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• How will Grandfathered Plans/Health care reform affect my business?

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• The law changes the health care system for EVERYONE in the United States—individuals, employers, medical providers insurance companies, and state and federal agencies.

• NO ONE IN THE UNITED STATES GOES UNTOUCHED BY THIS LAW!

Common Sense:

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Reform Step 1---Reality

The health reform law is bigger in scope and impact than the Social Security Act of 1935. This law is enormous!

Companies need to understand the impact of the reform and what they need to do to properly implement.

8 Healthy Reform Steps for Your Company!

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• Fact vs. FictionSome health reform features only apply to employers. Other features apply to individuals, insurance companies, state agencies, and federal agencies. Review health reform law or summaries of the law, and the timelines that identify actions for employers.

You can start the review at: http://www.dol.gov/ebsa/healthreform/

Reform Step 2

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Dates are the key to success!

Health care reform was signed on March 23, 2010!Example, March 23, 2010 is a key date for defining the “grandfather” status of your plan.

Reform Step 3---Plan Snap Shot

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Changes that will cause a plan to lose its grandfather status:

Entering into a new policy or contract of insurance (refers to insurance for employees, rather than stop loss insurance that protects the employer)

Exclusion of certain diagnosis or treatment

Any increase in coinsurance

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• Increase in a fixed dollar cost sharing requirement other than a co-pay, such as a deductible or out-of-pocket limit, that exceeds 15% plus medical inflation. (“Medical Inflation”-This number is calculated using he CPI amount for any month in the 12 months before the new change is to take effect.)

• An increase in co-pay that exceeds $5 plus medical inflation.

Continued……

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• Once you take a snap shot of your plan on March 23, 2010 and decide whether to keep the plan you have, you are ready to determine the effect of health reform on your company plan.

• You need to review the following aspects of your plan:

Reform Step 4---Positive & Effect

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Step 4 ….Continue…..

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• How does the automatic appeals process apply to our company?

• Do the automatic enrollment provisions apply to my company?

• How do the new w-2 reporting rules apply to my company?

• Is the company eligible to apply for a wellness program grant?

• How can we communicate health reform to our employees?

Step 4…Continued….

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• See if your state has requirements for coverage more generous than health reform. Also check to see if your State will have their own high risk pool or if people with pre-existing conditions will need to be referred to the “national high risk pool”

Reform Step 5---Verify State Requirements

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Pay attention to changes you must make to your plans for 2010 and 2011. These requirements begin your timeline.

TRY NOT TO WORRY ABOUT ANY OTHER YEARS BEYOND 2011 AT THIS TIME.

Reform Step 6---Develop Action Plan

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Pay attention to changes you must make to your plans for 2010 and 2011. These requirements begin your timeline.

TRY NOT TO WORRY ABOUT ANY OTHER YEARS BEYOND 2011 AT THIS TIME.

Reform Step 6---Develop Action Plan

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This Healthcare Committee Team should represent many disciplines from your company. (Accounting, payroll, tax, legal, IT, and HR)

Meet quarterly and be sure to take meeting minutes with action bullets and assignees

Reform Step 7---Establish a Healthcare Committee Team

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• As the government issues new guidance, there will be changes to your action plan. Keep the plan updated

• Do what is necessary for 2010 and 2011

Reform Step 8---Action Plan Updated

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• Waiting Periods----Waiting periods cannot be longer than 90 days

• Dependent to Age 26 Coverage ---Children must be eligible for coverage to age 26, regardless of whether other coverage is available

• Pre-existing Condition Exclusions—Group Health plans can no longer have any pre-existing condition exclusions.

• Annual Limits---All annual limits on benefits are prohibited!

2014 and beyond!

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