Here’s the “dirty little secret” about the new “pay-or-play” requirements: Most plans will pass easily and few plans will have any problems with penalties. Here’s the less obvious part of compliance: The steps called for by the new regulations make good sense for a plan to do. Inventorying enrollees to confirm coverage, adopting uniform plan definitions and approaches to calculating cost-sharing, and engaging benefit “consumers” are all steps that can benefit a self-funded plan. This webinar, the third in our series, explores these themes and presents the positive side to “Obamacare” compliance. For more information, please visit: http://www.healthdecisions.com

1. ““Obamacare” Compliance:Obamacare” Compliance:
How It Helps Self-funded PlansHow It Helps Self-funded Plans
Presented by:
Si Nahra, Ph.D., President
June 27, 2013

2. 2
About Health Decisions, Inc.
Pioneering Specialists in Group Health CarePioneering Specialists in Group Health Care
Post-Payment AdministrationPost-Payment Administration
For Over 25 YearsFor Over 25 Years
RespectRespect for Existing Proceduresfor Existing Procedures
EmphasisEmphasis on Customizationon Customization
FocusFocus on Solutionson Solutions
Customer
Philosophy:
© Copyright 2013
Health Decisions, Inc.

3. Orientation towards our topic
• Distrust of government is an American value.
• Disrespect for anything the government does is not.
• Partisan politics do not apply.
© Copyright 2013
Health Decisions, Inc.
3

4. Presidents’ Policies
Presidents Health Policy Legacy
Roosevelt/Truman Social Security
Eisenhower Employment-based Benefits
Kennedy/Johnson Medicare/Medicaid
Nixon/Ford HMOs
Carter National Health Planning
Reagan Dismantle Carter program. Rely on Market Forces
Bush I Federally Qualified Health Centers
Clinton HIPAA
Bush II Medicare Part D (Rx)
Obama ACA and the Rise of the Consumer Market
Post-Obama 2016/17 may be tougher than 2014
4© Copyright 2013
Health Decisions, Inc.

5. Focus Today
Affordable Care Act
(Title I, Subtitles A, C, and F)
Self-funded Group Health Plans
•Shared Responsibility AKA Pay-or-Play
•Other related requirements
© Copyright 2013
Health Decisions, Inc.
5

6. Gauging Intent
• No lifetime limits
• Coverage of preventive health
• Extension of dependent
coverage
• Uniform explanation of coverage
• Standard plan comparisons
• Limits on coverage costs
• Common eligibility rules
• Confirmed offer of coverage
• Limits on out-of-pocket costs
• Taxes for research and risk
Who Benefits Most?
Individual consumers
Self-funded plan role?
Implementation
A way to get to individuals
© Copyright 2013
Health Decisions, Inc.
6

7. What Plan Compliance Means
1. Play by the same rules
2. Manage eligibility and enrollment
3. Pay taxes for research and risk
© Copyright 2013
Health Decisions, Inc.
7

8. 1. Play by the same rules
Provision Consumer Impact Plan Consequence
Minimum Value Consumer knows what
they are getting and how it
compares
Easy to pass for most.
Out-of-pocket limits an
issue for some.
Spending accounts help.
Affordability Consumer costs for
getting coverage capped
at 9.5% of family income.
Easy to pass for most.
Issue for some low-wage
workers.
Per occurrence fine small and unlikely.
Out-of-pocket
accumulator
All consumer cost sharing
for services counts
towards limits tied to
spending accounts.
Brings order to chaos.
Many will need to re-do
cost sharing rules and
administration.
© Copyright 2013
Health Decisions, Inc.
8

9. 2. Manage eligibility and enrollment
Provision Consumer Impact Plan Consequence
FTE Eligibility Same eligibility rules
apply wherever you go.
New process needed.
Brings direction to most
overlooked area.
Impacts certain groups
(hourly, seasonal) more.
Offer of enrollment Presents and explains
options.
Opportunity to take
Or
Obstacle to avoid
Overall fine can be large but easy to avoid.
© Copyright 2013
Health Decisions, Inc.
9

10. 3. Pay taxes
Provision Consumer Impact Plan Consequence
Research None Disturbing precedent.
See slide 3: Distrust of
government is an
American value.
Risk
© Copyright 2013
Health Decisions, Inc.
10

11. Options
• Ignore
• Delay
• Fight
• Comply
© Copyright 2013
Health Decisions, Inc.
11

12. Why Comply?
• The Good
– Creating a market with comparable products
– Adopting uniform plan definitions
– Standardizing how individual liability is calculated
– Defining eligibility-enrollment-entitlement processes
• Outweighs the Bad
– Changes to existing policies and procedures
– Taxes
© Copyright 2013
Health Decisions, Inc.
12

13. 131313
Past Webinars Available
Recordings of past webinars are available upon request, including:
• Mid-June 2013 – Employer Mandate Calculations Explained
• May 2013 – Pay or Play: A Bigger Challenge for TPAs than for Plans
• April 2013 - The Most Overlooked Part of Health Reform: Enrollee Communications
• March 2013 – Why Cost Sharing is not Working
• February 2013 – Loss of Fiduciary Control
• January 2013 – Top 10 Do’s and Don'ts of Data Warehousing
• December 2012 – Union Trusts: Health Reforms Most Overlooked Winner?
• November 2012 – Year-end Renewal and Bidding: Opportunities for Control and Savings
• October 2012 – The 5 Most Important Things an Effective Dependent Audit Should Include
• September 2012 – Old Question, New Twist: Is Self-funding Right for Your Group Health Plan?
• August 2012 – Are You Ready to Manage Your Health Plan Costs?
• June 2012 - Group Health Brokers’ Future: Disintermediation or Re-intermediation
For more information, please visit www.healthdecisions.com
Copyright Health Decisions, Inc.
6/2013

14. © Copyright 2013
Health Decisions, Inc.
14
For More Information
Contact
si@healthdecisions.com
734-451-2230
Connect with me on LinkedIn
Add me to your circles on Google+
Follow us on Twitter: @hlthdecisions
Like us on FaceBook