• Information Only

• Always review all options with an experienced Health Care Benefits Specialist

• Review the Facts at: http://www.whitehouse.gov/healthreform/myths-and-facts

Health Care Reform FactsHealth Care Reform Facts

About AWISAbout AWIS

AWIS was established in 1983 by a group of doctors to market affordable Association Healthcare benefits.

AWIS was established in 1983 by a group of doctors to market affordable Association Healthcare benefits.

Today, AWIS is a licensed and registered insurance agency in over 40 states and 2 territories. (DC & PR)

Today, AWIS is a licensed and registered insurance agency in over 40 states and 2 territories. (DC & PR)

Willie Martinez – Executive Director of Marketing (19 years Licensed Health Insurance Agent)

AWIS – “A ” rating with “BBB” Limited Group Health and Dental Insurance Benefits 30 Years in Business

Willie Martinez – Executive Director of Marketing (19 years Licensed Health Insurance Agent)

AWIS – “A ” rating with “BBB” Limited Group Health and Dental Insurance Benefits 30 Years in Business

Our Association Healthcare Program is one of the three types of Healthcare Programs used today in

our Healthcare System:

Our Association Healthcare Program is one of the three types of Healthcare Programs used today in

our Healthcare System:

Government Medicare and MedicaidGovernment Medicare and Medicaid

Major Medical HMO and PPO InsuranceMajor Medical HMO and PPO Insurance

Association Health Care Benefits**Association Health Care Benefits**

** By becoming a member of our National Association of Preferred Providers *(NAPP), our members are eligible to purchase limited group medical, dental, and/or life insurance benefits after a waiting period.

For specific waiting periods, call Member Services @ 1-866-365-5829

*$12 per year, for an Entire Family

InsurersInsurers’’ filings with the State of California for 2013 filings with the State of California for 2013

Aetna is proposing rate increases of as much as 22%

Anthem Blue Cross 26%

And Blue Shield of California 20%

“These rate requests are all the more striking after a 39% rise sought by Anthem Blue Cross in 2010” (Granted 19%)

Health Insurers Raise Some Rates by Double Digits

“The New York Times” (Jan. 5, 2013)

Health Insurers Raise Some Rates by Double Digits

“The New York Times” (Jan. 5, 2013)

In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders

The rate increases can amount to several hundred dollars a month

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more.

2013 Rate Increases Across the Country

2013 Rate Increases Across the Country

Exchange plans are supposed to be approved by HHS no later than Jan. 1, 2013.

Initial Plans Available Oct. 2013, with an Effective Date of Jan. 1, 2014.

States also have discretion to allow businesses with more than 100 employees to purchase coverage in the Exchanges beginning in 2017.

In addition, states may opt to allow the Federal government to establish an Exchange in their state rather than implement their own.

Benefit MandatesBenefit Mandates

Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits. (This does not include Co-Insurance)

Limit any waiting periods for coverage to 90 days.

Allow states the option of merging the individual and small group markets.

Benefit Mandates (Effective Jan. 1, 2014)

Benefit Mandates (Effective Jan. 1, 2014)

Provides a comprehensive set of services

Covers at least 60% of the actuarial value of the covered benefits

Limits annual cost-sharing to the current law HSA limits($5,950/Ind. & $11,900/Fam.)

Require all qualified health benefits plans, including those offered through the Exchanges and those offered in the individual and small group markets outside the Exchanges, (except grandfathered individual and employer-sponsored plans), to offer at least the Essential Health Benefits Package.

Create an Essential Health Benefits Package that:

Create an Essential Health Benefits Package that:

Essential Health BenefitsEssential Health Benefits

Essential health benefits must include items and services within at least the following 10 categories:

1. Ambulatory patient services2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services,

including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and Habilitative services and devices8. Laboratory services9. Preventive and wellness services and chronic disease management10. Pediatric services, including oral and vision care

The cost-sharing features will be addressed in separate rules and will determine the actuarial value of the plan, expressed as a “metal level” as specified in statute:

1. Bronze at 60% Coverage2. Silver at 70% Coverage3. Gold at 80% Coverage4. Platinum at 90% Coverage

Four Federal Exchange PlansFour Federal Exchange Plans

They will have to pay a penalty (a tax)

What happens if Individuals don’t want

to purchase health insurance?

What happens if Individuals don’t want

to purchase health insurance?

The first year of implementation – 2014 – the fee is either $95 or 1 percent of your income, whichever is greater

Up to $2,085 per family or 2.5 percent of your income, whichever is greater

In 2016 if you still don’t have health insurance, the fine increases to $695 per adult/$347.50 per child

For Companies with 50 or more “Full-Time” employees:

The employer faces a $2,000 fine per “Full-Time” employee after the first 30 “Full-Time” employees if health insurance is not provided to at least 95% of all "Full-Time” employees.

Does the employer have to keepproviding health insurance?

Does the employer have to keepproviding health insurance?

A health care plan that charges a lower premium and has a higher deductible than traditional health care plans. It is usually paired with a Health Savings Account (HSA) to provide maximum benefits at the lowest cost to individuals.

Often, small business owners find that Health Savings Accounts and HDHP's are a cost-efficient way to provide health insuranceto their employees.

High Deductible Health Plans as an Option

for Small Business Owners

High Deductible Health Plans as an Option

for Small Business Owners

A benefit of a HDHP is that the sum of the high deductible and the maximum out-of-pocket expenses that you pay for covered medical expenses have a ceiling

Another benefit of a HDHP is that it may provide preventive care with no deductible or with a much lower deductible.

Benefits of the HDHPBenefits of the HDHP

Meant to force consumers to save money through their HSA for medical expenses such as co-payments, prescriptions, and lower out-of-pocket medical costs.

HDHP kicks in when there are larger, catastrophic medical costs.

Not only does this plan save the consumer or employee money, it is a cost-efficient way for small businesses to offer their employees’ health insurance as the premiums are lower than for traditional health insurance plans.

IRS Publication 969 gives more extensive information on the HDHP/HSA Health Care Accounts.

HSA/HDHP Medical Plan SummaryHSA/HDHP Medical Plan Summary

Example: Blue Cross Blue Shield (28 Year Old male Non-Smoker)

“Deductible” Rx Drug CoverageMonthly Premium

80% Coverage

$250 $10 Generic, $30 Preferred, $45 Non-Preferred $265.00

“Deductible” Rx Drug CoverageMonthly Premium

90% Coverage

$2,500 $10 Generic, $50 Preferred, $65 Non-Preferred $110.00

PPO Select Choice   Lifetime Benefit: No Limit

Office Visit Copay: $25Out-of-pocket Limit: Deductible plus $3,000

Blue Edge Individual HSA Lifetime Benefit: No Limit

Office Visit Copay: Deductible and CoinsuranceOut-of-pocket Limit: $3,000

Total Savings = $155.00 Per Month Per Employee

Example: Blue Cross Blue Shield (53 Year Old Male Non-Smoker)

“Deductible” Rx Drug CoverageMonthly Premium

80% Coverage

$250 $10 Generic, $30 Preferred, $45 Non-Preferred $713 - $892

“Deductible” Rx Drug CoverageMonthly Premium

90% Coverage

$2,500 $10 Generic, $50 Preferred, $65 Non-Preferred $297 - $371

PPO Select Choice   Lifetime Benefit: No Limit

Office Visit Copay: $25Out-of-pocket Limit: Deductible plus $3,000

Blue Edge Individual HSA Lifetime Benefit: No Limit

Office Visit Copay: Deductible and CoinsuranceOut-of-pocket Limit: $3,000

Total Savings = $416.00 - $521.00 Per Month Per Employee

Benefits Include: Benefits Include: •$1,000 per day in hospital•$2,000 per Day for ICU/CCU•$5,000 per accident ($100 Deductible)•$5,000 Critical illness(Heart attack, Stroke, Cancer, etc.) •$50 Physician Office visit re-imbursement(5x Year) •Dental HMO (Optional)•Hospital Patient Advocacy(Negotiates Hospital Bills)

Other Benefits Available/Can be specially designedfor any size company

Add a Supplemental Plan to CoverDeductibles and Co-Insurance

Add a Supplemental Plan to CoverDeductibles and Co-Insurance

Med Plus $1,000/$2,000

Monthly Fee (Single $149.95 / Family $229.95)

One-Time Enrollment Application Fee ($100)

Annual NAPP Fee ($12)

Benefits$5,000 Accidental Injury ($100 Deductible)

$10,000 AD&D ($5,000 Spouse/$2,000 Child)

Hospital Patient Advocacy (Negotiates Hospital Bills on your Behalf)

$50 Physician Office visit Reimbursement (5 X Per Year Per Family Member)

$100,000 Emergency Travel Assistance (World-Wide)

Hospitalization - $1,000 Per Day Per Family Member (31 Days Per Year Per Family Member)

ICU/CCU - $2,000Per Day Per Family Member (31 Days Per Year Per Family Member)

How about an Association Plan with Limited Group Insurance Benefits?

How about an Association Plan with Limited Group Insurance Benefits?

$24.95 $29.95 $21.95 $19.95 $21.95 $34.95 $59.95/$79.95

$89.95/$119.95

$39.95/$49.95

1. 24 HR-MD $20 Generic RX Card

Comprehensive Blood Tests

Dental Care Legal Services

Accident Disability

$5,000 Critical Illness

$10,000 Critical Illness

$15,000 Term

Life/$15,000 AD&D

2. Network Doctor Discounts

Pharmacy Discount Program

Lab Services Vision Care Pet Care $300 Per Week

Primary/Primary

& Spouse

Primary/

Primary &

Spouse

Single/Family

3. X X Radiology & Imaging

Hearing Care Roadside Assistance

Up to 26 Weeks

Not Available

CA, FL, and IL CA., and IL. CA ,FL, IL, HI, NJ

CA, FL, IL FL CA

Optional Add-On Benefits at an Additional Cost Per MonthOptional Add-On Benefits at an Additional Cost Per Month

This Plan is Only Available To NAPP Members

Your Dental HMO PlanYour Dental HMO Plan

No waiting periods for ANY pre-existing

conditions

Largest dental network in the U.S (over 189,000

dentists)

In business since 1954

All U.S Active Duty military members

have these dental plans

No health questions

No age limits

Already serve over 25 million customers

Sample Co-PaysSample Co-Pays

Full List of Description of Benefits & Co-Pays at: www.________.awisdental.com

Full List of Description of Benefits & Co-Pays at: www.________.awisdental.com

* Does not apply to initial extensive Cleaning.

• The Cost of these AWIS Association Health Plans, (Supplemental plans) will cost less than the difference between the cost of the Traditional Comprehensive Plan and the High Deductible HSA Plan.

• HD HSA Plans Qualify under the New Health Care Reform Law.

• More Coverage at a lower cost

SavingsSavings

Bottom Line:Bottom Line:

Census report from the company

Copy of any Current Health Plans in force

Renewal date, if any

Proposals within 5 – 7 Business days.

Will Include One or more Options

Free No-Obligation QuoteFree No-Obligation Quote

THANK THANK YOU!YOU!And Welcome to And Welcome to

American WorkersAmerican WorkersInsurance ServicesInsurance Services