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The ABCs of the Affordable Care Act For Students

The ABCs of the Affordable Care Act For Students. Topics to Cover. ABCs of the ACA for Students Heathcare.gov What do you have access to, as a Student Options offered by AHP. Student Coverage and ACA.

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The ABCs of the Affordable Care Act For Students

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  1. The ABCs of the Affordable Care Act For Students

  2. Topics to Cover • ABCs of the ACA for Students • Heathcare.gov • What do you have access to, as a Student • Options offered by AHP

  3. Student Coverage and ACA • What is more beneficial? Student health insurance or dependent coverage under their parents’ plans, or the Health Insurance Marketplace? • How does ACA relate to Students? • What are the 2014 ACA changes? • What are the Essential Health Benefits? • What is Minimum Essential Coverage? • How will the Marketplace affect us? • What are the key dates?

  4. Definition of Student Health Insurance Coverage: A type of individual health insurance coverage. ABCs of Reform • Must meet the following conditions: • Must be enrolled as a student (or a dependent of a student) in the institution. Offering dependent coverage is determined by the university • Does not condition eligibility for the health insurance coverage on any health status • Meets any additional requirements that may be imposed under state law • Eligibility decisions that determine student status under student health insurance plan coverage is up to the university and or the insurer

  5. ABCs of Reform Student Plans under ACA: A type of Individual Coverage

  6. Minimum Essential Health Coverage ABCs of Reform Will my student health insurance plan satisfy the individual mandate?

  7. Tax Penalty ABCs of Reform • When filing 2014 taxes in 2015, individuals must indicate on their returns if they have health insurance coverage and, if not, pay a fine. • The individual penalty is the greater of $95 or 1 percent of income, rising to the greater of $695 or 2.5 percent of income, in 2016. The Congressional Budget Office estimates that less than 2 percent of Americans who don’t have health insurance will pay the fine. 2014

  8. ABCs of Reform “Mandate Exemptions” Included in individual coverage mandate but exempt from paying the penalty Excluded from individual coverage mandate Individuals who are not lawfully in the United States; Individuals who are incarcerated; Religious conscience objectors; or Members of a health care sharing ministry. Individuals who have “unaffordable coverage” (based on household income and required contributions for coverage); Individuals who have income below the threshold for filing a tax return; Individuals who are members of an Indian tribe; An individual whose first coverage gap experience of a calendar year lasts less than 3 months; or Individuals who apply for and receive a hardship exemption from HHS.

  9. Major ACA Changes in 2014 ABCs of Reform • Essential Health Benefits (EHB) will be included in every insurance plan • Prevention comes with no out-of-pocket cost (for in-network providers only) • There are no annual or lifetime limits • Simplified coverage descriptions will be available – summary of benefits and coverage (SBC) must be provided to students • Pre-existing conditions will be covered • ACA fees and taxes apply Effective upon renewal in 2014

  10. What are the Essential Health Benefits? ABCs of Reform ACA lists 10 categories of essential health benefits (EHBs) that must be covered by non-grandfathered individual and small group plans in 2014.  Each state benchmark plan sets the standard for EHBs in the state.  In Illinois, Oklahoma and Texas, the state benchmark plan is a BCBS plan. Plans that DO have to cover EHBs in 2014: Plans on the exchange Non-grandfathered, individual health care plans (Student Plans are considered individual for ACA purposes) Non-grandfathered, fully insured small group health plans Plans that DO NOT have to cover EHBs in 2014: Self-insured/ASO health plans Grandfathered health plans Large group health plans • 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; and • Pediatric services, including oral and vision care.

  11. What Are Marketplace Qualified Health Plans? ABCs of Reform • Provide essential health benefits package • Offered by licensed insurer • Certified by the exchange as “qualified health plans” No one is required to purchase health insurance through the Marketplace Premium tax credits and subsidies or cost-sharing assistance are only available to those that qualify and purchase on the Marketplace and may apply to select plans

  12. Marketplace Coverage (Metallic Levels) ABCs of Reform Individual and insured small group plans, sold on and off the Marketplace, will have to meet one of four metallic levels that correspond to plan actuarial value (AV). Student plans are sold off exchange. Bronze Silver Gold Platinum P 60% Actuarial Value 70% Actuarial Value 80% Actuarial Value 90% Actuarial Value

  13. Summary of Benefits Coverage Requirements ABCs of Reform Under the Affordable Care Act, all health insurers and group health plans are required to provide consumers with a Summary of Benefits and Coverage (SBC). The SBC is a summary of the benefits and health coverage offered by a particular plan. The SBC is intended to provide clear, consistent, easy-to-understand descriptions that may make it easier for people to understand their health insurance coverage and for consumers to shop for and compare insurance plans. • The SBC is completed using a government-designed template, so the SBC will be consistent across all health insurance plans and will include: • What is covered by the plan • What is not covered by the plan • Cost-sharing provisions and exclusions • Coverage examples • A website and phone number for customer service and obtaining more information • The items in the SBC represent an overview of coverage; they are not an exhaustive list of what is covered or excluded. The full terms of coverage are located in the insurance policy. • SBC is listed on the AHP website at ahpcare.com/mwsu

  14. ACA Toolkit ABCs of Reform • FAQ • Postcard • Today’s Webinar • Bcbstx.com/Reformandyou

  15. Effective upon renewal in 2014 • Individual mandate • Essential Health Benefits Required • No Pre-existing conditions exclusions for anyone • Unlimited lifetime maximums • Annual fee on health insurers, tax changes Summary: Student Health Plans

  16. Federal Marketplace • The Federal Health Insurance Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options. • With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll. • www.healthcare.gov

  17. Student Health Insurance options as a student at Texas Woman’s University • The TWU Student Health Insurance Plan (SHIP) is underwritten by Blue Cross and Blue Shield of Texas and administered by Academic Health Plans • https://www.academichealthplans.com/twu/2013-2014/

  18. Advantages of Student Health • Covers Health Center at 100% • Includes Broad PPO Network • Includes Global Emergency Services • Has nurse line and additional features geared for students • Lower cost than most Exchange Plans • Easy enrollment procedure

  19. Questions?

  20. Who Can Apply for Assistance? (Student Plans Not Eligible) Appendix • Must file an annual tax return and must purchase coverage on the Marketplace • Citizens and legal residents may be eligible for premium tax credit to reduce the cost of coverage and/or cost-sharing subsidies based on income and family size. • Incomes between 100% and 400% of federal poverty level (FPL) are eligible for a premium tax credit to reduce the cost of coverage on the Marketplace. 2013 individual FPL is $11,490. • For example • Up to 400% of FPL in 2013 • Up to $45,960 for individuals • Up to $62,040 for a family of 2 • Up to $78,120 for a family of 3 • Up to $94,200 for a family of 4 • Marketplaces are required to tell enrollees about their eligibility for subsidies at the time they enroll. • Cost-sharing subsidies* protect lower income people from high out-of-pocket costs at the point of service.** • If a person’s income: • Is 100-150% ($11,490-17,235) the AV must be 94% • Is 150-200% ($17,235-$22,980) AV must be 87% • Is 200-250% ($22,980-$28,725) AV is 73% *Based on the second lowest-cost silver plan in their area for up to 250% of FPL ** Out-of-pocket cost savings only apply to Silver plans.

  21. Health Plan Comparison Appendix

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