Professional Documents
Culture Documents
CONTENTS
I. II. III. IV. V. Background The Issue and Goal Current Situation Remaining Challenges Minimum Essential Coverage (MEC)
VI. The Case for Minimum Essential Coverage VII. What Now?
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Background
AmeriCorps Provisions Minimum Coverage Requirements (Full Time Members) Low Front End Cost Sharing Annual deductible - $250 or less 80% Coinsurance (50% mental health and substance abuse exception) No more than $1,000 out-of-pocket maximum Wide Array of Benefits Accident and Sickness Physician, hospital, emergency room, prescriptions, lab & xray
Background
Patient Protection and Affordable Care Act (ACA) Lifetime and Annual Limits Prohibition of Lifetime Limits Restrictions on Annual Dollar Limits Essential Health Benefits Overlap with AmeriCorps Provisions Expansion Examples: Preventive Care and Rehab Services Limited Medical Benefits Waiver Applicable to Mini-Meds Prevent Loss of Coverage Temporary Individual Mandate Personal Responsibility/Subsidy/Exchanges
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Increased Claim Liability = Increased Premium 28% increase is estimated impact Access/Insurer challenges (No employer/employee relationship)
Goal
Compliance with the Affordable Care Act Affordable coverage for grantees Quality benefits for members Provide Minimum Essential Coverage (MEC) Avoid individual mandate penalty for covered members
Current Situation
Limited Medical Plan Waiver
Not subject to the Affordable Care Act Less than 1 Year (364 day policy period) Non-renewable
Remaining Challenges
The Corps Network Plan Short Term Limited Duration Continuity of Coverage Policy Replacement (2013-2014) not yet approved by DC Logistics Second Term of Service - Enforced Break in Coverage Continuation of Coverage - Virtually Eliminated Suspensions/Term Exceeds 364 Days Coverage Terms on after 364 days Establish Minimum Essential Coverage (MEC) Avoid individual mandate shared responsibility penalty
What Now?
Secure Policy Replacement
Compliant with Affordable Care Act Affordable to grantees Adequate for members Gain MEC status Three part plan Educate Americas Service Commissions State Commissions Programs Advocate
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Questions
Chris Rooney Vice President Willis of Seattle 1-800-456-1415 x7428 chris.rooney@willis.com
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