Understanding the Impact of Health Care Reform on Your...
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Understanding the Impact of Health Care Reform on Your Plan
Transcript of Understanding the Impact of Health Care Reform on Your...
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!
