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Design Powerpoint FINAL with Color

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Information about Design Powerpoint FINAL with Color
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Published on December 7, 2007

Author: Shariyar

Source: authorstream.com

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Ensuring a Healthy Workplace: MASSACHUSETTS HEALTH CARE REFORM AND YOUR BUSINESS :  MASSACHUSETTS HOSPITAL ASSOCIATION presents: Ensuring a Healthy Workplace: MASSACHUSETTS HEALTH CARE REFORM AND YOUR BUSINESS TODAY’S TOPICS ABOUT TOMORROW’S HEALTH CARE :  TODAY’S TOPICS ABOUT TOMORROW’S HEALTH CARE Background The basics of the law The health care options The requirements The benefits Helpful resources THE CHALLENGE IN NUMBERS :  THE CHALLENGE IN NUMBERS Estimated number of uninsured before Health Care Reform: 532,000 Source: BCBSMA Foundation/Urban Institute A COMMONWEALTH OF SHARED RESPONSIBILITY :  A COMMONWEALTH OF SHARED RESPONSIBILITY Employers Individuals Health Plans State Agencies Health Care Providers THE REASONS FOR HEALTH CARE REFORM… :  THE REASONS FOR HEALTH CARE REFORM… Growing number of uninsured Cost shift. Demand, cost strain hospitals and health care providers Cost makes insurance expensive, especially for individuals and small businesses Increased insurance premiums for everyone …AND THE SOLUTION :  …AND THE SOLUTION The Massachusetts Health Care Reform Law will: Provide new affordable products for individuals and small businesses Subsidize insurance for the low-income uninsured Require individuals age 18 and over to have health insurance by July 1, 2007 Require new employer responsibilities TWO OPTIONS UNDER ONE CONNECTOR :  TWO OPTIONS UNDER ONE CONNECTOR Commonwealth Care Government-subsidized For individuals up to 300% of federal poverty level that don’t qualify for other insurance Coverage by Massachusetts’ four Medicaid Managed Care organizations Commonwealth Choice For uninsured not eligible for Commonwealth Care and small businesses 35 choices: Seven participating health plans each offering five different products Open enrollment begins May 2007 COMMONWEALTH CHOICE: Requirements :  COMMONWEALTH CHOICE: Requirements Plans effective July 1, 2007 through June 30, 2008 All products must provide reasonably comprehensive coverage of health services, including: Preventative and primary care Emergency services Hospitalization Ambulatory services Mental health Prescription drugs No annual, per sickness or lifetime benefit maximum No plans that limit covered services based on a fee schedule COMMONWEALTH CHOICE: Health Plans:  COMMONWEALTH CHOICE: Health Plans Each plan will offer three levels of coverage: Premier (Gold), Value (Silver), Basic (Bronze) that vary in premium, cost-sharing, and provider network. The plans are: Neighborhood Health Plan Tufts Health Plan Health New England Fallon Community Health Plan Blue Cross Blue Shield of Massachusetts ConnectiCare Harvard Pilgrim Health Care COMMONWEALTH CHOICE: Premium Costs - Final Bids :  COMMONWEALTH CHOICE: Premium Costs - Final Bids Competitive premiums across all three benefit levels Average uninsured resident (37 years old) will have the following options: Basic (Bronze) plan: $175 to $288 per month (before tax savings) Value (Silver) plan: $239 to $424 Premier (Gold) plan: $303 to $583 OTHER BUSINESS OPTIONS: Insurance Partnership (IP) :  OTHER BUSINESS OPTIONS: Insurance Partnership (IP) Helps eligible employers with 50 or fewer full-time employees Employer must offer health plan and contribute at least 50% IP subsidies for businesses: For individual plan = up to $400 per employee per year For two-person plan = up to $800 per employee per year For family plan = up to $1,000 per employee per year Employee also receives payments to help pay his portion OTHER OPTIONS FOR LOW-INCOME INDIVIDUALS :  OTHER OPTIONS FOR LOW-INCOME INDIVIDUALS MassHealth Children’s Medical Security Plan Healthy Start THE EMPLOYER’S RESPONSIBILITY :  THE EMPLOYER’S RESPONSIBILITY “Fair and reasonable” employer contribution Section 125 plan offering Health Insurance Responsibility Disclosure (HIRD) forms Non-discrimination provision FAIR SHARE CONTRIBUTION :  FAIR SHARE CONTRIBUTION Employer with 11 or more full-time employees “Fair and reasonable” contribution At least 25% of employees participate in an employee-sponsored health plan, or… Employer offers at least 33% of premium cost, or… Be assessed up to $295 per employee per year SECTION 125 PLAN :  SECTION 125 PLAN Employees pay for health plan with pre-tax dollars Option must be offered by employers with 11 or more full-time employees Certain exemptions apply Part-time, temporary, seasonal employees Service employees (waitresses, bartenders, etc.) 60-day waiting period allowed Option encouraged for employers with less than 11 full-time employees FREE RIDER SURCHARGE:  FREE RIDER SURCHARGE Assessed on employers with 11 or more employees and that do not offer Section 125 plan Surcharge assessed for use of “state-funded health services”: One employee or dependent receives free care more than three times per year, or… Employer has five or more employees (or their dependents) receiving free care in a year Surcharge varies according to employer size and free care used after the state-funded costs exceed $50,000 HEALTH INSURANCE RESPONSIBILITY DISCLOSURE (HIRD) FORMS :  HEALTH INSURANCE RESPONSIBILITY DISCLOSURE (HIRD) FORMS Required for employers with 11 or more employees Employer form: Filed annually Details employment information and subsidized health plans offered, including Section 125 Employee form: Collected by employer and maintained for three years Details employee choice of employer-sponsored plan or alternative INDIVIDUAL MANDATE:  INDIVIDUAL MANDATE All Massachusetts residents age 18 and up must have health insurance by July 1, 2007, or… Resident faces loss of personal income tax exemption for 2007 and monthly fines in 2008 Employers not responsible for enforcement of individual mandate MINIMUM CREDITABLE COVERAGE :  MINIMUM CREDITABLE COVERAGE Connector voted recently to define “minimum creditable coverage” – the amount of health insurance one needs to comply with the individual mandate Maximum deductible ($2,000/$4,000) Maximum out-of-pocket ($5,000/$10,000) Comprehensive coverage Prescription drugs – required Lifetime maximum – allowed Compromise: 18-month phase-in – Jan. 1, 2009. So, any current insurance product qualifies HSA Plans – exempt Self-insured plans - exempt EMPLOYER RESPONSIBILITIES :  EMPLOYER RESPONSIBILITIES Fewer than 11 Full-Time Employees Not subject to the requirements of the law May establish Section 125 plans Employees may purchase through the Connector EMPLOYER RESONSIBILITES:  EMPLOYER RESONSIBILITES 11 or more Full-Time Employees Must: Establish Section 125 plans File Health Insurance Responsibility Disclosure (HIRD) forms Offer to pay at least 33% of cost for full-time employees, or have 25% participate under group plan If not, employer must pay Fair Share Contribution ($295 per employee per year) EMPLOYER RESPONSIBILITES :  EMPLOYER RESPONSIBILITES Fewer than 50 Full-Time Employees May purchase group insurance (with individual choice) from the Connector May be eligible for the Insurance Partnership (IP) eligibility expanded to include annual incomes up to 300% of federal poverty level THE BENEFITS FOR EMPLOYERS :  THE BENEFITS FOR EMPLOYERS Decrease in the uninsured and in the cost shift onto employers who provide health insurance All employers contributing something, reducing cost shift Broader and more affordable product choice for individuals and small businesses Reduction of administrative work associated with negotiating health insurance Pre-tax payroll deduction plan for employees Transparency of price and quality of health insurance products THE BROADER BENEFITS FOR EMPLOYERS :  THE BROADER BENEFITS FOR EMPLOYERS Employers who provide health insurance Build employee loyalty Better recruit and retain employees Improve productivity INFORMATION AT YOUR FINGERTIPS :  INFORMATION AT YOUR FINGERTIPS Commonwealth Health Insurance Connector: www.mass.gov/connector Associated Industries of Massachusetts (AIM): www.aimnet.org Insurance Partnership: www.insurancepartnership.org YOUR HOSPITAL IS HERE FOR YOU :  YOUR HOSPITAL IS HERE FOR YOU For help with questions, visit [insert department and your local community hospital or health center info here, and website as appropriate], or visit the Massachusetts Hospital Association’s website at www.gethealthcoverage.net Slide27:  Thank you for coming and for helping make Massachusetts a leader in affordable health care for all! Flowers by Phone A phone-order-only florist, Bridgewater:  Flowers by Phone A phone-order-only florist, Bridgewater Number of employees = 8 5 full-time 3 part-time (work fewer than 35 hours/week) Offers insured plan with 90-day waiting period Only the 5 full-time employees are eligible 3 are enrolled, 2 waive coverage and some may not have it elsewhere Company pays 70% of the premium for all eligible employees Section 125 Premium Only Plan? = No Ware River Glass Company A commercial and residential glass supplier and installer, Ware:  Ware River Glass Company A commercial and residential glass supplier and installer, Ware Number of employees = 20 15 full-time 5 part-time (work fewer than 35 hours/week) Offers insured plan with 90-day waiting period Only the 15 full-time employees are eligible 11 are enrolled, 4 waive coverage and some may not have it elsewhere Company pays 80% of the premium for all eligible employees Section 125 Premium Only Plan? = Yes May be eligible for Insurance Partnership subsidies depending on income of employees and other rules. SharpSet Professional Printers, Inc. Paper and printing company for financial services, Waltham :  SharpSet Professional Printers, Inc. Paper and printing company for financial services, Waltham Number of employees = 76 28 full-time 28 part-time (work fewer than 35 hours/week) 20 temporary (work fewer than 35 hours/week, for fewer than 12 weeks) Offered insured group health plan with 90-day waiting period Only the 28 full-time employees are eligible 14 are enrolled, 14 waive coverage and some may not have it elsewhere Company pays 100% of premium for owners and other managers, and 50% for other employees Section 125 Premium Only Plan? = Yes May be eligible for Insurance Partnership subsidies Boston Painting Company Painting company, Boston :  Boston Painting Company Painting company, Boston Number of employees = 120 30 full-time 90 seasonal (April-October) Offered insured group health plan with 60-day waiting period Only the 30 full-time employees are eligible 20 are enrolled, 10 waive coverage and some may not have it elsewhere Company pays 80% of coverage Section 125 Premium Only Plan? = Yes Not eligible for Insurance Partnership subsidies

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