Ensuring a Healthy Workplace: MASSACHUSETTS HEALTH CARE REFORM AND YOUR BUSINESS

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Ensuring a Healthy WorkplaceMASSACHUSETTS
HEALTH CARE REFORM AND YOUR BUSINESS
MASSACHUSETTS HOSPITAL ASSOCIATION presents
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TODAYS TOPICS ABOUT TOMORROWS HEALTH CARE

• Background
• The basics of the law
• The health care options
• The requirements
• The benefits
• Helpful resources

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THE CHALLENGE IN NUMBERS

• Estimated number of uninsured before Health Care
  Reform
• 532,000
• Source BCBSMA Foundation/Urban Institute

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A COMMONWEALTH OF SHARED RESPONSIBILITY

• Employers
• Individuals
• Health Plans
• State Agencies
• Health Care Providers

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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

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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

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TWO OPTIONS UNDER ONE CONNECTOR

• Commonwealth Care
• Government-subsidized
• For individuals up to 300 of federal poverty
  level that dont 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

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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

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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

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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

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OTHER BUSINESS OPTIONSInsurance 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

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OTHER OPTIONS FOR LOW-INCOME INDIVIDUALS

• MassHealth
• Childrens Medical Security Plan
• Healthy Start

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THE EMPLOYERS RESPONSIBILITY

• Fair and reasonable employer contribution
• Section 125 plan offering
• Health Insurance Responsibility Disclosure (HIRD)
  forms
• Non-discrimination provision

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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THE BROADER BENEFITS FOR EMPLOYERS

• Employers who provide health insurance
• Build employee loyalty
• Better recruit and retain employees
• Improve productivity

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INFORMATION AT YOUR FINGERTIPS

• Commonwealth Health Insurance Connector
  www.mass.gov/connector
• Associated Industries of Massachusetts (AIM)
  www.aimnet.org
• Insurance Partnership www.insurancepartnership.or
  g

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CARITAS GOOD SAMARITAN IS HERE FOR YOU

• For help with questions, contact CGSMC Financial
  Counselors at 508 427-3053.
• or
• Visit the Massachusetts Hospital Associations
  website at www.gethealthcoverage.net

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• Thank you for coming and for helping make
  Massachusetts a leader in affordable health care
  for all!