TEST

1. Partnership for Solutions to Health Care Reform
• June 2013

2. 1July 2, 2013
2014
Implementation of the
Affordable Care Act

3. 2July 2, 2013
Shared Responsibility for Access
•
2
2014
Individual
Mandate
Exchanges
Tax Credits
and
Subsidies
Employer
Penalty

4. 3July 2, 2013
2014 Market Reforms
 Fundamental Shift in the Pricing Models for Individual and Small
Market(<50)
 No Medical Underwriting
 Pricing Based on Geography, Age(3-1), Tobacco(1.5-1)
 Pricing Changes will proceed even if Public Exchanges not ready
 Individuals will have Access to Options across multiple Carriers
 How will the Availability of Coverage Shift the “Social Contract”
employers have historically entered into with employees for providing
health care?

5. 4July 2, 2013
Individual Mandate
 U.S. citizens and legal residents must have health insurance
(minimum essential coverage) or pay a tax
 Tax is the greater of:
• 2014: $95 per adult ($285/family) or 1% household income
• 2015: $325 per adult ($975/family) or 2% household income
• 2016: $695 per adult ($2,085/family) or 2.5% household
income (adjusted for inflation after 2016)
 Tax will not exceed national average cost of Bronze level coverage
 Exceptions include:
• Religious beliefs, undocumented workers, financial hardship
Is the penalty strong enough to move the needle?
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6. 5July 2, 2013
Employer Options
Engagement
Large Employers attempt to reduce unit cost and consumption
OR
Defined Contribution
Cap employer contributions and push cost changes to employees
OR
Disengagement
Push employees into Public Exchanges. Shift in Employer “Social
Contract” creating new buyers in the Marketplace
USI Affinity can deliver the Solutions for all Realtors

7. 6July 2, 2013
Public Exchanges
 Marketplace for individuals and small businesses to shop for private
health insurance coverage
 Pennsylvania and many other states have opted not to operate a
Public Exchange at this time
 Pennsylvania Public Exchange will be operated by Federal
Government
 HHS confirms Public Exchanges will work with Brokers
 Realtors enrolling in the Public Exchanges can be serviced by USI
Affinity
6

8. 7July 2, 2013
Public Exchanges
 Public exchanges will offer community rated metallic plans that will
be tightly regulated and priced.
 Qualified health plans sold through the Exchange and off Exchange
• Provide essential benefits
• The “metallic” plans: Bronze (60%) – Silver (70%) – Gold
(80%) – Platinum (90%)
 Subsidies available for qualified individuals and Tax credits for
qualified small employers
 Initial enrollment period to begin October 1, 2013 (must enroll by
December 22, 2013 for January 1, 2014 coverage)
• Will Federal Exchanges be Ready?
• Portion of SHOP Exchanges Delayed until 2015

9. 8July 2, 2013
Federal Poverty Level 2012
Persons in
family/household 100% FPL 400% FPL
1 $11,170 $44,680
2 $15,130 $60,520
3 $19,090 $76,360
4 $23,050 $92,200
5 $27,010 $108,040
6 $30,970 $123,880
7 $34,930 $139,720
8 $38,890 $155,560
For families/households with more than 8 persons,
add $3,960 for each additional person
8
2012 FPL for 48 Contiguous States and District of Columbia. Dept. of Health and Human Services
http://aspe.hhs.gov/poverty/12poverty.shtml (as visited 11.7.12). See website for information on Alaska and Hawaii.

10. 9July 2, 2013
Premium Tax Credit
 Government pays some of the
premium for Exchange-based
coverage
• sliding scale depending on income
• based on silver coverage
 Available to individuals between
100%-400% of FPL who:
• are not eligible for minimum
essential coverage or
• are eligible for minimum essential
coverage through an employer, but
that coverage is unaffordable or does
not provide a minimum value
 Small Employer Tax Credits
Available in SHOP Exchange
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Triggers the Employer
Penalty
Household
Income FPL
Initial Premium
Percentage
Final Premium
Percentage
Up to 133% 2% 2%
133% up to
150%
3% 4%
150% up to
200%
4% 6.3%
200% up to
250%
6.3% 8.05%
250% up to
300%
8.05% 9.5%
300% up to
400%
9.5% 9.5%

11. 10July 2, 2013
Premium Tax Credit
 Example A
• Mark earns $40,000 a year. He is age 40 and a single adult.
He does not have employer coverage available. Mark’s
household income is 348% of FPL.
• Mark goes to the Exchange. An estimated premium for Silver
coverage is $5,400. Mark must pay 9.5% of his income for
the premium, or $3,800. He will receive a $1,600 subsidy
(covering 30% of the overall premium).
 Example B
– Same as above but Mark makes $20,000 a year (174% of
FPL). Mark will have to pay 5.1% of income on health
insurance coverage. He will pay $1,019 and receive $4,381 in
subsidy.
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12. 11July 2, 2013
Private Exchanges and Market
 Plans offered off Public Exchange will be similar to Public Exchange.
 Must Fit Metallic Plans
 Different Delivery Systems/Networks
 Individual and Group Plan Designs will be Similar
 Individual vs. Group Pricing?
 Medical carriers are rolling out their Defined Contribution Solutions
combination of Paper and online.

13. 12July 2, 2013
Access for Realtors
 Sole Practitioners – Individual Plans
• Public Exchange and Off Exchange
 Groups – 1 to 50
• Public SHOP Exchange – One Carrier, One Plan to Qualify for Tax
Credits
• Traditional Plans or Defined Contribution
 Groups – 50+
• Traditional Plans, Private Exchanges and Self Funding
USI Affinity can deliver the Solutions for all Realtors

14. 13July 2, 2013
Realtors Exchange
 USI Affinity offers Realtors the Access, Advice and Advocacy they need
to save money, prepare for Health Care Reform and get the most of
their benefits.
 Access to Unique Products and Services,
 Advice on Benefits Design, Compliance and Funding Options
 Advocacy to help resolve issues from administration and claims to
complex clinical questions

15. 14July 2, 2013
USI Affinity – Partnership with Realtors
 USI Affinity is currently servicing in excess of $225 Million in Benefits
Premium. This gives USI Affinity the necessary leverage in the
marketplace to deliver solutions to the Realtors.
 Potential to offer Unique Solutions on Carrier Exchange
 USI has invested in a team of ERISA attorneys focused exclusively on
Employee Benefits and Health Reform. This investment is there to bring
your members the most up to date information on Health Care Reform
• USI Affinity field staff is backed up by a paperless call center which
handled more than 20,000 calls in 2012 and is scalable to handle
increased volumes in 2014. The advocacy provided to members will be a
differentiator as competitors move to strictly online solutions. USI
Affinity will offer a balance of technology and personal service.

16. 15July 2, 2013
Questions
855-874-0267
benefits@usiaffinity.com