YOUR HEALTH

YOUR BUSINESS

Health Care Reform Law

• What Does Health Care Reform Mean to You?- My Options- What About Pre-Existing Conditions

• When Does It Take Effect?

How can Brighton Health Solutions Help

Me?

The Patient Protection and Affordable Care Act of 2010

March, 2010: President Obama Signed Into Law Landmark Health Care Reform Legislation

March 23, 2010 – “Today, after almost a century of trying. Today, after over a year of debate. Today, after all the votes have been tallied, health insurance reform becomes law in the United States of America…We are a nation that faces its responsibilities and faces its challenges. Here in this country we shape our own destiny…That's what makes us the United States of America.”

– President Obama

Timeline of Key Elements: The Patient Protection and Affordable Care Act

2010 2011 20142012 2013 2015 & Beyond

• New federal rate review process established

• Insurance market reforms begin, including:

• Children may stay on parents’ policies until age 26 and no pre-ex exclusions for children until age 19

• Lifetime benefit limits prohibited

• Rescissions prohibited except for fraud

• Limited small business tax credits established

• Part D rebate for beneficiaries in the gap

• Temporary high risk pool created

• Statutory Medicaid drug rebates to states for drugs provided in managed care

• Funds for Community Health Centers

• MLR mandated: 85% for large group and 80% for small group and individual (non-group)

• Uniform coverage documents and standard definitions developed

• HSAs & FSAs limited • Discounts in Part D

“Donut Hole”• Annual fee on

pharmaceutical manufacturers begins

• Physician Quality Reporting Initiative bonuses

• Coverage for preventative services in Medicaid begins

• Reimbursement rates for primary care increased

• Medicare Advantage phase-in of capped FFS rates begins

• Quality bonus begins to be phased-in for Medicare Advantage plans

• Plans to merge Medicare incentives for physician quality reporting and for meaningful use of electronic medical records

• State Medicaid plans are required to pay primary care providers at Medicare rates

• Deduction for expenses allocable to the Part D subsidy for “qualified prescription drug plans” is eliminated

• High earner tax begins

• FSA contributions limited

• Annual fee on medical device sales begins

• Public reporting of physician performance information begins

• Annual insurance industry tax begins

• Insurance market reforms continue, including:

• Exchanges established• Guarantee issue

requirements • Standardized

minimum benefit offerings

• Prohibitions on annual limits, pre-existing condition exclusions, and rating based on health status

• MLR for MA and coding intensity changes go into effect

• Medicaid expansions become effective

• Individual and employer responsibility requirements begin

• Independent Payment Advisory Board presents first proposals

• Physician value-based payment program to promote quality for Medicare beneficiaries created in 2015

• States have flexibility to provide CHIP eligible's coverage in the Exchanges in 2015

• High-value plan excise tax begins in 2018

• “Donut hole” closed by 2020

How Does Insurance Help My Lifestyle?

• Success is built and sustained by being Healthy.

• How much do I want to Risk with my Health and My Family?

• How Much do my Team Members Risk?

• Fact: Half of All US Bankruptcies stem from a Medical Crisis

Preventing the 3 Types of Risk

1. Lost Income

2. Uncovered Medical Cost

3. Non-Medical Costs Associated with Accident or Illness

Major Medical Solutions

• Who can qualify for Major Medical?

• Why do I want Major Medical?– Health Care Law Requirement– Peace of Mind

Major Medical SolutionsBENEFITS:• Hospital inpatient room and board including intensive and cardiac care

• Hospital medical and surgical services and supplies

• Physicians' diagnostic, medical, and surgical services

• Other medical practitioners' services

• Nursing services including private duty service outside the hospital

• Anesthesia and anesthesiologist services

• Outpatient services

• Ambulance service to and from a hospital

• X-rays and other diagnostic and laboratory tests • Radiological and other types of therapy• Prescription drugs • Blood and blood plasma • Oxygen and its administration • Convalescent nursing home care • Home health care services

Dental Facts

• General StatisticsGeneral Statistics • Approximately 130 Million Americans lack dental coverage – nearly

triple the number without health insurance. (Managed Dental Care, August 2008)

• Research is pointing to associations between chronic oral infections and heart and lung diseases, stroke, and low-birth-weight, premature births.

Dental SolutionsBrighton Health Solutions works with

Partners that:• Provide an affordable way to reduce dental care costs

without restricting access to care – only $8 per month

• Provide no restrictions, limitations, or maximums

• Guaranteed Issue

• Have Discounts that range from 20% to 60%*

• Are Available at 98,000+ participating locations nationwide

Dental SolutionsExample Savings…Example Savings…

Actual Dental Visit – single member

Procedure Billed Discount Paid

X-Rays $37.00 49% $19.00

Limited Oral Evil $58.00 59% $24.00

Filling – Resin (2) $143.00 44% $80.00

Filling – Resin (3) $210.00 51% $104.00

TOTALS: $448.00 49% $227.00

Indemnity SolutionsFor those who cannot afford Major Medical

or cannot Qualify for Major Medical

• Guarantee Issue• Pays in addition to any coverage• Covers all pre-existing limitations

(including pregnancy)• First Dollar Benefits • No deductibles• No co-pays

Indemnity Solutions

BENEFITS• Guarantee Issue

• No Pre-ex

• No annual benefit maximums

• Assignable benefits

• Pays in addition to any other coverage

• Benefits apply regardless of where care is given

• National PPO Network included for claim discounts

• Telemedicine Services

• 24 Hour Nurse Line Assist

• Patient Advocacy

• Prescription Drugs benefits

• Dental Discount Program

• Insured Vision Program

• Lab & Imaging Discount Benefit

• Adult Wellness Plan

• Accident Medical benefit & AD&D with no annual limits

Disability Solutions

RISK PREVENTION

• How do You Qualify and How Much?• Why You Need it?

Life Insurance SolutionsPreparation and Peace of Mind through Proper Planning-

Why YOU Cannot Live Without This Benefit!!

1. Mortgage Protection2. Income Replacement

3. Final Expenses4. College Funding

International Insurance Solutions

Insurance helps to offset deductibles that your International Team Members have with their

current health programs.

• Who Qualifies?• Why You Need it?

International Insurance SolutionsWorldwide Coverage for Non - U.S. Citizens and Expatriates

Hospitalization

SurgeryOutpatient

Rx CoverageEmergency Room Accident

Emergency Medical EvacuationTransplants

Child WellnessMaternity

Global Term Life InsuranceGlobal Daily Indemnity

How Can Insurance Help To Support Your Team?

• Take Risk Out of Equation for You• Protect Your Family Income

• Support Your Team Members

Contact Information

Brighton Health Solutions877-261-4491801-261-2600

www.brightonhealthsolutions.comTroie Battles – Managing Partner