Jeff Crawford, Vice President jcrawford@lewer.com Ph: 800-821-7715, Ext. 148

1. AWISA Winter 2013Changes Under PPACA: What You and Your Students Need to Know About Health Care Reform Jeff Crawford, Vice President jcrawford@lewer.com Ph: 800-821-7715, Ext. 148 Monica Olson, M.Ed., Regional Sales Director molson@lewer.com Ph: 206-618-8337

2. PPACA: Patient Protection and Affordable Care Act MURKY Waters ahead? Shifting Sands Ahead

3. Top 5 List: International Insurance Plan Brainstorm a short list of what is valuable, important or necessary in an insurance plan. What is important to you, your staff or yourself when you think about using or administering an international student insurance plan?

4. Terms and Definitions • PPACA: Patient Protection and Affordable Care Act • ACHA: American College Health Association • Deductible: Small amount of money paid out of pocket for each sickness or injury • Co-pay: Small set amount of money paid out of pocket for each office or hospital visit • Co-Insurance: a certain set percentage of money to be paid for each service • SHP: Student Health Plan • MLR: Medical Loss Ratio

5. Affordable Care Act: Timeline of Events • March 23, 2010: Affordable Care Act was signed into law • March 21, 2012: Final regulations on student health insurance plans • June 28, 2012: United States Supreme Court upheld the constitutionality of most of PPACA

6. Affordable Care Act:Changes in Progress - Annual Limits

7. Affordable Care Act:Changes in Progress - Requirements PPACA requires all compliant student health plans (SHPs) to have: • Preventative Care: Student health coverage is required to provide preventive services without cost-sharing and co-pays. • Pre-existing Condition Limitations: Plans may not impose pre-existing condition limitations on those younger than age 19. • As of 2014, pre-existing conditions cannot be excluded.

8. Affordable Care Act: Changes in Progress - Requirements • Individual Mandate - January 1, 2014 • Essential Health Benefits: must include these 10 categories • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Pediatric services, including oral and vision care • Mental health and substance use disorder services, including behavioral health treatment • Rehabilitative and habilitativeservices and devices • Laboratory services • Preventive and wellness services, chronic disease management, and prescription drugs

9. PPACA Ripple Effect:Things to Consider • Waivers Examine waiver policy to close the gap for waivers and keep your risk exposure low • Cost-Benefit You want enhanced benefits, but there is a tipping point for cost and use…where is it?

10. PPACA Ripple Effect:Things to Consider 2014 Policy Year and Beyond: PPACA Plans • Unlimited Coverage • No Exclusion for Pre-Existing Conditions • MLR – 80% (Medical Loss Ratio) • Cost Increase and Destabilization

11. What is MLR?Medical Loss Ratio

12. What is Important for Your Students? • Unlimited Coverage • $250 Deductible • 20% Coinsurance • No Pre-existing Exclusion • Wellness Coverage • Increased $$ Premium • Current Accident & Sickness Coverage • $0 Deductible • 100% Network Coverage • Pre-existing Exclusion • Limited Wellness Coverage • Stable Premium Plan A Plan B

13. Action Options: What Can You Do? Policy Year: 2013-2014 • Compliant Plan • Participation mandate important • Benefits include wellness and immunizations • Other Options • Limited Duration: • Accident and Sickness Only Plan

14. Top 5 List: International Insurance Plan Now that you have learned about the upcoming PPACA changes… What is important to you, your staff or yourself when you think about using or administering an international student insurance plan?

15. Resources • http://www.healthcare.gov/law/full/patient-protection.pdf Affordable Care Act • http://acha.org/Topics/Affordable_Care_Act/AffordableCareAct.cfm ACHA Website • http://www.healthcare.gov/news/factsheets/2010/09/affordable-care-act-immunization.html ACHA Immunization List