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AmeriCorpsCoverage andHealth Care ReformSouthwest National Service Training Conference
July, 2013
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CONTENTSI. Background
II. The Issue and Goal
III. Current Situation
IV. Remaining Challenges
V. Minimum Essential Coverage (MEC)
VI. The Case for Minimum Essential Coverage
VII. What Now?
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BackgroundAmeriCorps Provisions
Minimum Coverage Requirements (Full Time Members)
Low Front End Cost Sharing
Annual deductible - $250 or less
80% Coinsurance (50% mental health and substance abuseexception)
No more than $1,000 out-of-pocket maximum
Wide Array of Benefits
Accident and Sickness
Physician, hospital, emergency room, prescriptions, lab & x-ray
A*C Provisions only require a $50,000 per causemaximum benefit
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BackgroundPatient Protection and Affordable Care Act (ACA)
Lifetime and Annual Limits
Prohibition of Lifetime Limits
Restrictions on Annual Dollar Limits
Essential Health Benefits Overlap with AmeriCorps Provisions
Expansion Examples: Preventive Care and Rehab Services
Limited Medical Benefits Waiver
Applicable to Mini-Meds
Prevent Loss of Coverage Temporary
Individual Mandate
Personal Responsibility/Subsidy/Exchanges
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The Issue & The Goal Affordability vs. Plan Design
Increased Claim Liability = Increased Premium
28% increase is estimated impact
Access/Insurer challenges (No employer/employeerelationship)
Goal
Compliance with the Affordable Care Act
Affordable coverage for grantees
Quality benefits for members
Provide Minimum Essential Coverage (MEC) Avoid individualmandate penalty for covered members
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Current Situation Limited Medical Plan Waiver
Temporary Expires in 2014
Limitation on new groups
Short Term Limited Duration Coverage
Not subject to the Affordable Care Act
Less than 1 Year (364 day policy period)
Non-renewable
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Remaining ChallengesThe Corps Network Plan
Short Term Limited Duration
Continuity of Coverage
Policy Replacement (2013-2014) not yet approved by DC
Logistics
Second Term of Service - Enforced Break in Coverage Continuation of Coverage - Virtually Eliminated
Suspensions/Term Exceeds 364 Days Coverage Terms onafter 364 days
Establish Minimum Essential Coverage (MEC)
Avoid individual mandate shared responsibility penalty
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Minimum EssentialCoverage (MEC)Effective January 1, 2014
What is MEC? - Guidance
Government sponsored plan
E.g., Medicare, Medicaid, CHIP, Tricare, Peace Corps
Employer-sponsored plan
Generally, all employer plans except limited medical
Individual plan
Applicability
MEC status prevents the shared responsibility penalty
Exceptions
e.g., 100% of FPL,
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Minimum EssentialCoverage (MEC)The Corps Network Strategy
3 Plans to gain MEC status
February 1, 2013 Proposed Rule
Designates AmeriCorps as MEC (not finalized)
Apply direct to HHS for MEC status
Change plan design to an ACA compliant structure
Maintain similar price point to today
ACA Compliant Trade off:
Low member cost share vs. catastrophic coverage
Remove per cause maximum (no lifetime benefit limit) Increase deductible, out-of-pocket maximum
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The Case for MECProven Value of The Corps Network Plan
Unique AmeriCorps Factors
Mandated coverage
Young demographic
Limited service duration
Program budget constraints
Member stipend
Evidence
95+% of enrollees have less than $2,000 in claims
99.9% of members do not encounter the $50,000 per causemaximum
2013 benefit increases (with policy approval)
Advantage over individual market
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What Now? Secure Policy Replacement
Compliant with Affordable Care Act
Affordable to grantees
Adequate for members
Gain MEC status
Three part plan
Educate
Americas Service Commissions
State Commissions
Programs
Advocate
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QuestionsChris Rooney
Vice President
Willis of Seattle1-800-456-1415 x7428
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