Getting the Best Deal on Health Insurance

1. Getting the Best Deal on Health Insurance After Health Care Reform By Patti Goldfarb & Vincent Morelli

2. What Employers Need to Know About Renewals Benefits Employee Contributions Before they get their renewal letter: What’s different this year Mandatory benefits, eligibility periods, How to qualify for health insurance tax credits Higher costs, less benefits—helping your employees What’s involved in adding supplemental benefits What’s considered affordable, New strategies, Caveats Tax Credits Helping Employees The Supplemental Process

3. Why is this year’s renewal so different? And why are my premiums so much higher? • ACA mandate require: • Age based rates for each employee • Separate rates for each dependent • Plan designs based on metallic tiers • Bronze, Silver, Gold and Platinum • Essential Health Benefits Health Reform Mandates affect premiums

4. What Every Policy Must Cover Essential Health Benefits Essential Health Benefits Cont’d • Outpatient hospital care • Trips to the emergency room • Treatment in the hospital for inpatient care • Care before and after your baby is born • Mental Health and Substance use disorder services : This includes behavioral health treatment, counseling and psychotherapy • Prescription drugs • Services and devices to help you recover if you are injured or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation and more • Your lab tests • Preventive servicers including counseling,, screenings and vaccines to keep you healthy and care for managing a chronic disease • Pediatric services : This includes dental care and vision care for kids *from www.healthcare.gov

5. Eligibility Periods This can be tricky • Eligible employees cannot be made to wait more than 90 days • No more first of the month following 90 days of consecutive fulltime employment • What constitutes an eligible employee? • Consecutive fulltime work of __ days • Completion of a training program • Attainment of some goal

6. Employee Contributions Passing on premium increases becomes more difficult • Charging more than 9.5% of wages can triggers penalties • For employers with > 100 employee • If an employee purchases coverage in the Exchange because they can’t afford the employer’s plan and • If an employee reciev.es s subsidy from the Exchange • $3,000 per employee • Defined Contribution is replacing percentage of premium • Allows employees more flexibility to choose benefits they really need • Easier budgeting for the employer • Works well with private exchanges

7. Small Business Tax Credit Before you start you need to know: FTE, Average Wages, Employer Premium Contribution, If you are Tax Exempt or not, Other credits your get from the state and Avg. State Premiums Do you have < 25 FTE? Yes No Does not Qualify Is your avg. EE wage < $50,000? Yes No Do you provide 50% or more of your EE only premium Box A –(((Avg. Wage- $25000/$25,000)x Premium Contribution x 50%)) = Tax Credit No Yes No Box A Premium Contribution – (((FTEs-10)/15)x50%)) If your total premium > or < the avg. for the state Then Yes > 10 FT employees& < $25,000 avg, wage No Tax Credit = Lesser of 50% of actual ER Premium Contribution or proration of contributions against small group avg.for the state Yes

8. Small Business Tax Credit Only looks at FICA Covered Wages • Excludes wages of • Sole Proprietors • Partners in a partnership • A Shareholders owning more than 2% of an S Corporation • Any owner of more than 5% of other types of business (i.e. LLC, C Corporation, etc.) • Family members (defined as) • Children and descendents of children • Siblings • Step Siblings • Nieces and Nephews • Aunts and Uncles • In-Laws

9. Private exchanges are shifting the way we think about and buy health insurance – and they’re changing the whole game. What is defined contribution? Defined contribution is a way for employers to control the amount they pay towards benefits. Through this option, employees receive an account credited by the employer for insurance. It’s like an allowance for the employee to spend on the health care they choose. If the employee wants more robust coverage than their employer’s contribution can cover, the employee can choose to pay the remaining portion of the bill. Many of the details of defined contribution still remain to be seen. For instance, employers can set the stipend, but they still need to pay attention to affordability requirements to avoid penalties. And, there may be certain parameters on the types of benefits that can be used by an employee's allowance. Still, it’s a unique concept that is already beginning to take center stage in the discussion as private exchanges become more popular. Carefully equipping employees for what’s ahead Consumerization of health care is not new – it’s a much broader trend. The reality is that with or without exchanges, individuals will continue to make more and more decisions when it comes to their health. Still, the emergence of exchanges is a game-changing shift in benefits delivery, in which everything from how employers offer insurance to the way employees protect their health and well-being, are quickly and fundamentally changing. What’s more – is that individuals may not be prepared.

10. Businesses gain more by making supplemental insurance available

11. CORE Benefit Enrollment Solutions Aflac’s Enrollment Architect: A valuable new-case setup and enrollment tool • Enrollment Architect Value Adds  • Census Update • Discount Cards • Beneficiary Audit • 401(k) Plan Communication • FSA Communication and Enrollment • Soft Dependent Audit • Core Benefit Communication • Core Benefit Enrollment • Employer Specific Messaging • Control of the enrollment process and timeline. • A consultative approach to assisting employees with their benefit options selections and enrollment tool • The ability to build your own cases in real-time, using core benefits and Aflac products • Competitive services and solutions: • Web-based broker and client reporting. • FSA needs analysis • Employee-benefit statements and electronic forms • Standardized carrier files • Dependent-beneficiary review • Census cleanse