Transcript Slide 1

@WeRRestaurants
/RestaurantDotOrg
/NationalRestaurantAssociation
Restaurant.org
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Individual Mandate and
Marketplace Realities: What
do I tell my employees?
(especially those not eligible for my group plan)
January 21, 2015
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Randy Spicer,
Vice President, Health & Insurance Services
National Restaurant Association
[email protected]
Clinton Wolf,
Senior Director, Strategic Initiatives
Optum
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Introduction
The Affordable Care Act is Here to Stay…
in One Form or Another.
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We need to:
Understand it
 Implement it in the way that best serves
your business
 Help employees make informed choices
and Comply with Individual Mandate
(…especially those not eligible for my group plan)

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Why now?
 Open enrollment ends February 15th.
 Employees are paying penalties for 2014.
 Many wait to enroll until the end.
 New Opportunities to help your employees
and your business.
 ACA impacts all Employers and Employees
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Reporting Requirements
Requirements are Substantial Under ACA
 Onus is on the Employer to Prove They Are/Are Not
Covered Under Act
 This Means Tracking Variable Hour Employees
 IRS May Require Proof
 If an Employee Goes to Marketplace (and Receives
Subsidy):
 Employer may have to Prove Offer for Coverage Made
 If No Offer Made…Penalty Imposed
 If Wrong Type of Coverage Offered…Penalty Imposed
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Standard Reporting
Standard Operating Procedure
 Notice of Exchanges
 Must Provide Notice of Exchanges Within 14c Days of Hire
 NRA Notification Tool at notify.restaurant.org
 Offer Coverage
 Do Not Offer Coverage
 Include in New Hire Process
 Have Employee Sign an Acknowledgement of Receipt & File
in Personnel File
 W2 Reporting – (File 250 or More W-2s)
 Provide Data on the Value of Health Care Coverage for
Employees Enrolled in a Plan on Box 12DD on W2
 Aggregate Cost (Employer + Employee)
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Impact Of ACA
People Report- Summary of Findings
 Two Most Common Tactics to Manage Cost
 Hire Relatively More Part-Time Employees
 Increase Prices
 Most Companies Plan to Offer Coverage
 Majority Believe Benefits Help Recruit and Retain
the Best Employees
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ACA Impact - Recruiting
Will it Help?
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Retaining Employees
Will it Help?
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Impact Of ACA
Impact on Recruiting/Retaining Will Grow

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Small Penalties Initially…Low Participation
Down the Road…Expectations will Change
Employees will Come to Expect Benefits
Earlier you Address Issue the Better


Find Solutions that Meet Business Needs
Find Solutions that Meet Employee Needs
 Need to Understand and Manage Benefits
for All Employees Going Forward
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ACA Creates New Coverage Options
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New Employer Benefit Models are Here
Group + Individual
Exchange
Individual Exchange
Only
• Provide Group Benefits
to some Employees and
Individual Exchange
access/support for others.
• Provide all Cobra
eligibles access/support
to Individual Exchange.
• Provide employees
access and possibly
compensation &
resources to enroll.
• Provide employees
access only to Individual
Exchange
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I have COBRA and it’s too expensive. Can I drop it during Open
Enrollment and enroll in a Individual Marketplace plan instead? Yes,
during Open Enrollment, you can sign up for a Individual Marketplace
plan even if you already have COBRA. You will have to drop your COBRA
coverage effective on the date your new coverage begins.
I’m leaving my job and will be eligible for COBRA. Can I shop for
coverage and subsidies on the Individual Marketplace instead? Yes,
leaving your job and losing job-based health coverage will trigger a
special enrollment opportunity that lasts for 60 days. You can apply for
Individual Marketplace health plans and (depending on your income) for
premium tax credits and cost sharing reductions during that period. If
you enroll in COBRA coverage through your former employer, however,
you will need to wait until the next Open Enrollment period if you want
to switch to a Individual Marketplace plan.
Employee Communication: Individual
Mandate
What do I tell my
Employees?
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Communicate - Employees
What Do They Want to Know?
 What Does ACA Mean to Me?
 What are my Choices?
 What Will it Cost?
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Affordable Care Act
What does it mean to me?
Individuals MUST acquire and maintain “minimum essential
coverage” each month, qualify for an exemption, OR pay a
penalty through their individual tax returns.
 The obligation to make quality, affordable health insurance
coverage available to individuals is “shared” among:
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Federal and State governments
Employers
Insurers; and
Individuals
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Individual Mandate
What Choices do Employees Have?
 Get Coverage Through Their Employer
 Buy an Individual Plan Through Either:
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The Federal Health Insurance Marketplace (May be
Eligible for Subsidy);
The Private Exchange Market; or
Private Insurance Provider
 Obtain Coverage from the Government (Medicaid,
Medicare, TRICARE)
 Go Uninsured (Will Pay Penalty Unless They Qualify
for an Individual Exemption)
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Individual Penalty
Assessed April 2015
Those Without Coverage Pay a Tax Penalty the Greater of :
2016 = $695 or 2.5% Taxable Income
2015 = $325 or 2% Taxable Income ($16,250+)
2014 = $95 or 1% Taxable Income
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Employee Cost
What will it cost?
 If You Offer Coverage…They are Not Eligible for a
Subsidy thru the Exchange
 If You Don’t Offer Them Coverage…They could be
eligible for a Subsidy thru the Exchange
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Health Exchanges
Exchange Plan Types
Metal Level
Target
Actuarial Value
Range of Allowable Actuarial
Value
Bronze
60%
58% - 62%
Silver
70%
68% - 72%
Gold
80%
78% - 82%
Platinum
90%
88% - 92%
Catastrophic Plans available for those under 30 and for those who are exempt because
no affordable coverage is available or they have a hardship exemption.
Sample Catastrophic Plan
Individual Deductible
Family Deductible
Covers Essential Benefits
$6,600
$13,200
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Health Insurance Exchanges
Exchange Credits
What makes someone eligible for exchange credits?
 The individual’s household income is between 100% - 400%
of the federal poverty level; and
 The individual does not have access to employer provided
coverage…
(1) that has an actuarial value of at least 60% or
(2) the cost of coverage exceeds 9.5% of the individual’s
household income.
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Subsidy Calculator- Kaiser Family Foundation
Premium Assistance for Coverage in
Exchanges
This tool illustrates health insurance premiums and
subsidies for people purchasing insurance on their own in
new health insurance exchanges (or “Marketplaces”)
created by the Affordable Care Act (ACA). Middle-income
people who are not eligible for coverage through their
employer, Medicaid, or Medicare, can apply for tax credit
subsidies available through state-based exchanges.
http://kff.org/interactive/subsidy-calculator/
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Family of Four; Two Adults & Two Children
Results:
The information below is about subsidized exchange coverage. Note that subsidies are
only available for people purchasing coverage on their own in the exchange (not
through an employer). Depending on your state's eligibility criteria, you or some
members of your family may qualify for Medicaid.
Household income in 2015: $35,775 is 150% of poverty level
Maximum % of income you have to pay for the premium is : 4.02%
Health Insurance premium in 2015 (for a silver plan, before tax credit): $8,474 /year
You could receive a government tax credit subsidy of up to: $7,036 per year
(which covers 83% of the overall premium)
Amount you pay for the premium:$1,438 per year (which equals 4.02% of your
household income and covers 17% of the overall premium)
You are guaranteed access to a Silver plan with an actuarial value of 94%. Your out-ofpocket maximum for a Silver plan (not including the premium) can be no more
than $4,500.
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Health Exchanges
Exchange Plan Types
Metal Level
Target
Actuarial Value
Range of Allowable Actuarial
Value
Bronze
60%
58% - 62%
Silver
70%
68% - 72%
Gold
80%
78% - 82%
Platinum
90%
88% - 92%
Catastrophic Plans available for those under 30 and for those who are exempt because
no affordable coverage is available or they have a hardship exemption.
Sample Catastrophic Plan
Individual Deductible
Family Deductible
Covers Essential Benefits
$6,600
$13,200
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Communicate - Employees
Many Are Waiting for Your Guidance
 A lot of misinformation is out there
 Understand their interest
Make sure they know the cost of being covered and Not covered
Some may be covered under parent or spouse’s plan
Health insurance is a secondary concern that is trumped by earnings
 Most have never had insurance and don’t understand what is really
being offered
 Might bring in your broker to talk to them about insurance
 Understand what they are signing up for
 Don’t care if you are a classified as small or large employer – they are
interested whether you will offer insurance
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UnitedHealthcare Alliance
All Medical & Specialty Products Available
Exclusive:
• Medical Discounts: Up to 5 % savings on
manual premium for 51+ groups.
• Optum Restaurant Healthcare Discount card –
$5 pepm and includes family
• Voluntary dental for part-timers with purchase of
full-time dental policy
• 5% Discount on Specialty Products
• Greatly Improved pricing for Groups:
–Offering for first time
–Offering to new employee segments
• Individual Exchange Tool Kit in Select
Markets
Tools to Share with Employees
PARTNERING TO HELP EMPLOYEES AVOID PENALTIES
Partnered to provide:
• Easy to share information
• Posters
• Fliers
• Newsletter/email content
More information and enrollment:
• Web and 800# available
• 800# is preferred
Spirit of Sharing information
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For Small Employers (under 50 FTEs)
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For Large Employers (over 50 FTEs)
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Download Resources
www.uhctogether.com/TXkits
www.uhctogether.com/FLkits
www.uhctogether.com/NCkits
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Individual Exchange To Do List
1.
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4.
Download the tool kit.
Understand the options available.
Communicate with employees
Stay tuned to the Health Care HQ for the latest
updates Restaurant.org/Healthcare
Questions?
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Visit NRA Health Care HQ www.restaurant.org/healthcare
Randy Spicer,
Vice President, Health & Insurance Services
[email protected]
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