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11367s0814 Edt.08.25.14

Allied™ Pay or Play Solutions Cost-effective options for the Employer Shared Responsibility provisions of the Affordable Care Act. 11367s0814 Edt.08.25.14. Allied Pay or Play Solutions Employer Shared Responsibility (Pay or Play) Impacts, Requirements & Penalties

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11367s0814 Edt.08.25.14

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  1. Allied™ Pay or Play Solutions Cost-effective options for the Employer Shared Responsibility provisions of the Affordable Care Act 11367s0814 Edt.08.25.14

  2. Allied Pay or Play Solutions • Employer Shared Responsibility (Pay or Play) • Impacts, Requirements & Penalties • Product Solutions for Large Employers • Sample Cases • Submissions and Underwriting

  3. Allied National Innovation Stability Service 3

  4. Allied National • Operational Profile • Underwriting • Claims Administration • Policy Service • Actuarial • Compliance • Product Development • Case Management • Sales & Marketing • Legal 4

  5. What you need to know and learn to understand Pay or Play ACA Pay or Play Regulations and Language: • What is an applicable large employer? • What is an FTE? How to count FTEs? • How do the penalties work? • PMEC/Skinny Plans/MVP/Narrow Plans • Affordability • 2015 rules vs 2016 rules – group size, penalties • Transition relief rules - All employee test/All FT employee test These are the high points -THIS IS NOT ALL!!!! Expect the rules to change 5

  6. For the Individual - Employee What does ACA mean for an individual? • Individual Mandate says individuals must have health insurance or pay a penalty. • Penalty starts at $95 for 2014 then in 2016 escalates to $695 or 2.5% of taxable income (which ever is greater). • Insurance can be employer provided or an individual plan.Must be qualifying Minimum Essential Coverage. 6

  7. For a Business – Employer What you need to know about ACA for businesses . . . 7

  8. Do I have to offer health insurance to my employees on January 1, 2015? more than 100 less than 100 Based on full-time equivalent employee counts. Part-timers count! In 2016, the employer size drops to 50! 8

  9. What type of coverage must I offer? • Employer coverage must meet TWO levels of tests under Section 4980H • “A” test – “The Sledgehammer” • Must provide Minimum Essential Coverage to 95% of full-time eligible employees (70% in 2015) • The Penalty? $2,000 per full-time eligible employee less the first 30 (80 in 2015) • Penalty triggered by employee going to the Exchange and receiving subsidy 9

  10. What type of coverage must I offer? Employer coverage must meet TWO levels of test under Section 4980h “B” test – “The Tackhammer” • Must provide Minimum Value Coverage to 95% of employees • Coverage must be Affordable (no more than 9.5% of household income). • The Penalty? $3,000 per employee who receives subsidized coverage on the Exchange 10

  11. What If I don’t Play? PENALTY EXAMPLES Employer with 180 full-time eligible employees (A) Failure to provide MEC: $2,000 (180 - 80*) = $200,000 non tax deductible penalty ($300,000 in 2016!) (B) Failure to provide Minimum Value affordable coverage: $3,000 per employee with subsidized coverage * less 80 is 2015….less 30 in 2016 11

  12. What are an Employer’s Options? • Pay the penalty? • Find the cheapest way to avoid penalties? • Provide a major medical health plan to everyone? • Provide an affordable alternative in the middle? 12

  13. Allied Pay or Play Solutions • Creative suite of products to meet any employer’s needs • Uses a mix of self-funded and fully insured options • Low-cost Alternatives • Meets Current Minimum Essential Coverage (MEC) and Minimum Value standards • Four plan levels 13

  14. Allied Pay or Play Solutions Offering four plan levels to manage the expense of this mandate:

  15. Allied Pay or Play Solutions • Plan Level 1 – Self Funded PMEC • Preventive Services Only Minimum Essential Coverage (PMEC) • Meets MEC requirement and avoids the employer sledgehammer penalty • Meets individual mandate and covered employees avoid that individual penalty • Lowest cost way to avoid penalties 15

  16. Allied Pay or Play Solutions Plan Level 2 – Fully Insured Limited Benefit Plans Fixed Indemnity plan on top of PMEC • Allows employer to provide additional benefits on top of a PMEC plan • Employer paid or voluntary • Benefits for hospitalization, office visits, Rx drugs Gap Plan • Supplement for high deductible plans • Employer paid or voluntary 16

  17. Allied Pay or Play Solutions Plan Level 3 – Self-funded Minimum Value Plans Allied Minimum Value Plan (MVP) • Low Cost Narrow MVP plan – one size fits all • Guaranteed Issue – No Medical Underwriting • First dollar benefits - $0 deductible with copays • Eliminates In-Patient, Surgery and Specialty Drugs • Adds indemnity benefits for In-Patient & Surgery • Currently Satisfies Minimum Value 60% standard 17

  18. Allied Pay or Play Solutions Plan Level 3 – Self-funded Minimum Value Plans Allied MediPay Plan • Comprehensive Major Medical - Controls costs by basing provider reimbursement on Medicare • Physicians reimbursed at 125% • Facilities at 125-200% as selected. • Lowers monthly costs 10% to 30% below traditional PPO reimbursement • Members subject to balance bill 18

  19. Allied Pay or Play Solutions • Plan Level 4– Self Funded Traditional Plans • Allied Funding Advantage Plans • Premium Advantage – traditional PPO plans • Provider Freedom – no network, see any provider, protection from balance bills • MediPay Plan – no network, Medicare reimbursement - Employee is responsible for all balance bills under MediPay 19

  20. Plan Structures • Fully Insured Structure • Limited Benefit • Gap Plans • Self Funded Structures • Funding Advantage, PMEC, MVP, MediPay • 12-21 contracts • Plan run out period ends the last day of month 21 • Refunds calculated in month 22 • Refunds disbursed in month 23 • Monthly accounting summary • Quarterly claims reports • Renewal offers on all groups

  21. Claims Payment Balance Bill Obligations ID cards for PMEC/MVP/MediPay will show Medicare reimbursement levels. Members receive Advocacy help in balance bill situations.

  22. Underwriting Time Frame 24

  23. Time Frame: Medically Underwritten Cases 25

  24. Time Frame: PMEC - MVP 26

  25. Agent’s Compensation Funding Advantage & MVP Default 2-6% adjustable as required PMEC 10% Limited Benefit & Gap TBD 27

  26. Our Sales TeamContact Us Email or fax data to “Sales” sales@alliednational.com 888-767-7133 Fax: 913-945-4390 Our Team • Dan Meylan: National Sales Director; 913-945-4253 • Bill Ringhofer: Regional Sales Manager; 913-945-4266 • Randy Wehner: Sales Manager; 913-945-4267 • Matthew Bryon: Account Executive; 913-945-4255 • Cheryl Knight: Account Executive; 913-945-4261 28

  27. Allied National, Inc.4551 W. 107th St. #100Overland Park, KS 66207 Questions? Allied Sales Support 888-767-7133 www.alliednational.com sales@alliednational.comtwitter.com/alliednational Fax: 913-945-4396 29

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