HEALTH CARE REFORM Chief Executive Boards Update Rob Gilmore Principal Benefitdecisions, Inc. November 2009
The Players Senate Finance House “Tri-Committee” Sen. Charles Grassley (R-Iowa) Ranking Republican Sen. Max Baucus (D-Mont.) Chair House “Tri-Committee” Rep. Charles Rangel (D-N.Y.) Chair, Ways & Means Rep. George Miller (D-Calif.) Chair, Education & Labor Rep. Henry Waxman (D-Calif.) Chair, Energy & Commerce
Health Care Reform Trends: Guarantee issue Modified community rating Individual mandates Low income subsidies Cost control, quality improvements Wellness & prevention Delivery system reforms
Delivery System Reform Public/Government Mandate Employer Mandate Health Insurance Exchange Funding - Health benefit tax exemption
No longer about health care reform
Possible Funding End or cap to tax break for employer- provided health benefits Roll back tax cuts Reduce Medicare cost Increase taxes on upper income Tax on soda
Where is Congress now? House 3 bills passed Senate 2 bills one Conference committee Once approved, delivered to the President for signature
Every action..... Cause Effect Public Option Dumping risk Increase public funding Eliminate Pre X w/o individual mandate Insure when needed Tax on the rich benefits Cost shifting to individuals
Good news! Risk Management programs remain available, like: Health Savings Accounts Health Reimbursement Accounts Wellness programs except for GINA Family history on Health Risk Assessments
Section 105 Plans Health Reimbursement Insurance Insurance Employer $2,500 Employee Employee $500 Reduces premium cost 20+% No increase out of pocket exposure to employees +40% of employees will not have expenses greater than $500 Trend increases on a lower starting point
Financial Impact Projections
Section 105/Health Reimbursement Arrangement Claim Process How do employees get reimbursed for items covered under your health plan (105 plan)? STEP 1: Patient goes to a medical provider STEP 2: The provider submits the claim to the insurance carrier (primary) STEP 3: Insurance carrier (primary) processes the patient’s claim STEP 4: An Explanation of Benefits (EOB) will be sent to the patient from the insurance carrier showing what was applied to the deductible STEP 5: Employee sends a copy of the EOB to a Third Party Administrator (TPA) who will reimburse the employee per coverage under your 105 Plan
Wellness Programs Develop balance with sick care programs - health insurance Educate & engage on positive lifestyle choice Positive impact on bottom line - improved productivity and lower absenteeism
Why manage health risk? Productivity Follows Risks 7 Hours/week difference in productivity = 353 hours/year = Over 2 months/year difference in productivity High Medium Low
Wellness Programs Create incentives for wellness Up to 20% premium differential Reduction in premium contribution for complying with wellness policies Biometric screening Cholesterol, hypertension, BMI Some can detect tobacco use Cannot ask family medical history
Wellness Contribution Strategy Non compliant subsidize compliant
Health Care Reform Yogi Berra - “It ain’t over, till it’s over”
HEALTH CARE REFORM Chief Executive Board Update Rob Gilmore Principal Benefitdecisions, Inc. November 2009