Transcript Noise Paper - Rocky Mountain Administrators

Who We Are


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Formed in 2010 by Luanne Gentilini and Preston
Bostrom.
Based in Worland, Wyoming with an office in
Baker, Montana.
Mission statement: “To provide exceptional service
to our clients and their employees while
responding quickly and efficiently to the ever
changing healthcare payer environment.”
PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com
The Affordable Care Act
The Road So far:
2010
Temporary high risk pool
Early retiree reinsurance program
(ERRP)
Small Business Tax Credit
Adult child coverage until age 26
No pre-existing conditions for
children until age 19
Rescissions prohibited except for
fraud or non-payment
Lifetime dollar limits prohibited
Annual dollar limits restricted
Preventive services with no cost
sharing*
Pediatricians as PCP’s direct
access to OB/GYN’s *
ER coverage as in-network – no
prior authorization *
Initial appeals review standards *
Medicare Part D rebate
Online consumer information at
healthcare.gov
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2011
Annual rate review process
Appeals ombudsman and
process documentation*
Medical loss ratio: 85% for large
group, 80% for small group and
individuals
HSA/HRA/FSA: limitation for
OTC medications
Increase penalty for non-qualified
HAS withdrawals
Small business wellness grants
Annual fee on pharmaceutical
manufactures begins
Discounts on Medicare Part D
“donut hole”
Non-discrimination rules apply to
insurance plans (implementation
delayed until regulations are
released) *
Auto-enrollment for groups with
200+ Full-time employees
(implementation delayed until
regulations are released)
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2012
Appeals provision fully
implemented *
Uniform explanation of coverage
and standard definitions
60 day advance notice of
materials modification
Accountable Care
Organization requirements
Quality bonus begins for
Medicare Advantage plans
Patient –Centered Outcomes
Research Institute (PCORI) fee
($1.00 per member per year)
Administration simplification
begins
Expanded women’s preventive
care services
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PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com
2013
Employee notification of
access to Exchanges
Employer’s to report value of
employer-sponsored health
benefits on W2’s
FSA contributions limited to
$2,500
High earner tax begins
Annual fee on medical device
sales begins
Deduction for expenses
allocable to the Part D subsidy
for qualified prescription drug
plans eliminated
PCORI fee increases to $2.00
per member per year
ICD – 10 code adoption
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The Affordable Care Act
Now and On The Way:
2014
2015 and Beyond
Health benefit exchanges
States can open Exchange to CHIP eligible - 2015
Guarantee issue and renewal rules *
and to all employer - 2017
No annual limits
High value plan excise tax begins – 2018
No pre-existing condition exclusions
Insurance industry tax through 2018
Rating restrictions *
Medicare Part D “donut hole” closed by 2020
Individual & employer mandates
Tax credits and subsidies for individuals and small
employers
Standardized essential health benefits
Waiting period limitations
Mandatory coverage for clinical trials *
Annual insurance industry tax
Out-of-pocket limits must comply with out-of-pocket
Limits for HSA qualified plans *
Deductible caps cannot exceed $2,000 per individual
and $4,000 family *
Coverage for all adult children until age 26 including
those that have employer coverage (formerly not
covered for grandfathered plans)
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*applies to grandfathered plans
Note: Some provisions apply to fully insured business
PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com
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PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com
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PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com
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PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com
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PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com
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PO Box 788, Worland, WY. 82401 Phone: 307-347-2606/1-800-383-8808
Fax: 307-347-2646
www.rockymuntainadministrators.com