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1. Partnership for Solutions to Health Care Reform ã June 2013 2. 1July 2, 2013 2014 Implementation of the Affordable Care Act 3. 2July 2, 2013 Shared Responsibility…
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  • 1. Partnership for Solutions to Health Care Reform • June 2013
  • 2. 1July 2, 2013 2014 Implementation of the Affordable Care Act
  • 3. 2July 2, 2013 Shared Responsibility for Access • 2 2014 Individual Mandate Exchanges Tax Credits and Subsidies Employer Penalty
  • 4. 3July 2, 2013 2014 Market Reforms  Fundamental Shift in the Pricing Models for Individual and Small Market(<50)  No Medical Underwriting  Pricing Based on Geography, Age(3-1), Tobacco(1.5-1)  Pricing Changes will proceed even if Public Exchanges not ready  Individuals will have Access to Options across multiple Carriers  How will the Availability of Coverage Shift the “Social Contract” employers have historically entered into with employees for providing health care?
  • 5. 4July 2, 2013 Individual Mandate  U.S. citizens and legal residents must have health insurance (minimum essential coverage) or pay a tax  Tax is the greater of: • 2014: $95 per adult ($285/family) or 1% household income • 2015: $325 per adult ($975/family) or 2% household income • 2016: $695 per adult ($2,085/family) or 2.5% household income (adjusted for inflation after 2016)  Tax will not exceed national average cost of Bronze level coverage  Exceptions include: • Religious beliefs, undocumented workers, financial hardship Is the penalty strong enough to move the needle? 4
  • 6. 5July 2, 2013 Employer Options Engagement Large Employers attempt to reduce unit cost and consumption OR Defined Contribution Cap employer contributions and push cost changes to employees OR Disengagement Push employees into Public Exchanges. Shift in Employer “Social Contract” creating new buyers in the Marketplace USI Affinity can deliver the Solutions for all Realtors
  • 7. 6July 2, 2013 Public Exchanges  Marketplace for individuals and small businesses to shop for private health insurance coverage  Pennsylvania and many other states have opted not to operate a Public Exchange at this time  Pennsylvania Public Exchange will be operated by Federal Government  HHS confirms Public Exchanges will work with Brokers  Realtors enrolling in the Public Exchanges can be serviced by USI Affinity 6
  • 8. 7July 2, 2013 Public Exchanges  Public exchanges will offer community rated metallic plans that will be tightly regulated and priced.  Qualified health plans sold through the Exchange and off Exchange • Provide essential benefits • The “metallic” plans: Bronze (60%) – Silver (70%) – Gold (80%) – Platinum (90%)  Subsidies available for qualified individuals and Tax credits for qualified small employers  Initial enrollment period to begin October 1, 2013 (must enroll by December 22, 2013 for January 1, 2014 coverage) • Will Federal Exchanges be Ready? • Portion of SHOP Exchanges Delayed until 2015
  • 9. 8July 2, 2013 Federal Poverty Level 2012 Persons in family/household 100% FPL 400% FPL 1 $11,170 $44,680 2 $15,130 $60,520 3 $19,090 $76,360 4 $23,050 $92,200 5 $27,010 $108,040 6 $30,970 $123,880 7 $34,930 $139,720 8 $38,890 $155,560 For families/households with more than 8 persons, add $3,960 for each additional person 8 2012 FPL for 48 Contiguous States and District of Columbia. Dept. of Health and Human Services http://aspe.hhs.gov/poverty/12poverty.shtml (as visited 11.7.12). See website for information on Alaska and Hawaii.
  • 10. 9July 2, 2013 Premium Tax Credit  Government pays some of the premium for Exchange-based coverage • sliding scale depending on income • based on silver coverage  Available to individuals between 100%-400% of FPL who: • are not eligible for minimum essential coverage or • are eligible for minimum essential coverage through an employer, but that coverage is unaffordable or does not provide a minimum value  Small Employer Tax Credits Available in SHOP Exchange 9 Triggers the Employer Penalty Household Income FPL Initial Premium Percentage Final Premium Percentage Up to 133% 2% 2% 133% up to 150% 3% 4% 150% up to 200% 4% 6.3% 200% up to 250% 6.3% 8.05% 250% up to 300% 8.05% 9.5% 300% up to 400% 9.5% 9.5%
  • 11. 10July 2, 2013 Premium Tax Credit  Example A • Mark earns $40,000 a year. He is age 40 and a single adult. He does not have employer coverage available. Mark’s household income is 348% of FPL. • Mark goes to the Exchange. An estimated premium for Silver coverage is $5,400. Mark must pay 9.5% of his income for the premium, or $3,800. He will receive a $1,600 subsidy (covering 30% of the overall premium).  Example B – Same as above but Mark makes $20,000 a year (174% of FPL). Mark will have to pay 5.1% of income on health insurance coverage. He will pay $1,019 and receive $4,381 in subsidy. 10
  • 12. 11July 2, 2013 Private Exchanges and Market  Plans offered off Public Exchange will be similar to Public Exchange.  Must Fit Metallic Plans  Different Delivery Systems/Networks  Individual and Group Plan Designs will be Similar  Individual vs. Group Pricing?  Medical carriers are rolling out their Defined Contribution Solutions combination of Paper and online.
  • 13. 12July 2, 2013 Access for Realtors  Sole Practitioners – Individual Plans • Public Exchange and Off Exchange  Groups – 1 to 50 • Public SHOP Exchange – One Carrier, One Plan to Qualify for Tax Credits • Traditional Plans or Defined Contribution  Groups – 50+ • Traditional Plans, Private Exchanges and Self Funding USI Affinity can deliver the Solutions for all Realtors
  • 14. 13July 2, 2013 Realtors Exchange  USI Affinity offers Realtors the Access, Advice and Advocacy they need to save money, prepare for Health Care Reform and get the most of their benefits.  Access to Unique Products and Services,  Advice on Benefits Design, Compliance and Funding Options  Advocacy to help resolve issues from administration and claims to complex clinical questions
  • 15. 14July 2, 2013 USI Affinity – Partnership with Realtors  USI Affinity is currently servicing in excess of $225 Million in Benefits Premium. This gives USI Affinity the necessary leverage in the marketplace to deliver solutions to the Realtors.  Potential to offer Unique Solutions on Carrier Exchange  USI has invested in a team of ERISA attorneys focused exclusively on Employee Benefits and Health Reform. This investment is there to bring your members the most up to date information on Health Care Reform • USI Affinity field staff is backed up by a paperless call center which handled more than 20,000 calls in 2012 and is scalable to handle increased volumes in 2014. The advocacy provided to members will be a differentiator as competitors move to strictly online solutions. USI Affinity will offer a balance of technology and personal service.
  • 16. 15July 2, 2013 Questions 855-874-0267 benefits@usiaffinity.com
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