1. 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 Phone: / Fax:

2. 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 Phone: / Fax:

3. 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 and to all employer
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 Phone: / Fax:

4. RockyMountainAdministrators.com Home Page
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5. RockyMountainAdministrators.com Click “OK”
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6. RockyMountainAdministrators.com Enter Login Information.
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7. RockyMountainAdministrators.com Personal Home Page
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8. Presentation Download Available at:
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