1. Wellness & Prevention Initiatives,2010 PPACA Provisions, Health Insurance Exchanges, and OTC Drug Reimbursements and Mini Med Plans Presented by Sharon Alt

3. 2010 PPACA Provisions

4. Health Insurance Exchanges

5. OTC Drug Reimbursements/Mini Med PlansSource: www.HealthCare.gov

6. Wellness & Prevention Initiatives Under PPACA

8. PricewaterhouseCoopers’ Health Research Institute survey disclosed approximately $303 billion to $493 billion is spent annually on treating preventable illnesses.Source: www.HealthCare.gov

10. Employee wellness discounts

11. Break time for nursing mothers

12. Posting of nutritional requirements

13. Government funding for wellness programs

14. Small business grants for wellness programsSource: www.HealthCare.gov

16. Co-pays are eliminated for certain recommended immunizations, breast care screenings and other preventive care/screenings for women and children.

17. Requirements do NOT apply to “grandfathered” health plans.Source: www.HealthCare.gov

19. May be expanded to 50% subject to the discretion of the Secretary of Health and Human Services (HHS). Source: www.HealthCare.gov

21. Employers are not required to compensate employees during such breaks.

22. Employers with less than 50 employees may qualify for exceptions if it can be proven the requirement would impose an undo hardship. Source: www.HealthCare.gov

24. The number of calories for each item must be disclosed on menus, menu boards and drive through menus.

25. Menus must also feature “a succinct statement concerning suggested daily caloric intake.”

26. Includes buffet items and vending machines. Source: www.HealthCare.gov

27. Wellness & Prevention Initiatives Government Funding for Wellness Programs Prevention and Public Health Fund The Prevention and Public Health Fund will be administered through HHS and will support prevention and public health programs. Beginning with the fiscal year 2010, $500 million will be appropriated to various programs within HHS, with the amount of appropriations increasing each year to $2 billion in the fiscal year 2015 and each year thereafter. Source: www.HealthCare.gov

29. Community Transformation grant program (designed to fund state and municipal wellness programs by creating walking paths, nutrition awareness programs, etc)

30. Education and Outreach Campaign for Preventive Benefits (a planned public-private partnership to raise awareness on preventive care)

31. Immunization programs.Source: www.HealthCare.gov

32. Wellness & Prevention Initiatives Government Funding for Wellness Programs Prevention and Public Health Fund School-based health centers (facilities that provide primary health care to students on school campuses) will receive $50 million per year in grant funding through 2013. These grant monies are to be used only for expenditures on facilities and equipment, not for personnel hiring. Source: www.HealthCare.gov

34. Grants will be awarded beginning in 2011.

35. $200 million appropriated for a five year period.Note: Money will likely go quickly. Small businesses need to be prepared with a wellness program proposal which meets the criteria and requirements as described in the PPACA, and developed by the Secretary of HHS. Source: www.HealthCare.gov

37. Did NOT have a workplace program in place as of March 23, 2010 (date of PPACA enactment). Source: www.HealthCare.gov

39. How much grant money can a qualified employer receive?

40. Money runs out in 2015?

41. Where is the money? Source: www.HealthCare.gov

42. 2010 PPACA Provisions

44. Health Insurers cannot deny children health insurance because of a pre-existing condition.

45. Small business tax credits

46. Businesses with fewer than 25 “full time” employees can begin receiving a tax credit at 35% up to a maximum of 50% - subject to calculations and time frame.

47. Seniors get donut hole rebate

48. Seniors will get a rebate to fill the donut hole in Medicare drug coverage. Source: www.DHHS.gov

50. Insurers must reveal how much money is spent on overhead.

51. Customer appeals process

52. Any new plan must now implement an appeals process for coverage determination and claims.

53. Indoor tanning services tax

54. Imposes a 10% tax on indoor tanning services (effective for services on, or after July 1, 2010).Source: www.DHHS.gov

56. New screening procedures will be implemented to help eliminate health insurance fraud and waste.

57. Medicare expansion to rural areas

58. Medicare payment protections will be extended to small rural hospitals and other facilities that have a small number of Medicare patients.

59. Deductions for Blue Cross Blue Shield

60. Non-profit Blue Cross Blue Shield organizations will be required to maintain a medical loss ratio (MRL). Source: www.DHHS.gov

62. Chain restaurants will be required to provide a “nutrient” content disclosure statement alongside their menus.

63. Better coverage for early retirees

64. A temporary program for companies that provide early health benefits for those aged 55-64.

65. Better consumer information on the web

66. New website through HHS to make it easier for Americans in any state to seek out affordable health insurance options. Source: www.DHHS.gov

68. A two year temporary credit (to a maximum of $1 billion) to encourage investment in new therapies for the prevention and treatment of diseases.

69. Break time for nursing mothers

70. Requires employers to furnish reasonable break time and place for nursing mothers for up to one year after the child’s birth.

71. Cost-sharing obligations for preventive services are prohibitedSource: www.DHHS.gov

73. Group plans IRC section 105(h) rules

74. Group plans will be required to comply with the IRC section 105(h) rules that prohibit discrimination in favor or highly compensated individuals – rules apply to both self-funded and fully-insured plans.

75. Wellness grants for small employers

76. Small employers seeking to implement wellness programs can now access federal grant money.Source: www.DHHS.gov

78. The cut-off age for young adults to continue to be covered by their parents’ health insurance rises to the age of 26.

79. No lifetime caps

80. Annual caps will be limited, and banned in 2014.

81. Adults with pre-existing conditions covered

82. A temporary high-risk pool will be set up to cover adults with pre-existing conditions – Health Insurance Exchanges will eliminate the program in 2014.Source: www.DHHS.gov

84. New plans must cover checkups and other preventive care without co-pays, ALL plans will be affected by 2018.

85. The end of rescissions

86. Insurance companies can no longer cancel policies when an individual gets sick. Source: www.DHHS.gov

87. Health Insurance Exchanges

88. Health Insurance Exchanges Definition A Health Insurance Exchange is an organized marketplace for the purchase of health insurance set up as a governmental or quasi-governmental entity to help insurers comply with consumer protections. Source: www.HealthReform.gov

90. When will Exchanges go in effect?

91. What are Small Business Health Options Program Exchanges?

92. Who can participate in the Exchange?

93. Subsidies?Source: www.HealthReform.gov

95. States are required to have their Exchanges up and running no later than January 1, 2014.

96. Four plan choices and a catastrophic plan will be offered in each Exchange.

97. States may form regional Exchanges or allow more than one exchange to operate in a state as long as each exchange serves a distinct geographical area.Source: www.HealthReform.gov

99. Have adequate provider networks

100. Contract with the essential community providers

101. Contract with navigators to conduct outreach and enrollment assistance

102. Are accredited with respect to performance on quality measures

103. Use a uniform enrollment form and use a standard format to present plan information. Source: www.HealthReform.gov

105. Small businesses with up to 100 employees will be able to purchase qualified coverage no later than January 1, 2014.Source: www.HealthReform.gov

107. Separate Exchanges will be created for small businesses to purchase coverage through the Exchange (SHOP).Source: www.HealthReform.gov

109. Those who work for an employer who does offer health coverage whose wages are less than the poverty cut-off level, would also be eligible for a subsidy if the portion of premium they are required to pay is more than 9.8% of their income.Source: www.HealthReform.gov

110. OTC Drug Reimbursements and Mini Med Plans

112. Under the new standard, the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained. Source: www.DHHS.gov

114. Rules apply to grandfathered and new group health plans.Source: www.DHHS.gov

115. Waiver Process for “Mini-Med” Plans The Interim Final Regulations provided that these restricted annual limits may be waived by the Secretary of HHS if compliance with the IFR would result in a significant decrease in access to benefits or a significant increase in premiums. The preamble to the IFR further provided that guidance from HHS regarding the scope and process for applying for such a waiver would be issued in the near future. The memorandum issued by HHS on September 3, 2010 (the “HHS memorandum”), provides such guidance. Source: www.DHHS.gov

116. Waiver Process for “Mini-Med” Plans Waivers are only available or plans that were in existence before September 23, 2010. When does the waiver application have to be submitted? For plan years beginning before November 2, 2010, the waiver application must be submitted at least 10 days in advance of the start of the year. Otherwise, the application must be submitted at least 30 days before the beginning of the plan year. When will HHS process the wavier application? HHS will process complete requests generally within 30 days of receipt, but for plan years beginning before November 2, 2010, HHS will process the application no later than five days in advance of the year. Source: www.DHHS.gov

117. Waiver Process for “Mini-Med” Plans If granted, for how long will a waiver apply? Waivers will be granted initially only for the first plan year beginning between September 23, 2010, and September 23, 2011. New waiver applications must be submitted for later years and HHS may change the approval process in the future. What information must be included in the application? • The terms of the plan for which a waiver is sought • The number of individuals covered by the plan • The annual limit(s) and rates applicable to the plan • A brief description of why compliance with the IFR on annual limits would result in a significant decrease in access to benefits for those currently covered by the plan, or significant increase in premiums • An attestation. Source: www.DHHS.gov

118. Thank You Additional questions can be submitted through HealthcareExchange.com