Patient Protection and Affordable Care Act: Timeline for Implementation Commissioner Kim Holland Oklahoma Insurance Department

Oklahoma Health Stats: Oklahoma ranks 49 th out of 50 States in the overall health of its citizens.

3 Overall State Ranking 2008 Commonwealth Fund (Measures Performance of State Health Systems) 50 United Health Foundation (Measures Health of State Populations) 43

4 Percentage of Citizens Without Health Insurance StateRank Texas1 New Mexico2 Oklahoma6 Arkansas10 Louisiana12 Colorado16 Missouri27 Kansas % 12.2 % 13.0 % 19.5% 21.4% 24.1% 18.0% 17.8% U.S.= 15.1% Source: U.S. Census Bureau, American Community Survey Release Date: September 22, 2009

There are Many Unanswered Questions

Effective 2010 Coverage for Children with Preexisting Conditions Guarantee Issue for Children Temporary High Risk Pool Funds –Provides $5 Billion to states to pay claims for individuals with Pre-X who have been without coverage for at least 6 months –Premium Required ─ 100% of Standard Risk Rate Coverage for Preventive Services –Requires plans to provide coverage without cost sharing for: Preventive services, Immunizations recommended by CDC, and preventive screenings for infants, children, adolescents & women

Effective 2010 Adult Dependent Coverage –Requires plans that provide dependent coverage to extend coverage to adult children up to age 26 Prohibition of Lifetime Dollar Limits –Applies to plans on their first renewal date after September 23, 2010 Tax Credits for Small Business –Employers with 25 or fewer employees and annual wages < $50k/yr

Effective 2010 What is a Grandfathered Plan? –A plan in existence on Grandfathered Plans are Excluded From: –Covering young adults to age 26 if they have other employer coverage –Waiver of pre-x for individual plans only –Annual limit provisions for individual plans only –Choice of provider requirements –Pre-authorization restrictions for emergency room services –Preventive care coverage requirements –New claims and appeal processes

Effective 2010 Causes for Loss of Grandfathered Status: –Entering into a new policy, contract or certificate on or after (fully insured) –Eliminating all or most benefits to diagnose or treat a particular condition –Increasing coinsurance percentage –Increasing a deductible or out-of-pocket limit more than 15% + medical CPI –Increasing a copay by the greater of: more than $5 or 15% + medical CPI –Decreasing the employer contribution for any tier of coverage by more than 5% –Any change to annual limits (includes adding or deleting)

Effective 2014 Guarantee Issue & Renewability –Standards developed by HHS Prohibition of Excessive Waiting Periods –Group plans may not impose waiting periods that exceed 90 days Prohibition of Annual Dollar Limits on Plans Include Essential Benefits

Effective 2014 Individual Mandate –Penalty for Noncompliance: Greater of $695/yr (3X that $ for family) OR 2.5% of household income –$95 in 2014 (or 1% taxable income) –$325 in 2015 (or 2% taxable income) –$695 in 2016 (or 2.5% taxable income) After 2016, penalty will be increased at COLA rate Individual Incentives –Advanceable Premium Credits Available for those making between % FPL –Cost-sharing Subsidies Available for those making between % FPL Native Americans <300% FPL ─ No cost sharing (Approx. 8% of Population) Available only for Exchange purposes

Effective 2014 Employer Mandate Employers with 50+ employees must offer coverage or face a penalty If a large employer does not offer minimum essential coverage and one of its employees receives a subsidy through the Exchange, it will be subject to a penalty of up to $2,000 per employee. When calculating applicable penalty, the number of employees is reduced by 30. Large employers who do offer coverage but the coverage is insufficient or not “qualified” or “affordable” and whose employees receive a subsidy through the Exchange will be subject to a penalty of $3,000 per employee receiving a subsidy. The penalty shall not exceed $2,000 times the number of fulltime employees. Employers of 50 or fewer employees are exempt from these requirements. Reinsurance Pool for High Dollar Claims

Effective 2014 State-Based Exchanges –Would allow individuals and small businesses with up to 100 employees to purchase coverage –Beginning in 2017, businesses with more than 100 employees would be allowed to purchase coverage Benefit Tiers Established for Exchange Plans Rating Standards

Q & A Commissioner Kim Holland Oklahoma Insurance Department