To the Participants: The phone lines have been muted You may type your questions in the GoToWebinar box on the right Q & A will be sent in a follow up email Follow up email will include: Link to this presentation Follow up email will include more info on all resources Recorded webinar will be posted at www.TheBrokerageInc.com

ACA Open Enrollment 2018: Updates and Observations Where are we now and where are we headed?

During this session we will cover: Quick legislative overview Review changes to the ACA certification process Current product availability in Texas (this webinar is designed for Texas opportunities) Alternative products for health insurance coverage Charging a service fee vs. commission Sales ideas to grow your agency during the 2018 OEP

ACA Legislative Overview The uncertainty surrounding Senate Republicans' latest repeal-and-replace bill is putting more pressure on Democrats to reach a deal to stabilize the Affordable Care Act Sens. Lamar Alexander and Patty Murray have been working on a plan to tweak the ACA through a mix of looser regulations and more reliable funding Alexander's hand in those talks may be getting stronger as a side effect of the momentum behind a repeal bill sponsored by Sens. Lindsey Graham and Bill Cassidy ACA Legislative Overview

Sens. Lisa Murkowski and John McCain are publicly rooting for the stabilization effort to succeed, and Graham-Cassidy can't pass without at least one of them Murkowski has actively participated in the four hearings the Health, Education, Labor and Pensions Committee has held on stabilization, often staying longer than most other members On Sunday, McCain mentioned this effort by name on Face the Nation, saying Republicans shouldn't "ram" their proposal through Why?

The Problem While Democrats say the negotiations are going well and weekend talks were "productive," per a Democratic aide, Republicans disagree "There's no deal, and one doesn't look imminent. If there's no deal, I assume that means Republicans are going to flock to the only thing that's on the table," a senior GOP aide said

Yes, but… McCain and Murkowski could vote against Cassidy-Graham-Heller- Johnson regardless Both their states stand to lose under the bill, according to an early analysis by the left-leaning Center on Budget and Policy Priorities But it seems that if what they've been calling for all along is within reach, it gives them a lot more of an excuse to vote against a GOP- only bill

Who to watch: Murray If she can strike a deal with Alexander — which hinges on giving states more flexibility through innovation waivers — it could deeply influence McCain and Murkowski's decision

Authored by Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The new repeal bill would replace the Affordable Care Act’s insurance subsidies with block grants to states 01 The measure would end Obamacare’s requirements that individuals obtain health insurance and that most employers provide it to their workers 02 Would give states flexibility to address the needs of people with pre-existing medical conditions. 03

Need to act by Friday, Sept 29 Republican Rand Paul of Kentucky said Monday he’s opposed to the Graham-Cassidy bill, saying it doesn’t go far enough John McCain of Arizona said he’s “not supportive” yet, citing the rushed legislative process If it passed the Senate, the House would have to pass the bill without any changes. House Speaker Paul Ryan said Monday that the measure is Republicans’ last best chance to repeal Obamacare. Need to act by Friday, Sept 29

July 2017, Majority Leader Mitch McConnell’s effort to pass a replacement with only Republican support suffered a spectacular defeat in the Senate Despite all the obstacles, Democrats quickly geared up for another campaign against repeal, warning that the latest bill is a serious threat "This bill is worse than the last bill," Senate Democratic leader Chuck Schumer of New York told reporters Monday. "It will slash Medicaid, get rid of pre-existing conditions. It’s very, very bad."\ Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana

State based, hybrid high risk pools Designed to stabilize the individual major medical marketplace For the purpose of providing financial backing for the higher risk associated with some individuals New hybrid high-risk pools are one of an important set of ideas to improve the cost, plan choice and healthcare provider options available to consumers in the individual market They would serve as an important market stabilizer and should be a first priority in actions taken to improve healthcare in the individual market

Stabilize the exchange marketplace 1. Change the age banding ratio to five to one 2. Evaluate Essential Health Benefits to determine which are most critical to good health based on medical evidence 3. Evaluate preventive care benefits to determine which truly prevent future illness and ensure good health 4. Encourage value-based purchasing and transparency in the cost of healthcare 5. Make electronic medical records interoperable

Sanders offers Medicare-for-all a significant change from 2013 when Sanders, who lost the 2016 Democratic presidential nomination to Hillary Clinton, attracted no co- sponsors

Sanders offers Medicare-for-all Support for Sanders’s plan may be stronger among potential 2020 presidential candidates seeking to appeal to those who backed the Vermont senator’s campaign last year 01 Supporters include: 02 All frequently mentioned as potential 2020 Presidential candidates – are among the co-sponsors 03

Single Payer in our future? Senator Claire McCaskill of Missouri said the proposal is “premature,” and she would prefer allowing people age 55 to 64 to buy into the Medicare program The Democratic Party is increasingly wrapping itself in the flag of Medicare for all,” said Adam Green, co-chairman of the Progressive Change Campaign Committee Senator Tim Kaine of Virginia, Clinton’s 2016 running mate, said “I want everybody to be able to buy a public health plan; I want more choices rather than fewer”

ACA 2018 Penalties FPL Subsidies HealthCare.gov for on-exchange Off-Exchange – suggest using the carrier website directly ACA

01 02 03 04 Basic reminder There is only one ACA OEP is shortened to 45 days (Nov 1-Dec 15) 02 On Exchange means you qualify for an Advanced Premium Tax Credits 03 Off Exchange means you do not qualify for subsidies 04

ACA Certification Requirements

Current ACA Products at The Brokerage

“Belynda’s 2018 ACA Cheat Sheet”

BCBSTX ACA plans in all 254 Texas Counties On and Off Exchange plans in all TX Counties Bronze, Silver, Gold HMO Only, no PPO plans New, tiered commission implemented in 2017 2018 rate increase expected to be up to 25%

Quotes Enrollment App Tracking Commissions

Baylor Scott and White Off Exchange plans only HMO and EPO plan options Bronze plan only PPO Plans MUST BE REWRITTEN as EPO This opens an SEP for 2-1-18 and 3-1-18 eff dates HMO Members MUST set up a new 2018 or risk lapsing their coverage Specific plans by county located at www.TheBrokerageInc.com Agent commission EPO – 1%, HMO 2%

2018 Product Overview Off Exchange Only HMO-Bronze CTX/NTX EPO-Bronze For agent use only, not for consumer/beneficiary distribution.

Service Area Denton Collin Rockwall HMO/EPO HMO Only Tarrant Dallas El Paso Hood Johnson Ellis Erath Somervell Hill Coke Bosque Runnels Sterling Coleman Hamilton Freestone Limestone Mills McLennan Reagan Tom Green Coryell Irion Concho McCulloch Leon Falls Lampasas San Saba Bell Robertson Madison Schleicher Menard Burnet Milam Crockett Mason Llano Walker Williamson Brazos Grimes Sutton Kimble Burleson Travis Blanco Lee Washington Hays Bastrop Bexar, Comal, and El Paso networks are approved but not fully built Austin Comal Caldwell Fayette Waller Bexar

Summary of Major Changes to the Individual and Family Plan Portfolio – PY2017 to PY2018 HMO HMO offering changed from Bronze 6400 to Bronze 7300 Deductible: $7,300 ind/$14,600 family MOOP: $7,350/$14,700 Rx drugs: Deductible + 20% PPO PPO not available for 2018 EPO New for plan year 2018 Bronze 7300 plan added

Individual HMO Plans PY 2017: PY 2018: Benefits INN Bronze HMO 6400/50OV Benefits INN Individual/Family Deductible $6,400 / $12,800 Member Coinsurance 20% Individual/Fam MOOP $7,150 / $14,300 Inpatient hospitalization Deductible then 20% Outpatient Facility Fee Skilled Nursing Facility Primary Care Office Visit $50 copay (first visit), then Deductible then 20% Specialist Office Visit OP Mental Health/ Substance Abuse PT/OT & Rehabilitative ST Urgent Care $50 copay (first visit) Emergency Room Imaging (PET, CT, MRI) OP X-ray OP Lab Pharmacy Deductible N/A Preferred generic drugs $17 copay Preferred brand drugs Deductible then 50% Non-Preferred brand Specialty drugs HMO Bronze 7300 Benefits INN Individual/Family Deductible $7,300 / $14,600 Member Coinsurance 20% Individual/Fam MOOP $7,350 / $14,700 Inpatient hospitalization Deductible then 20% Outpatient Facility Fee Skilled Nursing Facility Primary Care Office Visit $50 copay (first visit), then Deductible then 20% Specialist Office Visit OP Mental Health/ Substance Abuse PT/OT & Rehabilitative ST Urgent Care $50 copay (first visit) Emergency Room Imaging (PET, CT, MRI) OP X-ray OP Lab Pharmacy Deductible N/A Preferred generic drugs Preferred brand drugs Non-Preferred brand Specialty drugs

HMO IFP Service Area Mirrors our current commercial service area, plus Bexar, Comal, and El Paso (networks still in development) Available in 61 Counties: Austin, Bastrop, Bell, Bexar, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coke, Coleman, Collin, Comal, Concho, Coryell, Crockett, Dallas, Denton, Ellis, El Paso, Erath, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Irion, Johnson, Kimble, Lampasas, Lee, Leon, Limestone, Llano, Madison, Mason, McCulloch, McLennan, Menard, Milam, Mills, Reagan, Robertson, Rockwall, Runnels, San Saba, Schleicher, Somervell, Sterling, Sutton, Tarrant, Tom Green, Travis, Walker, Waller, Washington, and Williamson

Individual EPO 2017 PPO 2018 EPO Bronze EPO 7300 Bronze PPO 7150 Benefits INN OON Individual/Family Deductible $7,150 / $14,300 $14,300 / $28,600 Member Coinsurance 0% 50% Individual/Fam MOOP 7,150 / 14,300 14,300 / 28,600 Inpatient hospitalization Deductible then 0% Deductible then 50% Outpatient Facility Fee Skilled Nursing Facility Primary Care Office Visit $60 copay (first 2 visits), then Deductible then 0% Specialist Office Visit $100 copay (first 2 visits), then Deductible then 0% OP Mental Health/ Substance Abuse PT/OT & Rehabilitative ST Urgent Care Emergency Room Imaging (PET, CT, MRI) OP x-ray OP Lab Pharmacy Deductible N/A Preferred generic drugs $40 copay Preferred brand drugs $100 copay Non-Preferred brand Specialty drugs 2018 EPO Bronze EPO 7300 Benefits INN Individual/Family Deductible $7,300 / $14,600 Member Coinsurance 20% Individual/Fam MOOP $7,350 / $14,700 Inpatient hospitalization Deductible then 20% Outpatient Facility Fee Skilled Nursing Facility Primary Care Office Visit $50 copay (first visit), then Deductible then 20% Specialist Office Visit OP Mental Health/ Substance Abuse PT/OT & Rehabilitative ST Urgent Care $50 copay (first visit) Emergency Room Imaging (PET, CT, MRI) OP x-ray OP Lab Pharmacy Deductible N/A Preferred generic drugs Preferred brand drugs Non-Preferred brand Specialty drugs

EPO Service Area EPO service area does not include El Paso or San Antonio. Available in 55 Counties: Austin, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coke, Coleman, Collin, Concho, Coryell, Crockett, Dallas, Denton, Ellis, Erath, Falls, Fayette, Freestone, Grimes, Hamilton, Hill, Hood, Irion, Johnson, Kimble, Lampasas, Lee, Leon, Limestone, Llano, Madison, Mason, McCulloch, McLennan, Menard, Milam, Mills, Reagan, Robertson, Rockwall, Runnels, San Saba, Schleicher, Somervell, Sterling, Sutton, Tarrant, Tom Green, Travis, Waller, Washington , and Williamson

Baylor Scott and White To quote and enroll 2017 plans, you are now required to log into Broker Office.  At this time there will be no paper applications available.  You can access this information at the Baylor Scott and White website  http://swhp.org/en-us/agents-brokers You can find instructions on this process on The Brokerage Inc website under individual major medical-ACA-Baylor Scott and White

Molina Healthcare of Texas On Exchange plans only Caters to government run programs like Medicaid, for example Specific plans by county located at www.TheBrokerageInc.com PMPM* agent commission *Per Member Per Month, up to five per app OEP sales - $16.88 first year only

Molina Healthcare of Texas When process 2017 Applications, you will have 3 options: You can log into your agent portal with Molina. Select your block of business tab and you will see the “Healthsherpa” tab.  Once you click here you will be taken to you personal link with “Healthsherpa” to process your application. You can also process your application directly online at healthcare.gov or Rabbitt App.  Remember Molina is On Exchange only. You can use HealthCare.gov There are instructions for navigating the agent website located on www.TheBrokerageInc.com

Memorial Hermann Exited the ACA marketplace

Oscar Health News plans in Austin (Hays, Travis and Williamson Counties) New plans in Comal Strong sales in Bexar County Dallas, Collin and Tarrant Counties have 2018 ACA Bronze plans, but they non- commissionable On and Off Exchange plans EPO Network

Oscar Health Updates You can still use hioscar.com to generate quotes and subsidy estimates for your clients Oscar continues to offer free telemedicine, concierge style service and simple-to-use tools that make it easy to find and receive great care Please check with The Brokerage on how to get appointed or recertified for 2018!

Health Insurance Alternatives ACA plans not available through The Brokerage Healthcare Sharing Ministry programs Minimum Essential Coverage (MEC) Short Term Major Medical Other Health Insurance Alternatives

How do employers move their employees to ministry plans? What if the employee does not share the same faith of the employer? Do employees have to attest that they practice the faith in order to join? Underwriting? How does the employer meet the employer mandate? Will it leave an employer open to a penalty? Questions for Health Care Sharing Ministry – The Brokerage does not offer these plans!

Keep in mind STM is not considered creditable coverage under the ACA and leaves the person subject to penalties!

Charging a fee vs. commission Can this be done legally in Texas?

Charging a fee vs. Commission General Life & Health Agent License Chapter 4054, Texas Insurance Code Agent defined broadly in Insurance Code to include acts on behalf of an insurer Dual Compensation is not Prohibited Ch. 4054: agents often have a dual role representing customers and on behalf of insurers

Charging a fee vs. a Commission Agent Fees and Policy Fees Permitted under Tex. Ins. Code § 550.001 Not restricted to only property/casualty agents Charging of fees has been common place, especially for health agents after the ACA No reported enforcement cases on charging agent fees by health agents

Charging a fee vs. Commission Disclosure Requirements if Dual Compensation Received by Agents Tex. Ins. Code § 4005.004. If agent receives compensation from both a customer (fees) and an insurer, the agent makes disclosure and obtain customer’s acknowledge that dual compensation will be received. Disclosure must include a description of the method and factors used to compute compensation received from an insurer.

Sample disclosure of Commission We Disclose to you that our agency receives compensation from an insurer or other third party. The compensation we receive includes the following if one or more boxes are checked [____] Commission computed as a percentage of the premium you pay for insurance. [____] Contingent commission, profit sharing or nonfinancial rewards, computed annual and based on the amount of premium and profitability of all insurance business we place through the insurer. This compensation [is/is not] guaranteed. [____] Other: _______________________________________ By signature below, I agree to pay the fees specified above to the [INSERT AGENCY NAME] and acknowledge receipt of the disclosure from the agency as referenced above in this acknowledgement and disclosure document. ________________________ Date:__________________ [Customer Signature]

Note from The Brokerage: This “Commission vs. Fee” info was provided by Thompson Coe. This info was a part of their presentation at the TX Assn of Health Underwriters Convention, May 2016

Ideas to grow your health insurance sales TRS Care

2018 TRS-Care “Educate the Educators”

HB 3976 made sweeping changes to TRS-Care Fueled by a $1.3 billion budget shortfall* Non-Medicare Eligible retirees will be offered an Aetna $1,500 High Deductible Health Plan (HDHP) Medicare Eligible Retirees will be placed into a Medicare Advantage PPO plan from Humana

Demographics of TRS-Care 20,000 new retirees added to the plan each year Retired teachers presently average $24,000 a year Medicare Status Retiree Count, July 2017 Participant Count as of July 2017, including dependents Medicare A & B 139,950 176,718 Medicare B Only 14,742 15,053 Non-Medicare 54,012 76,833 Total 208,704 268,604

2018 TRS-Care Non-Medicare Benefits High Deductible Health Plan Health Savings Account Optional In-Network $1,500/$3,000 Deductible $5,650/$11,300 Maximum Out-of-Pocket, 80%/20% Coinsurance Out-of-Network $6,000/$12,000 Deductible $14,300/$28,600 Maximum Out-of-Pocket, 60%/40% Coinsurance

Monthly premiums for non-Medicare retirees in 2018 Retiree/Surviving Spouse Only: $200 Retiree + Spouse: $689 Retiree/Surviving Spouse + Child(ren): $408 Retiree + Family: $999

Humana MA-PPO Plan

2018 TRS-Care Medicare Benefits Medicare Advantage Plan – Humana Drug benefits to be provided separately through SilverScript PPO – same benefits in or out of network $500 Deductible – all benefits subject to the deductible except for preventive $3,500 Maximum Out-of-Pocket $500 IP Hospital Copay per Visit $250 OP Hospital Copay per Visit

2018 TRS-Care Medicare Benefits Medicare Advantage Plan – Humana PPO – same benefits in or out of network $5 PCP Office Visit copay, $10 Specialist $0 Preventive Services copay $35 Urgent Care copay, $65 ER copay

Retiree/Surviving Spouse Only: $135 Retiree + Spouse: $529 Monthly premiums for Medicare retirees in 2018 Retiree/Surviving Spouse Only: $135 Retiree + Spouse: $529

2018 TRS-Care Rx Benefits

2018 TRS-Care Rx Benefits January 1, 2018, SilverScript will begin administering the prescription drug plan The new pharmacy benefit provider is CVS Caremark Retail Pharmacy = $5/$25/$50 Mail Order = $15/$70/$125 No “Donut Hole”

TRS-Care Marketing Ideas Social Media Teachers are better “networkers” than most industries Facebook – check out the TRTA Facebook webpage Read the live comments from the participants – angry! Grass Roots Ask “who do you know that is a retired educator that may be impacted by the TRS changes 1-1-18?” Incorporate this message into all AEP/OEP sales events Host “Educational and Sales Events” across Texas

TRS Care Marketing Assistance Agent referral letter TRS Care Member presentation Flyers to hand out Mailers We are developing a web page at www.TheBrokerageInc.com to post all of these marketing tools

2018 AEP and OEP should be the best enrollment season yet! Thank you 2018 AEP and OEP should be the best enrollment season yet!