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Some say the Affordable Care Act marginalizes the broker role. Others say ACA gives brokers new opportunities. Both are right. ACA elevates the broker advisory role. At the same time, it has introduced formidable new competitors. Ultimately, what the client needs determines what brokers need to do. This webinar explores different client situations. What are client needs and what does this mean for brokers? What must brokers do to counter competitive pressures? To view the entire webinar, please go to: https://www4.gotomeeting.com/register/258799735 For more information, please visit: http://www.healthdecisions.com.
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Presenter:
Si Nahra, Ph.D., President
October 30, 2014
ACA: Boon and Bane for Brokers
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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
Today’s Focus
• Self-funded plans
• Not “grandfathered”
• Not changing coverage
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ACA: Boon and Bane for Brokers
Boon
• Clients have lots of questions.
• Clients need support.
Bane
• Existing competition intensified.
• New competitors emerging.
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What to do?
Reap the boon and attack the bane.
• Know what your clients/prospects need.
• Know what you know.
• Know what you need.
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Know Your Client
Dimensions of Client Compliance Needs
Workforce # Entities # W-2s Levels Worker
Hours
Dependents
Benefits Benefits
Offered to
Benefits
Value
Maximum
OOP
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Know Your Client: Workforce
Dimensions of Client Compliance Needs
Workforce
# Entities # W-2s Levels Worker
Hours
Dependents
Single
Company
+/- 50 Stable Predictable Young and Single
Common
Owners
50-100 Changing Variable Family Years
Family of
Companies
100+ Fluctuates Fluctuates Older
Compliance Impact
National Plan
ID Assignment
ALE
Calculation
Monthly tracking, IRS
reporting, Communications
R&R Taxes, 19-26,
Monthly tracking
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Know Your Client: Benefits
Dimensions of Client Compliance Needs
Benefits
Benefits
Offered to
Benefits
Value
Maximum
OOP
All MEC + MV + Affordable Under Max +
Integrated + Enforced
Most MEC + MV Under Max +
Integrated
Some MEC Under Max
Compliance Impact
Pay or Play Compliance Individual
(overpayment) and
Plan (underpayment)
Liability
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MEC: Minimum Essential Coverage
MV: Minimum Value
Know What You Know
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Dimensions of Client Compliance Needs
Workforce # Entities # W-2s Levels Worker
Hours
Dependents
Benefits Benefits
Offered to
Benefits
Value
Maximum
OOP
Know What You Need.
Is it What Health Decisions Offers?
• Information and Data Integration for
Workforce and Benefits
• Calculations and Compliance Certification
• Individual Employee Tracking
• Individual Dependent Monitoring
The ability to respond to Inquiries from the
IRS and State Exchanges years later.
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Monthly Employee Eligibility Verification
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Month-by-Month Affordability Verification
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Establishment of Measurement Periods
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Application of Measurement Periods
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Monthly Dependent Coverage Status
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Other Coverage and Opt-Out
Documentation
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Trigger Events Communications Tracking
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Document Receipt Tracking
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Document Viewer
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For More Information
Contact
734-451-2230
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