Understanding the impact of Health Care Reform on your business in 2013.

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2. Introduction
General Overview of Health Care Reform (HCR)
Critical Decisions and Considerations for 2013
• Individual Mandate
• Employer Shared Responsibility (Play or Pay)
• Reporting
• Costs, Taxes & Fees
• State Exchange
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3. Provisions 2010 – 2018
• Mandates & Statutes
• Access To Affordable, Quality Coverage
• Taxes, Penalties, Fees & Credits
• Reporting & Administration
Impact to Business Owners
• More complexity in purchasing decisions
• Increased compliance requirements
• Rising costs for small businesses
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4. Individual Mandate
Employer Shared Responsibility (Play or Pay)
Reporting
Costs, Taxes & Fees
State Exchanges
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5. • Effective January 2014, all individuals must purchase
qualifying health coverage
• Limited exceptions apply
• Penalties for failure to comply collected through
individual’s federal income tax return
Penalty is lesser of above amount or the national average cost of bronze level coverage in the state exchanges
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6. • Are you prepared to answer employees’ questions?
• Will the penalty change your employees’ behavior?
• Will more employees enroll in your health insurance
offering?
• What is the impact to your plan design and total health
care cost?
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7. • 40 FTEs*
• Offers Coverage
• 75% Participation
• 10 FTEs currently
not enrolled
• $5,000 contribution
per employee
A. 10 FTEs (currently not enrolled) enroll
because of individual mandate
B. Employer’s costs of offering coverage
increases
C. 10 x $5,000 = $50,000
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*Full-Time Employees

8. Individual Mandate
Employer Shared Responsibility (Play or Pay)
Reporting
Costs, Taxes & Fees
State Exchanges
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9. • Employers with 50 or more FTEs (including FTEQs*) are
subject to Play or Pay penalties if certain minimum
requirements are not met (coverage, value and affordability)
• One or more FTEs obtains coverage through a state exchange
and receives a premium tax credit or cost sharing subsidy
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*Full-Time Equivalents: individual(s), not treated as full-time employees, who in combination are counted as a full-time
employee based on number of hours worked during a fixed time period

10. • Consider controlled group status
• FTE calculation is performed on
month-by-month basis and
requires following data:
– Employment Status (full-time,
part-time or seasonal)
– Hire Date
– Hours Worked
• Ongoing Data Tracking:
– Hours and status for all
employees to determine
coverage eligibility
– FTEs for purposes of
determining eligibility for
coverage
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11. 60% of minimum
essential benefits costs
covered by the plan*
Not to exceed 9.5% of
household income
*Actuarial plan value
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12. • Do you offer health insurance?
• Does your health insurance offering meet the minimum
value and affordability requirements?
• How many full-time employees do you have under the
new health care reform calculation?
• Do you think any of your full-time employees will receive
a subsidy for state exchange coverage?
• What is your exposure to play or pay penalties?
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13. • 50 FTEs (including FTEQs)
• ≠ MEC
A. 1 FTE goes to exchange
B. 1 FTE gets subsidy
C. Penalty on employer is triggered
D. (50 – 30) x $2,000 = $40,000
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*Minimum Essential Coverage: defined under HCR as (i) an employer-sponsored group
health plan, (ii) certain government programs such as Medicare, Medicaid, CHIP and
TRICARE, (iii) an individual policy

14. • 50 FTEs (including FTEQs)
• Offers Coverage
• ≠ Minimum Value
• ≠ Affordable
A. 10 FTEs go to exchange
B. 5 FTEs get subsidies
C. Penalty on employer is triggered
D. 5 x $3,000 = $15,000
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15. Individual Mandate
Employer Shared Responsibility (Play or Pay)
Reporting
Costs, Taxes & Fees
State Exchanges
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16. • Number of full-time employees (FTEs) employed each month
• Name, address and Taxpayer Identification Number of each FTE
during calendar year and months (if any) when employee (and
dependents) were covered under health plans
• Length of any waiting periods
• Certify coverage offered to FTEs and dependents
• Months employer sponsored plan was available
• Monthly premium for the lowest cost options
• Employer’s share of the total allowed costs of benefits
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17. • State/Local Reporting
• State Exchange Reporting
• Employment and Plan Offering Verifications
• Penalty Appeals
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18. • Are you prepared to comply with existing or future
reporting requirements?
• Are your payroll processing, benefits administration and
HR services managed by multiple systems and/or
vendors?
• How will you coordinate the tracking of necessary
information and submit the appropriate reports on a
timely basis?
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19. Individual Mandate
Employer Shared Responsibility (Play or Pay)
Reporting
Costs, Taxes & Fees
State Exchanges
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The Congressional Joint Committee on Taxation recently
identified more than 20 new or increased taxes, totaling
almost $1.1 trillion over the next ten years.
• Nearly double the original 2010 projection
• $25 billion in taxes affecting health insurance costs in 2014

21. Taxes and fees on insurers/health care industry will
increase costs for businesses by 3.5-4% or $400 PEPY*
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*Per Employee Per Year

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• Individual and small market reforms:
- States will heavily regulate small group and individual premiums
- Adjusted community rating will limit pricing variables to age, family
size, geography and tobacco use (some states may further limit
variations or eliminate altogether)
- Other rating factors will be prohibited (e.g., prior claims experience,
health status, gender, industry and duration of coverage)
- Pricing of identical medical plans offered inside & outside of state
exchanges must be the same
• Other requirements affecting costs include:
- Guaranteed issue and renewability
- Maximum deductible levels
- Minimum plan values

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• How will new small group pricing regulations impact your
cost structure?
• How will taxes and fees impact your cost structure?
• How can you modify your plan designs to offset expected
cost increases?
• Should you adjust employee contributions to offset
expected cost increases?
• Can you adjust your product or service prices to cover your
expected cost increases?

24. Individual Mandate
Employer Shared Responsibility (Play or Pay)
Reporting
Costs, Taxes & Fees
State Exchanges
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• State exchanges will be marketplaces for individuals and
small businesses to view, compare and purchase health
insurance
• Creation mandated by HCR
- Open Enrollment - October 1, 2013
- Fully-Operational - January 1, 2014
• Some regulations have yet to be finalized
• Processes, products and pricing still in development

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• Will include 4 levels of medical plans with varying coverage levels (“metal plans”)
• Some state exchanges are expected to initially offer only medical and
Rx coverage
• Full scope of products and pricing for exchanges is not known in all states
at this time
*% of minimum
essential benefits
costs covered by
the plan

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• Subsidies will be available through state exchanges for those
earning up to 400% of federal poverty level (FPL)
- $45,960 for individual, $94,200 for family of 4 (2013 FPL)
- Available only for coverage obtained though exchanges
- Unavailable if employer offers qualified coverage
• Subsidy calculations are complex
- Amounts based on a sliding scale using household
income/age/plan value and phased-out as income
approaches 400% FPL

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• There are two forms of subsidies: Premium Tax Credits &
Cost-Sharing Subsidies, both:
- lower overall cost of health insurance coverage for an
individual/family
- are based on a sliding income scale (those at bottom
receive most assistance, those at top receive least)
- are pegged to Silver Plans in the State Exchanges

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Federally
Facilitated
Exchanges (26)
State Based
Exchanges (18)
Partnership
Exchanges (7)

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• Employers relying on state exchanges for employee medical
coverage may be disadvantaged against competitors who attract and
retain top talent through a comprehensive benefits strategy
• State exchange medical plans may be viewed as a lower quality
solution because many believe the exchanges were developed to
serve the uninsured and underinsured
• State exchanges may not provide a consistent health insurance
solution for employees across multiple states
• State exchange products may initially be limited to medical and Rx
only, requiring you to seek other solutions for ancillary insurance
products (e.g., dental, vision, life, etc.)

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COMPLEXITY: Reduce administrative burdens through a dedicated
service team & best-in-class IT infrastructure
COMPLIANCE: Minimize risk of fines & penalties through continuous
monitoring of changing federal & state regulations
COSTS: Stabilize health care costs through our fully-insured health plan
and its low cost structure

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The information provided in this communication is for educational and informational purposes only, and is not legal advice.
IRS Circular 230 Disclaimer: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. federal
tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be
used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to
another party any transaction or matter addressed herein. You should seek advice based on your particular circumstances from
an independent tax advisor with respect to any federal tax transaction or matter addressed herein.