1. Restaurant.org @WeRRestaurants /RestaurantDotOrg
/NationalRestaurantAssociation

2. Individual Mandate and Marketplace Realities: What do I tell my employees? (especially those not eligible for my group plan) January 21, 2015

3. Randy Spicer, Vice President, Health & Insurance Services National Restaurant Association Clinton Wolf, Senior Director, Strategic Initiatives Optum

4. The Affordable Care Act is Here to Stay… in One Form or Another.
Introduction
The Affordable Care Act is Here to Stay… in One Form or Another.

5. Implement it in the way that best serves your business
We need to:
Understand it
Implement it in the way that best serves your business
Help employees make informed choices and Comply with Individual Mandate (…especially those not eligible for my group plan)

6. Open enrollment ends February 15th.
Why now?
Open enrollment ends February 15th.
Employees are paying penalties for 2014.
Many wait to enroll until the end.
New Opportunities to help your employees and your business.
ACA impacts all Employers and Employees

7. Reporting Requirements
Requirements are Substantial Under ACA
Onus is on the Employer to Prove They Are/Are Not Covered Under Act
This Means Tracking Variable Hour Employees
IRS May Require Proof
If an Employee Goes to Marketplace (and Receives
Subsidy):
Employer may have to Prove Offer for Coverage Made
If No Offer Made…Penalty Imposed
If Wrong Type of Coverage Offered…Penalty Imposed

8. Standard Operating Procedure
Standard Reporting
Standard Operating Procedure
Notice of Exchanges
Must Provide Notice of Exchanges Within 14c Days of Hire
NRA Notification Tool at notify.restaurant.org
Offer Coverage
Do Not Offer Coverage
Include in New Hire Process
Have Employee Sign an Acknowledgement of Receipt & File in Personnel File
W2 Reporting – (File 250 or More W-2s)
Provide Data on the Value of Health Care Coverage for Employees Enrolled in a Plan on Box 12DD on W2
Aggregate Cost (Employer + Employee)

9. Most Companies Plan to Offer Coverage
Impact Of ACA
People Report- Summary of Findings
Two Most Common Tactics to Manage Cost
Hire Relatively More Part-Time Employees
Increase Prices
Most Companies Plan to Offer Coverage
Majority Believe Benefits Help Recruit and Retain the Best Employees

10. ACA Impact - Recruiting
Will it Help?

11. Retaining Employees
Will it Help?

12. Small Penalties Initially…Low Participation
Impact Of ACA
Impact on Recruiting/Retaining Will Grow
Small Penalties Initially…Low Participation
Down the Road…Expectations will Change
Employees will Come to Expect Benefits
Earlier you Address Issue the Better
Find Solutions that Meet Business Needs
Find Solutions that Meet Employee Needs
Need to Understand and Manage Benefits for All Employees Going Forward

13. ACA Creates New Coverage Options

14. New Employer Benefit Models are Here
Group + Individual Exchange
Individual Exchange Only
Provide Group Benefits to some Employees and Individual Exchange access/support for others.
Provide all Cobra eligibles access/support to Individual Exchange.
Provide employees access and possibly compensation & resources to enroll.
Provide employees access only to Individual Exchange

16. I have COBRA and it’s too expensive
I have COBRA and it’s too expensive. Can I drop it during Open Enrollment and enroll in a Individual Marketplace plan instead?  Yes, during Open Enrollment, you can sign up for a Individual Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new coverage begins.
I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Individual Marketplace instead? Yes, leaving your job and losing job-based health coverage will trigger a special enrollment opportunity that lasts for 60 days. You can apply for Individual Marketplace health plans and (depending on your income) for premium tax credits and cost sharing reductions during that period. If you enroll in COBRA coverage through your former employer, however, you will need to wait until the next Open Enrollment period if you want to switch to a Individual Marketplace plan.

17. Employee Communication: Individual Mandate
What do I tell my Employees?

18. Communicate - Employees
What Do They Want to Know?
What Does ACA Mean to Me?
What are my Choices?
What Will it Cost?

19. What does it mean to me? Affordable Care Act
Individuals MUST acquire and maintain “minimum essential coverage” each month, qualify for an exemption, OR pay a penalty through their individual tax returns.
The obligation to make quality, affordable health insurance coverage available to individuals is “shared” among:
Federal and State governments
Employers
Insurers; and
Individuals

20. What Choices do Employees Have?
Individual Mandate
What Choices do Employees Have?
Get Coverage Through Their Employer
Buy an Individual Plan Through Either:
The Federal Health Insurance Marketplace (May be Eligible for Subsidy);
The Private Exchange Market; or
Private Insurance Provider
Obtain Coverage from the Government (Medicaid, Medicare, TRICARE)
Go Uninsured (Will Pay Penalty Unless They Qualify for an Individual Exemption)

21. Assessed April 2015 Individual Penalty
Those Without Coverage Pay a Tax Penalty the Greater of :
2016 = $695 or 2.5% Taxable Income
2015 = $325 or 2% Taxable Income ($16,250+)
2014 = $95 or 1% Taxable Income

22. Employee Cost What will it cost?
If You Offer Coverage…They are Not Eligible for a Subsidy thru the Exchange
If You Don’t Offer Them Coverage…They could be eligible for a Subsidy thru the Exchange

23. Health Exchanges Exchange Plan Types
Metal Level
Target Actuarial Value
Range of Allowable Actuarial Value
Bronze
60%
58% - 62%
Silver
70%
68% - 72%
Gold
80%
78% - 82%
Platinum
90%
88% - 92%
Catastrophic Plans available for those under 30 and for those who are exempt because no affordable coverage is available or they have a hardship exemption.
Sample Catastrophic Plan
Individual Deductible
Family Deductible
Covers Essential Benefits
$6,600
$13,200

24. Health Insurance Exchanges
Exchange Credits
What makes someone eligible for exchange credits?
The individual’s household income is between 100% - 400% of the federal poverty level; and
The individual does not have access to employer provided coverage…
(1) that has an actuarial value of at least 60% or
(2) the cost of coverage exceeds 9.5% of the individual’s household income.

25. Subsidy Calculator- Kaiser Family Foundation Premium Assistance for Coverage in Exchanges
This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). Middle-income people who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges.

26. Family of Four; Two Adults & Two Children
Results:
The information below is about subsidized exchange coverage. Note that subsidies are only available for people purchasing coverage on their own in the exchange (not through an employer). Depending on your state's eligibility criteria, you or some members of your family may qualify for Medicaid.
Household income in 2015: $35,775 is 150% of poverty level
Maximum % of income you have to pay for the premium is : 4.02%
Health Insurance premium in 2015 (for a silver plan, before tax credit): $8,474 /year You could receive a government tax credit subsidy of up to: $7,036 per year
(which covers 83% of the overall premium)
Amount you pay for the premium:$1,438 per year (which equals 4.02% of your household income and covers 17% of the overall premium)
You are guaranteed access to a Silver plan with an actuarial value of 94%. Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $4,500.

27. Health Exchanges Exchange Plan Types
Metal Level
Target Actuarial Value
Range of Allowable Actuarial Value
Bronze
60%
58% - 62%
Silver
70%
68% - 72%
Gold
80%
78% - 82%
Platinum
90%
88% - 92%
Catastrophic Plans available for those under 30 and for those who are exempt because no affordable coverage is available or they have a hardship exemption.
Sample Catastrophic Plan
Individual Deductible
Family Deductible
Covers Essential Benefits
$6,600
$13,200

28. Communicate - Employees
Many Are Waiting for Your Guidance
A lot of misinformation is out there
Understand their interest
Make sure they know the cost of being covered and Not covered
Some may be covered under parent or spouse’s plan
Health insurance is a secondary concern that is trumped by earnings
Most have never had insurance and don’t understand what is really being offered
Might bring in your broker to talk to them about insurance
Understand what they are signing up for
Don’t care if you are a classified as small or large employer – they are interested whether you will offer insurance

30. UnitedHealthcare Alliance
All Medical & Specialty Products Available
Exclusive:
Medical Discounts: Up to 5 % savings on manual premium for 51+ groups.
Optum Restaurant Healthcare Discount card – $5 pepm and includes family
Voluntary dental for part-timers with purchase of full-time dental policy
5% Discount on Specialty Products
Greatly Improved pricing for Groups:
Offering for first time
Offering to new employee segments
Individual Exchange Tool Kit in Select Markets 30

32. Partnering to help employees avoid penalties
Tools to Share with Employees
Partnering to help employees avoid penalties
Partnered to provide:
Easy to share information
Posters
Fliers
Newsletter/ content
More information and enrollment:
Web and 800# available
800# is preferred
Spirit of Sharing information

33. For Small Employers (under 50 FTEs)

34. For Large Employers (over 50 FTEs)

35. Download Resources

36. Individual Exchange To Do List
Download the tool kit.
Understand the options available.
Communicate with employees
Stay tuned to the Health Care HQ for the latest updates Restaurant.org/Healthcare
Questions?

37. Vice President, Health & Insurance Services rspicer@restaurant.org
Visit NRA Health Care HQ -
Randy Spicer,
Vice President, Health & Insurance Services