the eagle has landed

“THE EAGLE HAS LANDED”
INTRODUCTIONS
Ben Faesel, Senior Manager of Health
Care Reform Implementation
Stephanie Hoffmann, Director of
Business Development
Wes Reohr, Manager Small Group Sales
Mell McKelvey, Vice President,
Actuarial Services
GR-P11-433/2.PPT (10/10/2012)
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AGENDA
In the News
Employer Mandate
Out-of-Pocket Maximum
Participation Requirements
New Small Group Benefits
Exchange News
SHOP Alternatives
GR-P11-433/3.PPT (10/10/2012)
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IN THE NEWS
 ―All this would be funny if it wasn’t so crazy,‖ he said.
―The tea party Republicans have taken it to a whole
new level because they’re threatening to shut down
the government or shut down the entire economy …
unless I agree to gut a law that will help millions of
people.‖ – President Obama
 "The ACA is definitely escalating the pace of change,"
said Sandy Ageloff, senior consultant with Towers
Watson
GR-P11-433/4.PPT (10/10/2012)
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EMPLOYER MANDATE
As of 1/1/2014, large employers (50+ FTE
employees) must offer health benefits to
their full time workers or pay a penalty*
 Benefits must meet a number of
requirements for affordability and value
 Must report this plan information to the
federal government
* Penalties delayed until 1/1/2015
GR-P11-433/5.PPT (10/10/2012)
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MODEL NOTICES
 All employers were required to provide
employees prior to October 1, 2013 with a
written notice about the exchange, how to
request assistance, the availability of tax credits
the implications for the employee if they choose
to purchase a qualified health plan through an
exchange
 Draft language is available for employers and
will be provided by CBC through
capbluecross.com
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Out-of-Pocket Maximum
OUT-OF-POCKET MAXIMUM
ACA requirement
$6350/individual; $12,700/family
Deductible, copayment, coinsurance
not premium
Cross-accumulates medical and Rx
coverage
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OUT-OF-POCKET MAXIMUM
 2014: safe harbor provision
ACA requirements apply
Issuer administers Rx through third party =
no cross-accumulation with medical coverage
required
 2015: ACA requirement applies, no safe
harbor
Cross-accumulation medical + Rx coverage,
regardless of administration
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OUT-OF-POCKET MAXIMUM
 ACA requirement + safe harbor 2014:
 All medical coverage has OOP maximum
 If TPA for Rx coverage, cross accumulation
optional
 If no cross accumulation, Rx coverage:
 No OOP max in 2013 = no OOP max in 2014
 OOP max in 2013 = separate, ACA compliant
OOP max in 2014
GR-P11-433/10.PPT (10/10/2012)
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OOP ACCUMULATOR APPLICATION
What accumulates toward OOP Max?
2013
2014
Deductible
Medical
Drug
Dental/Vision
Coinsurance



Copays

Cost Sharing

Adult Cost Sharing
Child Cost Sharing

Note: Application of OOP max specific to Capital Blue Cross
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CAPITAL BLUE CROSS
OUT-OF-POCKET MAXIMUM 2014
 Small group (1-50)
 Medical + Rx coverage cross accumulate to ACA
compliant OOP maximum
 Mid-market group (51-99)
 Medical + Rx coverage cross accumulate to ACA
compliant OOP maximum
 Large group (100+)
 Medical coverage ACA compliant OOP maximum
 Rx coverage:
 No OOP max in 2013 = no OOP max in 2014
 OOP max in 2013 = separate, ACA compliant OOP max
in 2014
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DEDUCTIBLE LIMITS
Deductibles for plans in the small group
market are limited to $2,000
individual/$4,000 family, indexed to
average premium growth.
This amount may be increased by the
maximum amount of reimbursement
available to an employee under a flexible
spending arrangement.
Or do they?
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Participation Requirements
PARTICIPATION REQUIREMENTS
 Small Group
Guaranteed Issue
Participation Requirements
SHOP
Off Exchange
Open Enrollment Period
 Large Group
Guaranteed Issue
Risk
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NEW BENEFITS FOR SMALL GROUPS
Pediatric Dental
Pediatric Vision
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Exchange News
EXCHANGE NEWS
 The Obama administration is delaying another piece of
Obamacare — this time postponing online enrollment in
some of the small-business exchanges scheduled to open
Oct. 1 , sources tell POLITICO.
 "Small businesses will be able to participate in the SHOP
beginning on October 1 to evaluate their coverage
options," Health and Human Services Department
spokeswoman Joanne Peters said.
"In November, small businesses will be able to enroll in
coverage options, well ahead of when coverage begins on
January 1 ."
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EXCHANGE NEWS:
FROM OCTOBER 1
 22 –
successful enrollees on Access CT, Connecti cut’s exchange, as
of 11:30 a.m. 10,000 people had visited the site.
 34,500
– unique visitor s to the Connect for Health Colorado
Marketplace in the fir st three hour s. More than 1 ,300 created
accounts.
 1 ,000
– applications processed the morning of Oct. 1 by Kentucky’s
Kynect exchange. By 9:30 a.m. 24,000 people had visited the
website.
 200,000+
-- searches for HealthCare.gov on Google yesterday,
making it the third ―hot search‖ topic of the day
 30,000
– calls by 9:30 a.m. to Covered California’s ser vice center
-Politico
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SHOP Alternatives
INDIVIDUAL PRODUCTS:
ON MARKETPLACE
<60% AV
AV 60%
AV 70%
AV 80%
HMO
HMO
HMO
HMO
OPM MSP
HMO
OPM MSP
HMO
PPO
PPO
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AV 90%
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INDIVIDUAL PRODUCTS:
OFF MARKETPLACE
<60% AV
AV 60%
AV 70%
AV 80%
AV 90%
PPO
PPO
PPO
PPO
HMO
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SMALL GROUP PRODUCTS:
ON MARKETPLACE
AV 60%
HMO
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AV 70%
AV 80%
PPO
PPO
HMO
HMO
AV 90%
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SMALL GROUP PRODUCTS:
OFF MARKETPLACE
GR-P11-433/24.PPT (10/10/2012)
AV 60%
AV 70%
AV 80%
AV 90%
PPO
PPO
PPO
PPO
HMO
HMO
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CAPITAL BLUE CROSS’
PRODUCT PORTFOLIO OVERVIEW
2014
25–30 medical products
Three Rx products
2013
2–50 Off Marketplace
112 medical products
24 Rx products
5 medical and
Rx products
Old Portfolio
SHOP
25–30 medical products
Three Rx products
51–99
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Questions