1. HEALTH CARE REFORM Chief Executive Boards Update
Rob Gilmore
Principal
Benefitdecisions, Inc.
November 2009

2. 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

3. Health Care Reform Trends:
Guarantee issue
Modified community rating
Individual mandates
Low income subsidies
Cost control, quality improvements
Wellness & prevention
Delivery system reforms

4. Delivery System Reform
Public/Government Mandate
Employer Mandate
Health Insurance Exchange
Funding - Health benefit tax exemption

5. No longer about health care reform

6. 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

7. Where is Congress now? House 3 bills passed Senate 2 bills one
Conference committee
Once approved, delivered to the President for signature

8. 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

9. 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

10. 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

11. Financial Impact Projections

12. 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

13. 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

14. Why manage health risk? Productivity Follows Risks 7 Hours/week
difference in productivity
= hours/year
= Over 2 months/year difference in productivity
High
Medium
Low

15. 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

16. Wellness Contribution Strategy
Non compliant subsidize compliant

17. Health Care Reform
Yogi Berra -
“It ain’t over, till it’s over”

18. HEALTH CARE REFORM Chief Executive Board Update
Rob Gilmore
Principal
Benefitdecisions, Inc.
November 2009