Transcript PRESENTATION TITLE - Nekoosa School District Of

School District
of Nekoosa
Vickie Thoreson
Sr. Account Executive/Partner
April 2013
2
Compliance: Where Are We Now?
•
•
•
On June 28th, U.S. Supreme
Court upheld the
constitutionality of
Affordable Care Act (ACA)
Rationale based on
Congress’ power to tax,
not usual Commerce
Clause power
On November 6, 2012,
President Obama won reelection, solidifying the
future of the PPACA
New HCR Taxes & Fees that will trickle down to the Nekoosa
School District
• PCORI
$1 pmpm 1st year; $2 pmpm 2nd year *2014
– Patient-Centered Outcomes Research Institute
• Insurer Fees – 2.3% of premium *2014
• Transitional Reinsurance Fee *2014
$5.65 pmpm ($63 pmpy)
• Risk Adjustment Fee
*2014
< $1 pmpm (healthy vs unhealthy)
• Exchange Tax *2014
Insurer pays to participate in the Exchange
* Insurer pays but will trickle down to your premium
4
What we know
• If no changes are made, the
Cadillac tax for the Nekoosa
School District will be
approximately $341,000 in
2018
*Assumes 10% annual trend, and
carrier will likely raise premiums
accordingly
5
Cadillac Excise Tax - 2018
tax on premium that exceeds HCR premium benchmark
Annual Premiums
2013-2014
NSD Premium
(s)$9,022
(f) $19,885
6
What’s next
Employee/Individual
Not available to employers with
over 100 employees until 2017
No decision to date regarding participation of
employers with 50-100 employees; most likely
will be available only to employers with 50 or
less employees
Wisconsin – waited until after the election. On
November 16, 2012 Governor Walker announced that
Wisconsin would not establish an exchange but rather
allow the federal government to establish an
exchange… this leads to great uncertainly about the
future of Exchanges in Wisconsin and elsewhere…
stay tuned
7
What Can We Do to Prepare?
8
Healthier Population
• Stay healthy
• Get healthier
• Be wise consumers of
our medical plan
9
Watch for Wellness
Committee news in
the coming months!
WEA Trust Base Plan – What is it?
• Aligns with the market benefit
designs
• Aligns with State mandated
benefits
• Introduces $100 co-payment for
non-emergency high cost
radiology such as CAT, PET & MRI
10
WEA Trust Base Plan
• Encourages network usage with
separate out-of-pocket
• Benefit impact is minimal to District
members
• Will impact very small % of members
• Many schools changing to this benefit
design
11
Primary & Specialty Care
Primary Care
•
•
•
•
•
•
12
Family Practice
General Practice
OB GYN
Pediatrics
Geriatrics
Internal Medicine
Primary & Specialty Care
Specialty Care
•
•
•
•
•
13
Devotes attention to a particular branch of medicine
Cardiologist
Psychiatrist
Rheumatologist
Oncologist
Primary & Specialty Care
• Specialist office visit is typically 3-4 times more costly
• We oftentimes “self refer” to specialist
14
Primary & Specialty Care
• Effective July 1st 2013
• $10 Primary Care Co-Payment
• $25 Specialty Care Co-Payment
Don’t forget to use your Flex Plan!!
15
We’re here to help
16