Arthur J. Gallagher & Co. · NYSE:AJG
Arthur J. Gallagher & — Investor Presentation (August 2015)
28 slides from Arthur J. Gallagher &'s investor presentation, August 2015
Slide 1: Annual Enrollment in the Era of Healthcare Reform
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Annual Enrollment in the Era of Healthcare Reform COMPLIANCE CONSULTING | AUGUST 2015 ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ Agenda • New for 2016 under PPACA • Same‐Sex Marriage • Enrollment • Communications • Administr
Slide 2: New in 2016
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 NEW IN 2016 © 2015 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ 3 New in 2016 Employer Shared Responsibility • Began for some employers in 2015 • Begins for other employers in 2016 © 2015 GALLA
Slide 3: New in 2016
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 New in 2016 • Change in threshold for Employer Shared Responsibility penalty – Employers must offer coverage to at least 95% of their full‐time employees in order to avoid a 4980H(a) Employer Shared Responsibility Penalty – Headcount pe
Slide 4: New in 2016: Penalties for reporting failures
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 New in 2016 Penalties for Section 6055 and 6056 reporting failures rise in 2016 Previous Penalty Increased Penalty Failure Amount Amount Failure to file return with IRS or furnish statement to applicable individual in a timely $100 per
Slide 5: New in 2016
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 New in 2016 • Use of look‐back method will likely impact plan eligibility language – Adopt language for definitions • Full‐time employee • Part‐time employee • Variable Hour employee • Seasonal employee • Measurement period • Administra
Slide 6: New in 2016
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 New in 2016 • If plan does not have minimum value and meet federal poverty line safe harbor for affordability, employees must have an annual opportunity to accept or waive coverage – Minimum value = 60% value – FPL safe harbor • The off
Slide 7: New in 2016
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 New in 2016 • Plans losing grandfathered status, “older” PPACA requirements that will apply: – Preventive care at 100% (includes contraceptives) – Patient protections – selection of PCP, access to routine OB/GYN care, emergency room cov
Slide 8: New in 2016
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 New in 2016 • Religious‐Affiliated Nonprofit Employers (“eligible organizations”) – e.g. hospitals, universities – non‐ grandfathered – Accommodation for contraceptive coverage • Four criteria to qualify • Carrier must provide if insure
Slide 9: New in 2016
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 New in 2016 • Expansion of definition of “small employer” – Until 2016, the state definition of small employer applies That’s typically 1‐50 full‐time employees – In 2016, the definition of small employer automatically changes to 1‐100
Slide 10: Same-Sex Marriage
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Same-Sex Marriage • Supreme Court Decision – On June 26 , in the case of Obergefell v. Hodges, the th United States Supreme Court ruled, in a 5‐4 decision, that based on language in the United States Constitution, a state cannot refuse
Slide 11: Same-Sex Marriage
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Same-Sex Marriage • Requesting marriage certificate – Treat the same as opposite sex spouses • Imputed income – Windsor removed requirement to impute income for federal income tax purposes – Should no longer have to impute income for st
Slide 12: Enrollment Rules
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 ENROLLMENT RULES © 2015 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ 23 Enrollment • New Permitted Status Change Events – Marketplace special enrollment – Marketplace open enrollment 11/1/15‐ 1
Slide 13: Enrollment
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Enrollment • Important element in design • Annually review & communicate • Three sets of rules: – Federal – Insurer – Employer Automatic enrollment still delayed pending regulations. © 2015 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GAL
Slide 14: Communications
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Communications • Active employees • Modified enrollment materials for: – COBRA qualified beneficiaries – QMCSO(NMSN)* alternate recipients – Employees on leave (e.g., FMLA) • Beneficiaries (e.g., spouse and children) for SBC if a differ
Slide 15: Communications
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Communications • All Health Plans – Summary of Benefits & Coverage (SBC) • Content and format specified by regulations • Be sure to use the current year template – Must include statement that plan does/does not provide “minimum value” (
Slide 16: Communications
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Communications • All Health Plans – Annually Required Notices • Women’s Health & Cancer Rights Act • CHIPRA notice – current model May 2, 2014 • Creditable/noncreditable drug coverage (Part D) – most recent model April 4,2011 • HIPAA No
Slide 17: Communications
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Communications • Some Health Plans – GINA language in Health Risk Assessment – Michelle’s Law notice (if needed) – HIPAA wellness program alternative standard – EEOC Proposed Wellness Regulations © 2015 GALLAGHER BENEFIT SERVICES, INC.
Slide 18: Communications
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Communications • Communication materials – SBC – SMM/SMR/SPD • Communication methods – Electronic – DOL rules apply – Online enrollment – Mail – Hand‐delivery © 2015 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. | BUSINESS
Slide 19: Administration
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Administration • Employer Forms Insurer Forms – Cafeteria plan election − Enrollment form − Beneficiary designation – Waiver form(s) − Evidence of insurability • Medical ‐ special (non‐health coverage) enrollment • Optional coverage lif
Slide 20: Administration
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Administration • Tax Forms •Other Forms (if required) – Older child (after year of 26th birthday) − Birth certificates/adoption – Domestic partner, civil papers union partner − Student status (after 26th birthday) − Michelle’s Law (if a
Slide 21: Administration
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Administration • Data for Section 6056 Reporting to the IRS – Employers name, address, and EIN – Name and phone number for contact person – Calendar year for which the report is being filed – Certification whether employer offered MEC t
Slide 22: Administration
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Administration • Employer Coverage Tool – Employer info – name, EIN, address, phone, e‐mail and contact – General plan info: • Employee, spouse, dependents eligible • Minimum value • Employee contribution for lowest cost option • Antici
Slide 23: Administration
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Administration • Data Collection: – Drug plan reporting – CMS website – within 60 days after plan year begins – Information for Form W‐2 reporting of health coverage cost – Dependent SS#s for CMS reporting (insurer or TPA reports to CMS
Slide 24: Additional Resources
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Administration • Update – Plan Document & SPD – plan changes – Notices • COBRA general (initial notice) • COBRA election notice • Models available on DOL website* – Forms – Procedures *HCTC language may need to be added to model notice
Slide 25: GBS Resources
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 GBS Resources © 2015 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ 49 GBS Resources • Webinars (registration) – A Practical Review of Election Changes • http://ajg.adobeconnect.com/elections_201
Slide 26: GBS Resources
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 GBS Resources • Technical Bulletins – EEOC Issues Proposed Rule on Employer‐Sponsored Wellness Programs ‐ http://ajg.adobeconnect.com/tb_2015_02/ – Supreme Court Rules in Favor of Marriage Equality ‐ http://ajg.adobeconnect.com/tb_2015_
Slide 27: Additional Resources
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 Additional Resources • CHIPRA Model Notice – http://www.dol.gov/ebsa/chipmodelnotice.doc • COBRA Notices – http://www.dol.gov/ebsa/COBRA.html (main) • EBSA’s Interactive Advisor for Health Plans – http://www.dol.gov/elaws/ebsa/health/em
Slide 28: Thank You
Annual Enrollment in the Era of Healthcare Reform ‐ August 2015 THANK YOU ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™ 55 28
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