sw 2013 americorps coverage and health care reform

7/28/2019 SW 2013 AmeriCorps Coverage and Health Care Reform

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AmeriCorpsCoverage andHealth Care ReformSouthwest National Service Training Conference

July, 2013


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CONTENTSI. Background

II. The Issue and Goal

III. Current Situation

IV. Remaining Challenges

V. Minimum Essential Coverage (MEC)

VI. The Case for Minimum Essential Coverage

VII. What Now?


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BackgroundAmeriCorps Provisions

Minimum Coverage Requirements (Full Time Members)

Low Front End Cost Sharing

Annual deductible - $250 or less

80% Coinsurance (50% mental health and substance abuseexception)

No more than $1,000 out-of-pocket maximum

Wide Array of Benefits

Accident and Sickness

Physician, hospital, emergency room, prescriptions, lab & x-ray

A*C Provisions only require a $50,000 per causemaximum benefit


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BackgroundPatient 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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The Issue & The Goal Affordability vs. Plan Design

Increased Claim Liability = Increased Premium

28% increase is estimated impact

Access/Insurer challenges (No employer/employeerelationship)

Goal

Compliance with the Affordable Care Act

Affordable coverage for grantees

Quality benefits for members

Provide Minimum Essential Coverage (MEC) Avoid individualmandate penalty for covered members


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Current Situation Limited Medical Plan Waiver

Temporary Expires in 2014

Limitation on new groups

Short Term Limited Duration Coverage

Not subject to the Affordable Care Act

Less than 1 Year (364 day policy period)

Non-renewable


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Remaining ChallengesThe 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 onafter 364 days

Establish Minimum Essential Coverage (MEC)

Avoid individual mandate shared responsibility penalty


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Minimum EssentialCoverage (MEC)Effective January 1, 2014

What is MEC? - Guidance

Government sponsored plan

E.g., Medicare, Medicaid, CHIP, Tricare, Peace Corps

Employer-sponsored plan

Generally, all employer plans except limited medical

Individual plan

Applicability

MEC status prevents the shared responsibility penalty

Exceptions

e.g., 100% of FPL,


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Minimum EssentialCoverage (MEC)The Corps Network Strategy

3 Plans to gain MEC status

February 1, 2013 Proposed Rule

Designates AmeriCorps as MEC (not finalized)

Apply direct to HHS for MEC status

Change plan design to an ACA compliant structure

Maintain similar price point to today

ACA Compliant Trade off:

Low member cost share vs. catastrophic coverage

Remove per cause maximum (no lifetime benefit limit) Increase deductible, out-of-pocket maximum


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The Case for MECProven Value of The Corps Network Plan

Unique AmeriCorps Factors

Mandated coverage

Young demographic

Limited service duration

Program budget constraints

Member stipend

Evidence

95+% of enrollees have less than $2,000 in claims

99.9% of members do not encounter the $50,000 per causemaximum

2013 benefit increases (with policy approval)

Advantage over individual market


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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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QuestionsChris Rooney

Vice President

Willis of Seattle1-800-456-1415 x7428

[email protected]

sw 2013 americorps coverage and health care reform

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