NAVIGATING THE POST-ELECTION LANDSCAPE: THINGS TO KNOW FOR 2017

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November 17, 2016

Health Care Reform Web Meeting Series

Today’s agenda

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Post-election recap and

regulatory perspectives

Things to know for 2017

Cigna resources

Wrap-up

“Ask the experts” Q&A

Molly Tatting Director of Health Care Reform, Cigna

Kari Stevens Managing Counsel, Cigna

David Schwartz Head of Global Policy, Cigna

FEATURED SPEAKERS

3

Post-election recap

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“Repeal and replace”

HOUSE

• Lack of clarity on replacement plan

• Uncertainty for individuals and employers

• Amendments through budget reconciliation

Legal and political considerations

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Executive

Legislative

Judicial

Meanwhile, in the states Party control of state governments

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Democrat Republican

MT

WA

ID

OR

TX

ND

MN

WI

MI RI

ME

NH

VT

MA

CT

NY

PA NJ

DE MD

VA WV

NC*

SC

GA

FL

AL MS

LA

NM AZ

CA

NV

UT

WY

SD

NE

CO

KS

IA

MO

AR

IL IN

OH

KY

TN

HI

AK

DC

OK

Split Control Unicameral, Non-partisan

No Medicaid Expansion

Sources: National Conference of State Legislatures and Kaiser Family Foundation; Ballotpedia.org

*North Carolina results pending

Regulatory issues for employer-sponsored coverage

THINGS TO KNOW FOR 2017

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“State of the State” ACA and other health care topics

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Employer

Requirements

Taxes and

Revenue

High-Cost

Drugs

Wellness

Public

Exchanges

Nondiscrimination

IRS reporting requirements An overview

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Major administrative burdens for employers and

tax preparers

A less-than-robust ACA Information Returns

(AIR) system

SSN/TIN challenges of employees’ spouses

and dependents

Key learnings

Looking ahead

• 2016 final forms and

instructions are available

• 2016 reporting due on

original dates in the law

• Expect greater

enforcement on 2016

filings in 2017

Best practices

Use enrollment and other existing

processes to improve data accuracy Document efforts to obtain correct

names and SSNs of dependents

Wellness and incentive regulations

9

ACA FINAL IN 2013

ADA

GINA

VARIOUS PROGRAM

ACTIVITIES

• Type of activity;

participatory, health

contingent, activity-

only, outcome-based

• Which regulations

apply to each activity

(ACA, ADA, GINA)

Reasonable

alternatives and

accommodations

May require

employer to provide

alternative method to

earn incentives in

health-contingent

programs.

Incentive limits

30% max

(50% tobacco max)

based on cost of

enrolled coverage. No

limits for participatory

programs.

Reward timing

Information

protection

Follow HIPAA

rules for

protected health

information.

May require

additional

accommodations to

disabled individuals

to earn incentives.

FINAL IN MAY 2016

30% max for spouse

incentive only based on

lowest cost of self-only

plan. Limits apply to

any type of program

subject to GINA.

FINAL IN MAY 2016

30% max for employee

incentive only where

disability related exam

or inquiry based on

lowest cost of self only

plan. Limits apply to

any type of program

subject to ADA.

Require

additional

notification and

confidentiality

statements

for protecting

medical and

genetic

information.

Must be able to

qualify for

incentives at

least once per

year.

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Delayed until 2020 with many open issues

Cadillac tax Overview and forecast

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* National Business Group on Health, Large Employers’ 2016 Health Plan Design Survey, 2015.

of large employers expect their current health

plan – with no changes – with highest

enrollment would trigger the Cadillac tax.*

Employers

continue

to explore

cost cutting

measures

despite delay.

50% OVER

Advocacy efforts are still underway

www.fightthe40.com

Cigna is a founding member of the

Alliance and on its Executive Committee

For employers with insured plans, the insurer

will be required to eliminate categorical exclusions

or limitations on gender transition

Nondiscrimination impacts Insured vs. self-funded plans

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1557 (insured)

Title VII (ASO)

EEOC briefing indicates employers

with self-funded plans may have similar/

same obligations under Title VII

• Increased inquiries on alleged violations

• Requesting more detailed audit protocols:

1) Large document reviews

2) Interviews of key individuals

3) Claims reviews

Enforcement Current observations

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DOL

Initiating audits on certain insured plans, including

carrier investigations around ASO activities CMS

Partnered investigations on ERISA-governed

plans and service providers Federal State

Final thoughts and resources available to help stay on track.

RESOURCES

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Cigna resources Meeting a variety of needs

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• InformedOnReform.com,

our award-winning website

• News alerts, fact sheets,

timeline and FAQs

• Podcasts on wellness,

OOP regulations and more

• A replay will be available

within a few days under

“Web Meetings”

• Education, communication and

consulting services

• YourACARoadmap.com

• Online toolkits

Q&A

ASK THE EXPERTS

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