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Presenter:
Si Nahra, Ph.D., President
May 29, 2014
ACA Communications Requirements:
An Employee Relations Opportunity
Copyright Health Decisions, Inc.
05/2014
2
About Health Decisions, Inc.
Pioneering Specialists in
Group Health Care
Post-Payment Administration
For Over 25 Years
Respect for Existing Procedures
Emphasis on Customization
Focus on Solutions
Customer Philosophy
2014 ACA Series
Copyright Health Decisions, Inc.
05/2014
3
Non-grandfathered, calendar year plans.
Comply not just because you have to.
Comply in a way that helps your plan.
FOCUS
Quick Review
What you should have done.
• Reporting to employees
– W-2 plan values
– Summary of Benefits and Coverage (SBC)
– Exchange Notices
• Benefits
– Selected Essential Health Benefits
– No cost sharing for federal preventive care benefits
– No pre-existing conditions
– No lifetime maximums
– Dependents covered until 26
– Clinical trial coverage
• Safe Harbors
– Minimum Value Safe Harbor
– Affordability Safe Harbor
• New Out-of-Pocket rules implemented
Copyright Health Decisions, Inc.
5/2014
4
ACA Compliance
Checklist
Sessions available now.
Call 734-451-2230
Ask for Leslie.
E-mail
leslie@healthdecisions.com
Employee Communications
• Required: Scheduled or Event Driven
– ACA
– DOL
– IRS
• Opportunities
– ACA Q&A to and from employees
– Spouse/Dependent confirmation
– Public Exchange Navigation
– COBRA Options
– Private Exchange Options
Copyright Health Decisions, Inc.
05/2014
5
Scheduled Communications
Event DOL
http://www.dol.gov/ebsa/
pdf/rdguide.pdf
ACA IRS
Oct
Open
Enrollment
SPD, SMM,
WHCRA, Wellness
Summary of Benefits
and CoverageNov
Dec
Jan Tax Filings W-2 benefit value
6055/6056 Notices
W-2 filing
6055/6056 filingFeb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Open
Enrollment
SPD, SMM,
WHCRA, Wellness
Summary of Benefits
and CoverageNov
Dec
Copyright Health Decisions, Inc.
05/2014
6
Communication “Silent Period”
Event Communications
Event DOL ACA IRS
New Hires: Eligible Enrollment Rights Notice Marketplace Notice
Affordability Confirmation
W-4
New Eligible Enrollment Rights Notice Marketplace Notice
Affordability Confirmation
New Enrollee SPD, etc. Summary of Benefits and
Coverage
New Dependent MCSO Notice SSN Collection
New Hire: Ineligible Marketplace Notice W-4
Employment Termination Certificate of Credible
Coverage
COBRA Election Notice
New COBRA Notices
Change in Employment
Status
“Trigger Events”:
Notice of Change in
Eligibility
Change in Coverage
Status
Claim Payment
Processing
EOB
Notice of Benefit
Determination
Copyright Health Decisions, Inc.
05/2014
7
Communications Opportunities:
Going Beyond Minimum Requirements
Event Communication Opportunity
Post Open Enrollment
Post Tax Filing
Validation survey to confirm eligibility and enrollment
with required response to engage employee
New Hire/ New Eligible Personalized offers of election assistance
Trigger Events Follow-up survey to confirm understanding and
decision
New Hires Not Eligible Market Options and Navigator Assistance
Termination COBRA/ACA coordination and Navigator Assistance
Claims Request sharing of EOBs to compare payments
Copyright Health Decisions, Inc.
05/2014
8
Communications Opportunities
Filling In the “Silent Period”
Event DOL ACA IRS
Oct
Open
Enrollment
SPD, SMM, WHCRA,
Wellness
Summary of Benefits
and Coverage
Nov
Dec
Jan Tax Filings W-2 health plan value
6055/6056 Notices
W-2 filing
6055/6056 filing
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Open
Enrollment
SPD, SMM, WHCRA,
Wellness
Summary of Benefits
and Coverage
Nov
Dec
Copyright Health Decisions, Inc.
05/2014
9
• ACA Family Elections and Attitudes
• Satisfaction with Current Coverage
• Reactions to Proposed Changes
• Attitudes towards Private Exchange
• Provider Ratings
• Other Topics of Interest to Management
Communications Opportunities:
Why Bother? Employee Perspective
• ACA confusion and misinformation creates employee concerns
you help alleviate.
• ACA notices need explanations you provide.
• ACA election assistance and Navigators reduce concerns,
costs and COBRA elections.
• Opinion surveys show you care and foster positive relations.
• Use of outside firm shows respect for privacy.
Copyright Health Decisions, Inc.
05/2014
10
Communications Opportunities:
Why Bother? Employer Perspective
Copyright Health Decisions, Inc.
05/2014
11
Recruit/Retain a High-Quality Workforce.
Gain a competitive advantage over other employers
drawing from same labor pool.
How:
• Offer support to ineligible workers.
• Partner with eligible workers.
• Realize Savings
• Eliminate ineligible dependents.
• Reduce employee calls, concerns and complaints.
• Re-direct COBRA costs and other elections as appropriate.
• Engage consumer in monitoring costs and plan performance
Copyright Health Decisions, Inc.
05/2014
12
For More Information
Contact
si@healthdecisions.com
734-451-2230
Connect with me on LinkedIn
Add me to your circles on Google+
Like us on FaceBook
Follow us on Twitter

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Health Decisions Webinar: ACA Communication Requirements - An Employee Relations Opportunity

  • 1. Presenter: Si Nahra, Ph.D., President May 29, 2014 ACA Communications Requirements: An Employee Relations Opportunity
  • 2. Copyright Health Decisions, Inc. 05/2014 2 About Health Decisions, Inc. Pioneering Specialists in Group Health Care Post-Payment Administration For Over 25 Years Respect for Existing Procedures Emphasis on Customization Focus on Solutions Customer Philosophy
  • 3. 2014 ACA Series Copyright Health Decisions, Inc. 05/2014 3 Non-grandfathered, calendar year plans. Comply not just because you have to. Comply in a way that helps your plan. FOCUS
  • 4. Quick Review What you should have done. • Reporting to employees – W-2 plan values – Summary of Benefits and Coverage (SBC) – Exchange Notices • Benefits – Selected Essential Health Benefits – No cost sharing for federal preventive care benefits – No pre-existing conditions – No lifetime maximums – Dependents covered until 26 – Clinical trial coverage • Safe Harbors – Minimum Value Safe Harbor – Affordability Safe Harbor • New Out-of-Pocket rules implemented Copyright Health Decisions, Inc. 5/2014 4 ACA Compliance Checklist Sessions available now. Call 734-451-2230 Ask for Leslie. E-mail leslie@healthdecisions.com
  • 5. Employee Communications • Required: Scheduled or Event Driven – ACA – DOL – IRS • Opportunities – ACA Q&A to and from employees – Spouse/Dependent confirmation – Public Exchange Navigation – COBRA Options – Private Exchange Options Copyright Health Decisions, Inc. 05/2014 5
  • 6. Scheduled Communications Event DOL http://www.dol.gov/ebsa/ pdf/rdguide.pdf ACA IRS Oct Open Enrollment SPD, SMM, WHCRA, Wellness Summary of Benefits and CoverageNov Dec Jan Tax Filings W-2 benefit value 6055/6056 Notices W-2 filing 6055/6056 filingFeb Mar Apr May Jun Jul Aug Sep Oct Open Enrollment SPD, SMM, WHCRA, Wellness Summary of Benefits and CoverageNov Dec Copyright Health Decisions, Inc. 05/2014 6 Communication “Silent Period”
  • 7. Event Communications Event DOL ACA IRS New Hires: Eligible Enrollment Rights Notice Marketplace Notice Affordability Confirmation W-4 New Eligible Enrollment Rights Notice Marketplace Notice Affordability Confirmation New Enrollee SPD, etc. Summary of Benefits and Coverage New Dependent MCSO Notice SSN Collection New Hire: Ineligible Marketplace Notice W-4 Employment Termination Certificate of Credible Coverage COBRA Election Notice New COBRA Notices Change in Employment Status “Trigger Events”: Notice of Change in Eligibility Change in Coverage Status Claim Payment Processing EOB Notice of Benefit Determination Copyright Health Decisions, Inc. 05/2014 7
  • 8. Communications Opportunities: Going Beyond Minimum Requirements Event Communication Opportunity Post Open Enrollment Post Tax Filing Validation survey to confirm eligibility and enrollment with required response to engage employee New Hire/ New Eligible Personalized offers of election assistance Trigger Events Follow-up survey to confirm understanding and decision New Hires Not Eligible Market Options and Navigator Assistance Termination COBRA/ACA coordination and Navigator Assistance Claims Request sharing of EOBs to compare payments Copyright Health Decisions, Inc. 05/2014 8
  • 9. Communications Opportunities Filling In the “Silent Period” Event DOL ACA IRS Oct Open Enrollment SPD, SMM, WHCRA, Wellness Summary of Benefits and Coverage Nov Dec Jan Tax Filings W-2 health plan value 6055/6056 Notices W-2 filing 6055/6056 filing Feb Mar Apr May Jun Jul Aug Sep Oct Open Enrollment SPD, SMM, WHCRA, Wellness Summary of Benefits and Coverage Nov Dec Copyright Health Decisions, Inc. 05/2014 9 • ACA Family Elections and Attitudes • Satisfaction with Current Coverage • Reactions to Proposed Changes • Attitudes towards Private Exchange • Provider Ratings • Other Topics of Interest to Management
  • 10. Communications Opportunities: Why Bother? Employee Perspective • ACA confusion and misinformation creates employee concerns you help alleviate. • ACA notices need explanations you provide. • ACA election assistance and Navigators reduce concerns, costs and COBRA elections. • Opinion surveys show you care and foster positive relations. • Use of outside firm shows respect for privacy. Copyright Health Decisions, Inc. 05/2014 10
  • 11. Communications Opportunities: Why Bother? Employer Perspective Copyright Health Decisions, Inc. 05/2014 11 Recruit/Retain a High-Quality Workforce. Gain a competitive advantage over other employers drawing from same labor pool. How: • Offer support to ineligible workers. • Partner with eligible workers. • Realize Savings • Eliminate ineligible dependents. • Reduce employee calls, concerns and complaints. • Re-direct COBRA costs and other elections as appropriate. • Engage consumer in monitoring costs and plan performance
  • 12. Copyright Health Decisions, Inc. 05/2014 12 For More Information Contact si@healthdecisions.com 734-451-2230 Connect with me on LinkedIn Add me to your circles on Google+ Like us on FaceBook Follow us on Twitter