PPACA Act of 2010

1. PPACA Act of 2010 Update October 2011

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5. PPACA Update • Provisions Effective 2010 • Appeals and External Review • Dependent Coverage to age 26 • Doctor Choice • Annual and Lifetime Maximum $ Limits • Emergency Care • Preventive Services without Cost Share

6. PPACA Update • Provisions Effective 2011 • Carrier Medical Loss Ratio • 85% Large Groups • 80% Small Groups • Over the Counter Drugs FSA, HSA • No longer reimbursed unless Rx • HSA Distribution Tax Penalty

7. PPACA Update • Provisions Effective 2012 • W-2 Reporting 2012 Tax Year • Report in January 2013 • Small Employers with less than 250 W-2’s are exempt • 60 Day Plan Change Notification Required • Standardization of Coverage Documents • Page Limits • Lay Person Language • Uniform Definition of Standard Terms • Description of Coverage • Include Limitations, Reductions, Cost Sharing Provisions, Web Links for actual Contract download • $1,000 per Enrollee Penalty • Carrier Requirement

8. PPACA Update • Provisions Effective 2013 • FSA Limits • $2,500 Maximum on Health FSA • $5,000 Dependant Care Limit

9. PPACA Update • Provisions Effective 2014 • American Health Benefit Exchange • Option for Individuals and “Small Employers”. • Main objective is to make Health Insurance more affordable, accessible , and easy to purchase. • Four Main Coverage Levels:

10. PPACA Update • Provisions Effective 2014 • Essential Health Benefit • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental Health & substance abuse disorder services (including behavioral health treatment) • Prescription drugs • Rehabilitative & habilitative services and devices • Laboratory services • Preventive & wellness services & chronic disease management • Pediatric services, including oral and vision care

11. PPACA Update • Provisions Effective 2014 • Individual Mandate • US Citizens required to have “Minimum Essential” Coverage. • Subject to Tax Penalty • Calculated Monthly • Paid Annually • $95 - 2014 • $325 – 2015 • $695 - 2016

12. PPACA Update • Provisions Effective 2014 • Employer Mandates 50+ • If no Coverage offered to any Full-Time Employee receiving Premium Assistance. • $2,000 Annual Fee for each Full-Time Employee (minus 30) • If Coverage offered but Full-Time Employee receives Premium Assistance. • lesser of $3,000 per employee receiving assistance or $2,000 per employee (minus 30) • Full-Time Employees defined as 30+ Hours.

13. PPACA Update • Provisions Effective 2014 • Financial Assistance • Premium Tax Credit • Cost Sharing Subsidies • Auto-Enrollment • Requires Employer with 200 Full-Time Employees to enroll Employees into the Health Plan. • PA – Status • Hearings being held • Decision on whether to offer State or Federal Program

14. PPACA Update • What’s Next! • Supreme Court – Individual Mandate Challenge • June 2012? • CLASS Act – (Voluntary Long Term Care) • Originally estimated 86 Billion of total 210 Billion in savings from Health Care Reform • Participants premiums for 5 years were factored in, but no accounting for payments.