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The big picture

HEALTH CARE REFORM | WHAT TO EXPECT. Colorado Healthcare Associated Risk Management Annual Meeting September 20, 2013. The big picture. On March 23, 2010, the Affordable Care Act was signed into federal law.

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The big picture

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  1. HEALTH CARE REFORM | WHAT TO EXPECT Colorado Healthcare Associated Risk Management Annual Meeting September 20, 2013 The big picture

  2. On March 23, 2010, the Affordable Care Act was signed into federal law. It’s the most significant change to our nation’s health care system since Medicare was enacted in 1965.

  3. Primary purpose of legislation 1 3 2 More affordable coverage Better accessto care Improvedqualityof care Issuers must spend at least 80% of premium dollars on health care, and some people may be eligible for financial help through the marketplace Limits issuers’ ability to deny, limit, or rescind coverage, and ends annual and lifetime spending caps Creates a quality measures reporting system for health plans and insurance providers

  4. Changes already enacted Expanded, no-cost preventive care No annual or lifetime limits on essential health benefits Kids can stay on their parents’ plan until they turn 26 Children with pre-existing conditions are covered Grandfathered plans are exempt from many ACA requirements. As a result, people enrolled in grandfathered plans may not have coverage that reflects the changes listed above.

  5. General updates HEALTH CARE REFORM | WHAT TO EXPECT Delayed — Employer shared responsibility penalty • The IRS encourages groups with at least50+ full-time equivalent employees to comply with the employer shared responsibility requirements in 2014. • All other requirements for 2013 and 2014 remain in effect. • Employers who fail to comply with the shared responsibility requirements in 2014 will not face tax penalties. • Penalty for noncompliance now effective January 1, 2015.

  6. Key dates HEALTH CARE REFORM | WHAT TO EXPECT Employer exchange notice • New employees — Employers must provide the exchange notice to each new employee within 14 days of start date. • Existing employees — Employers must provide the exchange notice by October 1, 2013. • Exchange notices located at the Department of Labor website: • dol.gov/ebsa/pdf/FLSAwithplans.pdf • dol.gov/ebsa/pdf/FLSAwithoutplans.pdf

  7. Top 3 things you should know Coverage is guaranteed for people, even if they have pre-existing conditions 1 2 Most people must buy coverage 3 Federal financial assistance is available

  8. 1 Coverage is guaranteed • Known as guaranteed availability • Can’t be denied based on medical condition • No medical exam required • Preventive care included at no cost* * Grandfathered plans for individuals (those that were in effect on or before March 23, 2010) may not include all preventive services at no cost.

  9. 2 Most people must buy coverage Coverage options

  10. 2 Most people must buy coverage Enrolling through the individual marketplace

  11. 2 Most people must buy coverage You have help in the marketplace

  12. Individual exchanges • Behind the scenes: * If consumer is eligible for subsidies

  13. 3 Financial assistance through the marketplace Available federal financial assistance helps lower-income families afford health care coverage

  14. Connect for Health Colorado (connectforhealthCO.com) Let’s take a look…

  15. HEALTH CARE REFORM | WHAT TO EXPECT Health plans participating in the SHOP

  16. Supporting members and our communities

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