Health Decisions Webinar: April 2014 ACA Cost Sharing
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Health Decisions Webinar: April 2014 ACA Cost Sharing
- 1. Presenter: Si Nahra, Ph.D., President April 24, 2014 ACA Cost Sharing: The Ticking Time Bomb of Liability
- 2. Copyright Health Decisions, Inc. 04/2014 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. 04/2014 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. 04/2014 4 ACA Compliance Checklist Sessions available now. Call 734-451-2230 Ask for Leslie. E-mail leslie@healthdecisions.com
- 5. ACA Cost Sharing • New Preventive Care Cost Sharing Waiver EFFECTIVE NOW – November 2013 webinar • New Out-of-Pocket (OOP) Maximum Limits EFFECTIVE NOW medical and RX separate EFFECTIVE 2015 medical and RX together • New OOP Maximum Calculations Pre-ACA OOP Maximum ONLY coinsurance Post ACA OOP Maximum includes all cost sharing copays + deductibles + coinsurance Copyright Health Decisions, Inc. 04/2014 5
- 6. ACA Cost Sharing Pre-ACA • Copays assessed independently • Deductibles assessed independently • OOP Maximum calculations set plan-by-plan Difficult to detect error. Impossible to enforce. • March 2013 webinar Post ACA • Preventive has 0 cost sharing • Copays+deductible+coinsurance all count toward OOP Maximum • OOP Maximum calculations defined by law Error easier to detect. Enforcement possible practically and legally. Copyright Health Decisions, Inc. 04/2014 6
- 7. ACA Cost Sharing Employee Overpaid Plan Underpaid Employee Underpaid Plan Overpaid Preventive services error $ Copay assessment error $ Copay waiver error $ Deductible assessment error $ Deductible waiver error $ OOP Max too late $ OOP Max too soon $ Copyright Health Decisions, Inc. 04/2014 7
- 8. ACA Cost Sharing What to do. • Check with payer on what they are doing. • BUT do not rely solely on payer efforts. • Get claims and enrollment data. • Do not re-pay claims but confirm the results of claim payments. • Re-construct cost sharing levels person by person. • Confirm correct cases. • Flag cases for validation. • Monitor payer progress to 0 cases needing validation. Copyright Health Decisions, Inc. 04/2014 8
- 9. ACA Cost Sharing Resolution Strategies • Use of pre-tax accounts • Claim credit/debit • Monitor to remove current cases • Monitor to prevent future cases Copyright Health Decisions, Inc. 04/2014 9
- 10. ACA Cost Sharing • Minus: – New regulatory requirements – New liabilities • Plus – Brings order to chaos of cost-sharing – Levels the competitive playing field Copyright Health Decisions, Inc. 04/2014 10
- 11. Copyright Health Decisions, Inc. 04/2014 11 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