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Information Only Always review all options with an experienced Health Care Benefits Specialist

Health Care Reform Facts. Information Only Always review all options with an experienced Health Care Benefits Specialist Review the Facts at: http://www.whitehouse.gov/healthreform/myths-and-facts. About AWIS.

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Information Only Always review all options with an experienced Health Care Benefits Specialist

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  1. Health Care Reform Facts • Information Only • Always review all options with an experienced Health Care Benefits Specialist • Review the Facts at: http://www.whitehouse.gov/healthreform/myths-and-facts

  2. About AWIS • Willie Martinez – Executive Director of Marketing (19 years Licensed Health Insurance Agent) • AWIS – “A” rating with “BBB” • Limited Group Health and Dental • Insurance Benefits • 30 Years in Business Today, AWIS is a licensed and registered insurance agency in over 40 states and 2 territories. (DC & PR) AWIS was established in 1983 by a group of doctors to market affordable Association Healthcare benefits.

  3. Our Association Healthcare Program is one of the three types of Healthcare Programs used today in our Healthcare System: ** By becoming a member of our National Association of Preferred Providers *(NAPP), our members are eligible to purchase limited group medical, dental, and/or life insurance benefits after a waiting period. Government Medicare and Medicaid Major Medical HMO and PPO Insurance Association Health Care Benefits** *$12 per year, for an Entire Family For specific waiting periods, call Member Services @ 1-866-365-5829

  4. Health Insurers Raise Some Rates by Double Digits“The New York Times”(Jan. 5, 2013) “These rate requests are all the more striking after a 39% rise sought by Anthem Blue Cross in 2010”(Granted 19%) Insurers’ filings with the State of California for 2013 Aetna is proposing rate increases of as much as 22% Anthem Blue Cross 26% And Blue Shield of California 20%

  5. 2013 Rate Increases Across the Country In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders The rate increases can amount to several hundred dollars a month Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more.

  6. Benefit Mandates Exchange plans are supposed to be approved by HHS no later than Jan. 1, 2013. Initial Plans Available Oct. 2013, with an Effective Date of Jan. 1, 2014. States also have discretion to allow businesses with more than 100 employees to purchase coverage in the Exchanges beginning in 2017. In addition, states may opt to allow the Federal governmentto establish an Exchange in their state rather than implement their own.

  7. Benefit Mandates (Effective Jan. 1, 2014) Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits. (This does not include Co-Insurance) Limit any waiting periods for coverage to 90 days. Allow states the option of merging the individual and small group markets.

  8. Create an Essential Health Benefits Package that: Provides a comprehensive set of services Covers at least 60% of the actuarial value of the covered benefits Limits annual cost-sharing to the current law HSA limits($5,950/Ind. & $11,900/Fam.) Require all qualified health benefits plans, including those offered through the Exchanges and those offered in the individual and small group markets outside the Exchanges, (except grandfathered individual and employer-sponsored plans), to offer at least the Essential Health Benefits Package.

  9. Essential Health Benefits Essential health benefits must include items and services within at least the following 10 categories: • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services,including behavioral health treatment • Prescription drugs • Rehabilitative and Habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

  10. Four Federal Exchange Plans The cost-sharing features will be addressed in separate rules and will determine the actuarial value of the plan, expressed as a “metal level”as specified in statute: 1. Bronze at 60%Coverage 2. Silver at 70%Coverage 3. Gold at 80% Coverage 4. Platinum at 90%Coverage

  11. What happens if Individuals don’t want to purchase health insurance? They will have to pay a penalty (a tax) The first year of implementation – 2014 – the fee is either $95 or 1 percent of your income, whichever is greater In 2016 if you still don’t have health insurance, the fine increases to $695 per adult/$347.50 per child Up to $2,085 per family or 2.5 percent of your income, whichever is greater

  12. Does the employer have to keepproviding health insurance? For Companies with 50 or more “Full-Time”employees: The employer faces a $2,000 fine per “Full-Time”employee after the first 30 “Full-Time”employees if health insurance is not provided to at least 95% of all "Full-Time”employees.

  13. High Deductible Health Plans as an Optionfor Small Business Owners A health care plan that charges a lower premium and has a higher deductible than traditional health care plans. It is usually paired with a Health Savings Account (HSA) to provide maximum benefits at the lowest cost to individuals. Often, small business owners find that Health Savings Accounts and HDHP's are a cost-efficient way to provide health insuranceto their employees.

  14. Benefits of the HDHP A benefit of a HDHP is that the sum of the high deductible and the maximum out-of-pocket expenses that you pay for covered medical expenses have a ceiling Another benefit of a HDHP is that it may provide preventive care with no deductible or with a much lower deductible.

  15. HSA/HDHP Medical Plan Summary Meant to force consumers to save money through their HSA for medical expenses such as co-payments, prescriptions, and lower out-of-pocket medical costs. HDHP kicks in when there are larger, catastrophic medical costs. Not only does this plan save the consumer or employee money, it is a cost-efficient way for small businesses to offer their employees’ health insurance as the premiums are lower than for traditional health insurance plans. IRS Publication 969 gives more extensive information on the HDHP/HSA Health Care Accounts.

  16. Example: Blue Cross Blue Shield (28 Year Old male Non-Smoker) PPO Select Choice Lifetime Benefit: No Limit Office Visit Copay: $25 Out-of-pocket Limit: Deductible plus $3,000 Blue Edge Individual HSA Lifetime Benefit: No Limit Office Visit Copay: Deductible and Coinsurance Out-of-pocket Limit: $3,000 Total Savings = $155.00 Per Month Per Employee

  17. Example: Blue Cross Blue Shield (53 Year Old Male Non-Smoker) PPO Select Choice Lifetime Benefit: No Limit Office Visit Copay: $25 Out-of-pocket Limit: Deductible plus $3,000 Blue Edge Individual HSA Lifetime Benefit: No Limit Office Visit Copay: Deductible and Coinsurance Out-of-pocket Limit: $3,000 Total Savings = $416.00 - $521.00 Per Month Per Employee

  18. Add a Supplemental Plan to CoverDeductibles and Co-Insurance Benefits Include: • $1,000 per day in hospital • $2,000 per Day for ICU/CCU • $5,000 per accident ($100 Deductible) • $5,000 Critical illness(Heart attack, Stroke, Cancer, etc.) • $50 Physician Office visit re-imbursement(5x Year) • Dental HMO (Optional) • Hospital Patient Advocacy(Negotiates Hospital Bills) Other Benefits Available/Can be specially designedfor any size company

  19. How about an Association Plan with Limited Group Insurance Benefits?

  20. Optional Add-On Benefits at an Additional Cost Per Month This Plan is Only Available To NAPP Members

  21. Your Dental HMO Plan No waiting periods for ANY pre-existing conditions Largest dental network in the U.S (over 189,000 dentists) In business since 1954 All U.S Active Duty military members have these dental plans No health questions No age limits Already serve over 25 million customers

  22. Sample Co-Pays Detailed Oral exam = No cost X-Rays = No cost Office Visit = $5.00 Teeth Cleaning* = $5.00 (One routine teeth cleaning every 6 months) Fillings = $8.00 (Amalgam one surface) Tooth Extraction = $10.00 Root Canals = $165 to $365 Crowns = $185 to $395 Complete Denture (Maxillary) = $365 Braces = Child $1,900.00 / Adult $2,100.00 * Does not apply to initial extensive Cleaning. Full List of Description of Benefits & Co-Pays at: www.________.awisdental.com

  23. Savings • The Cost of these AWIS Association Health Plans, (Supplemental plans) will cost less than the difference between the cost of the Traditional Comprehensive Plan and the High Deductible HSA Plan. • HD HSA Plans Qualify under the New Health Care Reform Law. • More Coverage at a lower cost Bottom Line:

  24. Free No-Obligation Quote Census report from the company Copy of any Current Health Plans in force Renewal date, if any Proposals within 5 – 7 Business days. Will Include One or more Options

  25. THANK YOU! And Welcome to American WorkersInsurance Services

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