1. Providing ACA Tax and Benefit Compliance Plans
KeySolution MEC Plans
Providing ACA Tax and Benefit Compliance Plans

2. Executive Overview
Key Benefit Administrators (KBA) was founded in 1979 as a full-service group benefits administration firm specializing in self-funded medical plans.
Since that time, KBA has grown to become one of the country’s largest independently- owned third party administrators, supporting a wide variety of group benefit plans.
KBA is a member of the Key Family of Companies which has two major locations: Indianapolis, IN, and Ft. Mill, SC.
The Key Family is a commonly-held group of benefits-related organizations with over 900 employees, over 3,500 corporate customers, and over 2.2 million members under management.
We are committed to upholding four key principles . . .
Fundamentals, Extraordinarily Well
Innovative Healthcare Risk Management Techniques
High-Tech, High-Touch Service
Shared Strategic Leadership Role with Each Client

3. Key Points of Differentiation
Core competency in complex healthcare administration – years of self-funded medical experience
On staff legal counsel specializing in ERISA law, employer law, and healthcare reform law
Focus on flexible and creative solutions including strategic tax planning strategies
Integrated healthcare risk management
Healthcare risk management reports and EZ View™ technology
KBA
Medical Administration
AHDI/Risk Management
HRA/Flex
Limited Medical
Compliance Services
Gap Administration
Cobra Administration
Dental &Vision

4. Legal Compliance Full-time General Counsel Wallace Gray, JD, MBA
8-hour response time
Nationally Recognized Employee Benefits Expert
Plan documents, ERISA, COBRA, FMLA, ADA, ADEA, Medicare, Medicaid, etc.
Flexible Spending Accounts, Health Reimbursement Accounts, Wellness Programs
Plan Administration
Compliant terms and conditions, interpretive guidance, appeal processing, coordination with other benefit programs
Compliant Notices
HIPAA Privacy, COBRA, WCHRA
Legal Updates

5. ACA Tax Penalties Defined
Employee considerations:
Individual Mandate Penalty: 2.5% of adjusted household income or $695 per adult plus $ per child, whichever is greater
Employer Considerations:
A Penalty: If employers offer no coverage they will pay $2,160 per employee per year as an excise tax for all full time employees minus the first thirty
B Penalty: If employers does not meet Minimum Value and Affordability requirements they will be subject to a $3,240 excise tax on any employee who applies on the exchange and receives a subsidy.

6. Challenges for Employers
Affordable plans for employers
High financial barrier for entry
Large renewal increases
Meaningful benefits for employees
High Deductible plans not feasible for most employees
Underwriting considerations
Medical underwriting to adjust rates
Participation requirements

7. Objectives of KBA’s KeySolution MEC plans
Primary Objective:
Get employers compliant with the ACA at the lowest possible cost
Secondary Objective:
Provide meaningful benefits for employees that they can use and afford

8. Key Points to KeySolution MEC Plans
Flexible benefit options
Pick the strategy that fits the needs of the employers
Employee can choose the plan that fits their needs and budget
First dollar benefits
Employees don’t have to hit deductible before insurance works
Immediate impact to employees
Fixed rates that don’t change after the initial quote
Rates are firm
ACA Compliance
Employer compliant with $2,160 “A” penalty for offering plan
Enrolled employees are compliant with $695 penalty for not having coverage
Still subject to $3,240 “B” penalty for employees that receive tax credit

9. Available Benefit Plans (Set 1)
MEC
MEC Preferred
MEC Preferred Plus
ACA Required Preventive Benefits
100% Coverage for 71 Preventive & Wellness benefits
Compliant with “A” Penalty
Yes
Compliant with Individual Mandate
Disqualifies Employees from Tax Credit No
Additional Meaningful Benefits

10. Available Benefit Plans (Set 1 Continued)
MEC Preferred
MEC Preferred Plus
Inpatient Hospital Daily Indemnity Benefit
$100 daily benefit, 180 maximum days
$200 daily benefit, 180 maximum days
Inpatient Surgery & Anesthesia Daily Indemnity Benefit
N/A
$1,000 per day/$200 Anesthesia, 1 day maximum per benefit period
Outpatient Surgery & Anesthesia Daily Indemnity Benefit
$500 per day/$100 Anesthesia, 1 day maximum per benefit period
Outpatient Physician Office Visit Daily Indemnity Benefit
$30 per day, 6 day maximum per benefit period
$60 per day, 6 day maximum per benefit period
Outpatient Diagnostic X Ray and Lab Daily indemnity Benefit
$50 per day with a 2 day maximum per benefit period
$50 per day with a 3 day maximum per benefit period
Daily Prescription Drug Benefit
$15 per day, 20 day maximum per benefit period
Initial Hospital Admission Daily Indemnity Benefit
$500 per day,1 day maximum with 1 Admission per benefit period
$1,000 per day,1 day maximum with 1 Admission per benefit period
Critical Illness Benefit
$5,000 per Employee
Emergency Room Visit Daily Indemnity Benefit *covers illness and accidents
$100 daily benefit with a max of 3 days per benefit period
Ambulance Service Daily Indemnity Benefit
$100 per day, 3 day maximum per benefit period
Employee Group Term Life

11. Available Benefit Plans (Set 2)
MEC Heavy
MEC Heavy Preferred
MEC Heavy Preferred Plus
ACA Required Preventive Benefits
100% Coverage for 71 preventive & wellness benefits
Compliant with “A” Penalty
Yes
Compliant with Individual Mandate
Disqualifies Employees from Tax Credit No
Additional Meaningful Benefits

12. Available Benefit Plans (Set 2 Continued)
What is the MEC Heavy Plan? $0 Deductible / $5,000 Out of Pocket
Copays
Emergency Room Services
Facility Charges: $400 copay then plan pays 100% of daily benefit up to $7,500. Physician Charges: $400 copay then plan pays 100% of daily benefit up to $5,000.
Primary Care Visit to Treat an Injury or Illness
$15 copay then plan pays 100%
Specialist Visit
$25 copay then plan pays 100%
Imaging (CT, PET Scans, MRIs)
$400 copay then plan pays 100%
Laboratory Outpatient and Professional Services
$50 copay then plan pays 100%
X-rays and Diagnostic Imaging
Exclusions
Inpatient Hospital Services
Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Outpatient Facility Fee
Outpatient Surgery Physician/Surgical Services
Specialty Drugs & Compounds
Additional Benefits
ACA Required Preventive Benefits
100% Covered
Chronic Disease Management (CDM) Benefit
Life AD&D Benefit
$10,000 Benefit
Rx Coverage
Certain Generics
$15 Copay
Certain Preferred Brand Drugs
$25 Copay
Certain Non-Preferred Brand Drugs
$75 Copay

13. Available Benefit Plans (Set 2 Continued)
MEC Heavy Preferred
MEC Heavy Preferred Plus
Inpatient Hospital Daily Indemnity Benefit
$500 per day with 180 day benefit period maximum.
$1,000 per day with 180 day benefit period maximum.
Initial Hospital Admission Daily Indemnity Benefit
$1,000 1 day benefit with a maximum of 1 admission per benefit period.
$2,000 1 day benefit with a maximum of 1 admission per benefit period.
Inpatient Surgery & Anesthesia Daily Indemnity Benefit
$500 daily benefit with a maximum of 1 day per benefit period. Includes a 20% Daily Anesthesia Benefit.
$1,000 daily benefit with a maximum of 2 days per benefit period. Includes a 20% Daily Anesthesia Benefit.
Outpatient Surgery & Anesthesia Daily Indemnity Benefit
$250 daily benefit with a maximum of 1 day per benefit period. Includes a 20% Daily Anesthesia Benefit.
$500 daily benefit with a maximum of 2 days per benefit period. Includes a 20% Daily Anesthesia Benefit.
Intensive Care Daily Indemnity Benefit
$500 daily benefit with a maximum of 30 days per benefit period.
$1,000 daily benefit with a maximum of 30 days per benefit period.
Critical Illness Benefit
(Subject to domicile state)
$5,000 Benefit
$10,000 Benefit

14. Best Practices Analyze needs of client Choose a benefit Set
Employer & employee needs
Choose a benefit Set
MEC Plans (set 1) vs. MEC Heavy Plans (set 2)
Select base and buy-up plans
Provide choices to employees
Determine employer contribution
Subsidize base plan and allow employees to buy up
A greater employer contribution encourages employee participation. Employee dollars are added to the claims fund and can be used to offset costs for future benefit years
Educate employees
What do these plans provide
What options are still available

15. Requirements To generate a proposal Participation requirements
Excel census including employee DOBs, genders, and zip codes
Client’s legal name and domicile address
Participation requirements
MEC - 20 Enrolled employees per benefit set – consisting of enrolled and surcharged lives - subject to change by state
MEC Heavy - 10% of the eligible employees or 20 employees whichever is greater – consisting of enrolled and surcharged lives
Implementation fee and timeline
$1,000 Annual non-refundable fee
DocuSign paperwork and implementation fee 30 days in advance