Healthcare Reform Update 2010 -2011 Changes Donna

Healthcare Reform Update – 2010 -2011 Changes Donna Lively Director of Insurance Marketing Guide. Stone Financial Resources

Today’s Agenda: 1. Current status of PPACA 2. Healthcare reform timeline 2010 -2011 3. Immediate employer impact

Current Status Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act • On March 22, the House passed HR 3590, which was passed by the Senate on December 24, 2009 • The President signed the bill March 23, 2010 • The House and Senate then passed a reconciliation bill, HR 4872, to “fix” the original Senate bill • The President signed the bill March 30, 2010 • Regulations and Rules now being released…

Implementation Timeline 2010 -2011

Early Retiree Reinsurance Program Details of the Provision • Financial help for plans covering pre-65 retirees • Limited $5 B temporary fund Guide. Stone Response • Guide. Stone has applied for and been approved for the reinsurance • We have filed our claims but it is unsure if there will be government funds available to reimburse Guide. Stone • Any reinsurance funds received will be used to offset 2011 premium increases for all participants

Medicare Part D Closure of the Part D Coverage Gap • 2010: $250 rebate in the Part D Coverage Gap • 2011: 50% discount on brand name drugs in the coverage gap • 2011: Small decrease in participant responsibility for generic drugs in the gap (93% down from 100%) Guide. Stone Response • Participants in Guide. Stone’s Care Plus plan will receive these benefits should they move into the coverage gap • Generic drugs are already covered in the gap with an $8 copay.

Pre-existing Condition Insurance Details of the Provision • Uninsured adults with a pre-existing condition have access to insurance • 6 months without insurance • Declined by an insurance company due to pre-existing condition • $5 B temporary high-risk insurance pool • Ends when Exchanges are operational • www. pcip. gov Guide. Stone Response • Guide. Stone continues to offer Health Limited plan for those who have a pre-existing condition • Family members can purchase a Health Choice or Health Saver plan

Small Employer Tax Credit Details of the Provision • Less than 25 (FT equivalency) employees • Average wages <$50 K • Reimbursed up to 25% of employee premium contribution for non-taxed entities • Non-profit reimbursement regulations still being written Guide. Stone Response • Monitor non-profit regulations • Determine how churches can best qualify for credit

Grandfathering Effective in 2010 • “If you like your plan, you can keep it” • Only available to plans in existence on March 23, 2010 • Very limited changes allowed for employee contribution and cost sharing • Changes in insurer not allowed • Grandfathering can be beneficial • Can have significant cost implications Guide. Stone Response • Guide. Stone plans will not be grandfathered • Allows flexibility and choice

HRA/FSA/HSA Effective in 2011 • Tax on non-medical distributions from HSAs will increase from 10% to 20% • Over-the-counter drugs not prescribed by a doctor not reimbursable through FSA, HRA, or HSA • Non-medicine/non-RX can still be reimbursed through FSA without a prescriptions; i. e. Band-Aids, contact lens solutions, blood sugar test strips, etc. Employer Response • Employers may want to communicate with their employees and educate them on these issues • Visit www. Guide. Stone. org/Health. Reform for information

Dependent Children Age 26 Requirement • Dependent children up to age 26 remain on parents’ policies regardless of student status, residency, employment or marital status Guide. Stone Response • Beginning April 2010, allow dependent children up to age 26 on medical plan • Beginning January 2011, allows children up to age 26 regardless of residency, employment or martial status on medical, dental and term Life • Call 1 -888 -98 -GUIDE for assistance enrolling a dependent up to age 26

Dependent Children Pre-Existing Conditions for Children Under 19 • Effective January 2011 • Insurers cannot decline coverage for children under age 19 due to a pre-existing condition • Insurers cannot exclude coverage for pre-existing conditions for children under age 19 Guide. Stone Response • Guide. Stone removed pre-existing condition limitations for individuals under age 19 effective October 1, 2010 • Children applying for medical coverage for January 1 will not be declined due to pre-existing conditions

Other Health Plan Provisions Rescissions of Coverage • Effective for plan years beginning after September 23, 2010 • No rescission of coverage • Except in cases of fraud Guide. Stone Response: • Guide. Stone has never rescinded coverage for any reason other than fraud

Other Health Plan Provisions Coverage Limits • Effective for plan years beginning after September 23, 2010 • No lifetime coverage limits • No restrictive annual dollar limits on essential benefits Guide. Stone Response • Guide. Stone plans currently do not carry a lifetime limit • Guide. Stone plans do not have dollar limits on essential benefits

Other Health Plan Provisions Preventive Benefits Coverage: • Most health plans to cover preventive benefits at 100% • Preventive schedule determined by United States Preventive Services Task Force (USPSTF) Guide. Stone Response: • Guide. Stone’s preventive schedule in line with USPSTF • Effective January 1, 2011, Guide. Stone plans cover eligible preventive care services at 100% with no copay • Preventive Care Schedule available online soon

Other Health Plan Provisions Additional Resources for Claims Appeals • External company to handle certain levels of appeals • Mandates related to process and timing Guide. Stone Response • Guide. Stone finalizing external appeals process for claims that occur January 1, 2011 and after • Details in 2011 Plan Booklets

Immediate Impact of Reform for Employers

Immediate Impact of Reform for Employers • Possibility of increased insurance premiums • Additional medical benefits required by reform • Dependent coverage up to age 26 • No pre-existing condition limitations for children under 19 • Increased regulations • Educational Opportunities for Employees • FSA/HRA Changes • Enhanced plan benefits

Immediate Impact of Reform for Employees • PROS • Enhanced benefit coverage with fewer restrictions • Appeal process improvement • Benefit description improvement • Coverage for older dependent children • Seniors receive prescription drug assistance • CONS • Prescription required for FSA reimbursement of OTC drugs • Possible increase in premium

Questions and Answers