released) Appeals provision fully implemented * Uniform explanation of coverage and standard definitions 60 day advance notice of materials modification Accountable Care Organization requirements Quality bonus begins for Medicare Advantage plans Patient –Centered Outcomes Research Institute (PCORI) fee ($1.00 per member per year) Administration simplification begins Expanded women’s preventive care services Employee notification of access to Exchanges Employer’s to report value of employer-sponsored health benefits on W2’s FSA contributions limited to $2,500 High earner tax begins Annual fee on medical device sales begins Deduction for expenses allocable to the Part D subsidy for qualified prescription drug plans eliminated PCORI fee increases to $2.00 per member per year ICD – 10 code adoption PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808 Fax: 307-347-2646 www.rockymuntainadministrators.com

The Affordable Care Act Now and On The Way: 2014 2015 and Beyond Health benefit exchanges Guarantee issue and renewal rules * No annual limits No pre-existing condition exclusions Rating restrictions * Individual & employer mandates Tax credits and subsidies for individuals and small employers Standardized essential health benefits Waiting period limitations Mandatory coverage for clinical trials * Annual insurance industry tax Out-of-pocket limits must comply with out-of-pocket Limits for HSA qualified plans * Deductible caps cannot exceed $2,000 per individual and $4,000 family * Coverage for all adult children until age 26 including those that have employer coverage (formerly not covered for grandfathered plans) States can open Exchange to CHIP eligible - 2015 and to all employer - 2017 High value plan excise tax begins – 2018 Insurance industry tax through 2018 Medicare Part D “donut hole” closed by 2020 *applies to grandfathered plans Note: Some provisions apply to fully insured business PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808 Fax: 307-347-2646 www.rockymuntainadministrators.com

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Presentation Download Available at: http://www.rockymountainadministrators.com/presdownloads.html PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808 Fax: 307-347-2646 www.rockymuntainadministrators.com