1. Jeff Crawford, Vice President jcrawford@lewer.com Ph: 800-821-7715, Ext. 148 Monica Olson, M.Ed., Regional Sales Director molson@lewer.com Ph: 206-618-8337

2. Shifting Sands Ahead

3. Brainstorm a short list of what is valuable, important or necessary in an insurance plan. What is important to you, your staff or yourself when you think about using or administering an international student insurance plan?

4.  PPACA : Patient Protection and Affordable Care Act  ACHA: American College Health Association  Deductible : Small amount of money paid out of pocket for each sickness or injury  Co-pay : Small set amount of money paid out of pocket for each office or hospital visit  Co-Insurance: a certain set percentage of money to be paid for each service  SHP : Student Health Plan  MLR : Medical Loss Ratio

5.  March 23, 2010: Affordable Care Act was signed into law  March 21, 2012: Final regulations on student health insurance plans  June 28, 2012: United States Supreme Court upheld the constitutionality of most of PPACA

6. For plan years beginning January 2014: No annual limits No annual limits $500,000 For plan years beginning September 2012-December 2013: Annual coverage limits of no less than $500,000 $100,000 For plan years beginning July 2012-September 2012 : Annual coverage limits of no less than $100,000

7. PPACA requires all compliant student health plans (SHPs) to have: ◦ Preventative Care : Student health coverage is required to provide preventive services without cost-sharing and co-pays. ◦ Pre-existing Condition Limitations: Plans may not impose pre-existing condition limitations on those younger than age 19.  As of 2014, pre-existing conditions cannot be excluded.

8.  Individual Mandate - January 1, 2014  Essential Health Benefits: must include these 10 categories  Ambulatory patient services  Emergency services  Hospitalization  Maternity and newborn care  Pediatric services, including oral and vision care  Mental health and substance use disorder services, including behavioral health treatment  Rehabilitative and habilitative services and devices  Laboratory services  Preventive and wellness services, chronic disease management, and prescription drugs

9.  Waivers Examine waiver policy to close the gap for waivers and keep your risk exposure low  Cost-Benefit You want enhanced benefits, but there is a tipping point for cost and use…where is it?

10. 2014 Policy Year and Beyond: PPACA Plans  Unlimited Coverage  No Exclusion for Pre-Existing Conditions  MLR – 80% (Medical Loss Ratio)  Cost Increase and Destabilization

11. Current Premium$100,000 Claims$75,000 Loss Ratio (LR)75% Target70% Potential Refund$0 PPACA Premium$120,000 Claims$90,000 Loss Ratio (LR)75% Target80% Potential Refund5%

12. Plan A  Unlimited Coverage  $250 Deductible  20% Coinsurance  No Pre-existing Exclusion  Wellness Coverage  Increased $$ Premium Plan B  Current Accident & Sickness Coverage  $0 Deductible  100% Network Coverage  Pre-existing Exclusion  Limited Wellness Coverage  Stable Premium

13. Policy Year: 2013-2014  Compliant Plan Participation mandate important Benefits include wellness and immunizations  Other Options Limited Duration: Accident and Sickness Only Plan

14. Now that you have learned about the upcoming PPACA changes… What is important to you, your staff or yourself when you think about using or administering an international student insurance plan?

15.  http://www.healthcare.gov/law/full/patient- protection.pdf http://www.healthcare.gov/law/full/patient- protection.pdf Affordable Care Act  http://acha.org/Topics/Affordable_Care_Act/Aff ordableCareAct.cfm http://acha.org/Topics/Affordable_Care_Act/Aff ordableCareAct.cfm ACHA Website  http://www.healthcare.gov/news/factsheets/201 0/09/affordable-care-act-immunization.html ACHA Immunization List