AWISA Winter 2013Changes Under PPACA:

What You and Your Students Need to Know About Health Care

ReformJeff Crawford, Vice President

jcrawford@lewer.comPh: 800-821-7715, Ext. 148

Monica Olson, M.Ed., Regional Sales Directormolson@lewer.com

Ph: 206-618-8337

PPACA: Patient Protection and Affordable Care Act

MURKY WATERS AHEAD?

Shifting Sands Ahead

Brainstorm a short list of what is valuable, important or necessary in an insurance plan.

What is important to you, your staff or yourself when you think about using or administering an international student

insurance plan?

Top 5 List: International Insurance Plan

PPACA: Patient Protection and Affordable Care Act ACHA: American College Health Association Deductible: Small amount of money paid out of

pocket for each sickness or injury Co-pay: Small set amount of money paid out of

pocket for each office or hospital visit Co-Insurance: a certain set percentage of money

to be paid for each service SHP: Student Health Plan MLR: Medical Loss Ratio

Terms and Definitions

March 23, 2010: Affordable Care Act was signed into law

March 21, 2012:Final regulations on student health insurance plans

June 28, 2012:United States Supreme Court upheld the constitutionality of most of PPACA

Affordable Care Act: Timeline of Events

For plan years beginning January 2014: No annual limits  

For plan years beginning September 2012-December 2013: Annual coverage limits of no less

than $500,000

For plan years beginning July 2012-September 2012: Annual coverage limits of no less than

$100,000

Affordable Care Act: Changes in Progress - Annual

Limits

PPACA requires all compliant student health plans (SHPs) to have:

◦Preventative Care: Student health coverage is required to provide preventive services without

cost-sharing and co-pays. ◦Pre-existing Condition Limitations: Plans may

not impose pre-existing condition limitations on those younger than age 19.As of 2014, pre-existing conditions cannot be

excluded.

Affordable Care Act: Changes in Progress -

Requirements

Individual Mandate - January 1, 2014

Essential Health Benefits: must include these 10 categories Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Pediatric services, including oral and vision care Mental health and substance use disorder services, including

behavioral health treatment Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services, chronic disease management,

and prescription drugs

Affordable Care Act: Changes in Progress -

Requirements

WaiversExamine waiver policy to close the gap for waivers and keep your risk exposure low Cost-Benefit You want enhanced benefits, but there is a tipping point for cost and use…where is it?

PPACA Ripple Effect:Things to Consider

2014 Policy Year and Beyond: PPACA Plans

Unlimited Coverage

No Exclusion for Pre-Existing Conditions

MLR – 80% (Medical Loss Ratio)

Cost Increase and Destabilization

PPACA Ripple Effect: Things to Consider

What is MLR?Medical Loss Ratio

Current Premium $100,000Claims $75,000Loss Ratio (LR) 75%Target 70%Potential Refund

$0

PPACAPremium $120,000Claims $90,000Loss Ratio (LR) 75%Target 80%Potential Refund

5%

What is Important for Your Students?

Plan A

Unlimited Coverage $250 Deductible 20% Coinsurance No Pre-existing Exclusion Wellness Coverage Increased $$ Premium

Plan B

Current Accident & Sickness Coverage

$0 Deductible

100% Network Coverage

Pre-existing Exclusion

Limited Wellness Coverage

Stable Premium

Policy Year: 2013-2014

Compliant Plan• Participation mandate important• Benefits include wellness and immunizations

Action Options: What Can You Do?

Other Options• Limited Duration:

Accident and Sickness Only Plan

Top 5 List: International Insurance Plan

Now that you have learned about the upcoming PPACA changes…

What is important to you, your staff or yourself when you think about

using or administering an international student insurance plan?

http://www.healthcare.gov/law/full/patient-protection.pdf

Affordable Care Act

http://acha.org/Topics/Affordable_Care_Act/AffordableCareAct.cfm

ACHA Website http://www.healthcare.gov/news/factsheets/

2010/09/affordable-care-act-immunization.htmlACHA Immunization List

Resources