Understanding the Impact of Health Care Reform on Your Plan

The Objective

Health Care Reform – Overall Update

Small Group Requirements

Choices for Small Groups

New Plans, New Features

Questions?

Overview 2

Minimize impact on

you & your employees…

provide options to meet your needs

The Objective 3

Delayed Until 2015:

Health insurance coverage reporting (employer contributions)

Employees working 30+ hours are considered full-time and could be subject to penalty

Penalties for large groups (50 or more employees) if they don’t provide coverage; look-back period

Health Care Reform Update: 2015 4

What Still Impacts You in 2014?

Out-of-Pocket (OOP) Maximum

No pre-existing condition limitations

Waiting periods limited to 90 days

W-2 reporting

Individuals must have coverage or pay a penalty

Health Care Reform Update: 2014 5

Small Group Requirements

Essential Health Benefits

Provider network adequacy – type, number, reporting

Drug formulary – type, number that must be covered

State mandated “standard plans” (allowed to offer other options)

Actuarial Value & Metal Plans – Named after precious metals (Platinum, Gold, etc.) What the health plan must pay vs. what member pays

Small Group Requirements 7

Essential Health Benefits 8

Staying with 3 Tier Formulary Tier 1 = Generics Tier 2 = Preferred Brands Tier 3 = Non-Preferred Brands

Small Group – Open Formulary On & Off Exchange What you have today Smooth transition since no major changes

Rx Overview – Formulary Options 9

How Do the Metal Plans Work?

All plans must fall within pre-set actuarial value ranges named after precious metals

Actuarial Value Ranges Allowed for Small Groups by Metal Plan

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Bronze Silver Gold Platinum

Choices for Small Groups

You can:

Simply renew; automatically compliant with mandates

Choose another plan

Go to the SHOP Exchange Rates are the same on & off the exchange All employees must complete new paperwork

Choices for Small Groups 12

New Plans, New Features

Due to requirements of health care reform, all small group plans will be retired

You will be transferred to new, fully-compliant plan

New plan is closest match to current cost sharing

HealthyRewards for small groups is replaced by ExerciseRewards™ with new $600 gym reimbursement

New Plans for Small Groups 14

Introducing: SimplyBlue Plus

More options… Low cost Gold & Silver hybrid

plans offer first dollar drug coverage, HRA compatible

Some hybrid plans have higher deductibles for lower premium ($1,000 - $3,000)

HDHP Silver and Bronze packages offer HSA or HRA compatible options

Numerous deductible options

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SimplyBlue Plus

Moving to SimplyBlue Plus

Healthy Blue

SimplyBlue

BlueChoice/HMO Blue SSA Plans

HNY Branded EPO*

*Pending approval

Actuarial value of current plan determined, then your group is moved to closest match for cost sharing

Healthy NY Group

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All benefits follow model language provided by NYS

State mandated plans called “standard”

In-network, out-of-network = separate out-of-pocket maximum

All cost shares (copays, coinsurance, deductibles, Rx) accumulate toward the out-of-pocket maximum

Accumulating benefits will reset (nothing carried over from the previous product)

Non-standards named by metal level and a number (examples: Bronze 2, Platinum 9)

Groups transition to new plan at renewal

New Plans – Fully Compliant 17

Dependent to 29 Coverage

Domestic Partner Coverage (no cost)

Family Planning Exclusion*

Pediatric Dental Removed**

New Plans – Available Riders 18

*Group must file for religious exemption ** If stand-alone dental plan is purchased, coverage can be removed

New Features for Fitness

With $600 Gym Reimbursement Program & ExerciseRewardsTM – members enjoy:

Gym discounts

Three one-week free trial memberships to participating fitness facilities

Online interactive tools

Discounted, family programs offered through many of the facilities in the gym network

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ExerciseRewards™ Online

Create individualized fitness plans

Find your ExerciseRewards facility & try it out for free!

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Take one of many Ecoaching courses Build a 28-day customized meal plan

New Features: Dental & Vision Coverage

Adult vision coverage offered on all non-standard plans both on and off exchange

Pediatric dental & vision embedded into medical plans

Pediatric coverage for kids up to age 19 Uses Excellus BCBS Dental Networks

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Your Questions?

Engaging Your Members

Thank you!