summary & discussion of passed health care reform · 4/1/2010 · 2016. 2017. 2018. nadp...

NADP Member's Internal Use Only / Do Not Distribute 1

Summary & Discussion of Passed Health Care Reform

April 2009April 1, 2010

AgendaNADPs Next Steps: Internal & External Important Provisions for Dental TimelineImminent Issues & Deadlines

Congressional and RegulatoryThreats to the Dental MarketCommitment to Direction

4/1/2010 NADP Member's Internal Use Only / Do Not Distribute 2

NADP Internal Next Steps • Education & Analyses

– News & Background Handouts – Webinar Series specific to HCR & Additional Analyses

(dependent on resources)• Applicability of Market Reforms • Medicaid, Medicare Advantage & CHIP• Large Group vs. Small Group & Individual Market• Exchanges & State Participation• HIT / Administrative Simplification• Taxes / Pay-fors (tax model)• Impact of HCR on Market Trends & Segments


NADP External Next Steps Continue Congressional Lobby EffortsInitiate Federal Regulatory Efforts

Legal Memo: Market Reforms ApplicabilityOperational Memo: Offer of Separate Dental in ExchangesInfluencing Regulations from Dental Perspective


NADP Member's Internal Use Only / Do Not Distribute 5

SenateHELP

Senate Finance

Senate Manager’sAmendment

Health Care Reform: The Sum of Parts

4/1/2010

Important Provisions to Dental• Overview• Taxes• Application of Market Reforms• Impacts on Coverage

– Individuals and Small Groups– Large Groups

• Timeline

NADP Member's Internal Use Only / Do Not Distribute 64/1/2010

Health insurance admin fee

(includes dental)$14.3 billion





High-cost excise tax is established(dental excluded)


(includes dental)$8 billion



2014 2018201720162015

NADP MEMBER INTERNAL USE ONLY: DENTAL BENEFITS UNDER HEALTH CARE REFORM

Timeline of Taxation

PRELIMINARY NOTES1. Applicable to carriers by tiers of “net” premium: <$25 million, $25 to $50 million (50%);

and over $50 million (100%).2. Some exceptions for non‐profits, exempt activities & specified government programs.3. Total to be collected adjusted by the rate of premium growth in future years.


HHS Sec & States Set Review Process for "unreasonable premium increases" (dental

included)

NEW COVERAGE as of Sept 23: "Improving Coverage

REFORMS"No Lifetime Limits*

Restricted Annual Limits for Essential Benefits*

Recission Prohibited*No Cost Sharing for

PreventionQuality Reporting

Dependant Coverage to Age 26*

New Internal/External Appeals Processes

Non‐Discrimination on Salary

Eliminate Pre‐ex for Children*

*Also Applies to Grandfathered Plans

MARKET

REFORMS

2010Determine Applicability of Market

Reforms

Inform Development of Regulations

Lobby for Technical Fix to Stabenow Lincoln

File Rates ‐‐ New Process

Adjust grandfathered Plans & New Coverage to Meet "Improving

Coverage REFORMS"

NADP & Industry

Dental Plans


8


included)











MARKET

REFORMS


ReformsTrack & Disseminate Exchange

Requirements

Influence Development of Regulations

Inform Development of Regs‐‐esp. definition of pediatric dental services


Monitor Changes in HCR and Lobby if Impacting Dental

File Rates ‐‐ New Process File Rates ‐‐ New Process

Adjust grandfathered Plans & NewCoverage to Meet "Improving

Coverage REFORMS"

Develop & file new

products/alliances for 2014 Exchanges & Indi/Sm Group Mkt.

2011

Jan 1‐‐MLR Mandated (85% large group & 80% small group)

By March‐‐Uniform Coverage Explanation & Definitions Set by HHS (consultation with

states)

2011

NADP & Industry

Dental Plans


9


included)











MARKET

REFORMS



Requirements Track & Disseminate Exchange

Requirements

Inform Development of RegulationsInform Development of Regs‐‐esp. definition of pediatric dental services

Inform Development of Regulations


Monitor Changes in HCR and Lobbyif Impacting Dental


File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐ New Process


Coverage REFORMS"

Develop & file new


Complete approval of products for 2014

2011 20122012



states)

NADP & Industry

Dental Plans


10


included)











MARKET

REFORMS





Requirements


Inform Development of Regulations Inform Development of Regulations





File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐Adj for 2014 Admin Tax & Required Child Coverage


Coverage REFORMS"

Develop & file new


Complete approval of products for2014

Train sales force and market new products for 2014

2011 2012 20132013



states)

NADP & Industry

Dental Plans


11


included)











MARKET

REFORMS

COVERAGE

Health Insurance Exchanges Begin Operation

Essential Health Benefit Pkg. (including pediatric oral

health services) Established

Medical Plans to Include EHBP in all Indi/Sm. Group

Coverage

Separate Dental Allowed in Exchanges for Children

GENERAL

REFORMS

Guaranteed Issue & Renewal Required

Rating Restrictions Imposed (allows use of geography, age, tobacco use and

Indi./family within limits)

Excessive Waiting Periods Prohibited (Over 90 days)

Pre‐ex Prohibited

Coverage for Clinical Trials





Requirements Track Impacts of "Essential Health

Benefit Package"


Inform Development of Regulations Inform Development of Regulations Inform Development of Regulations






File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐ New Process File Rates ‐‐Adjust for 2014 AdminTax & Required Child Coverage

File Rates ‐‐ New Process


Coverage REFORMS"

Develop & file new


Complete approval of products for2014

Train sales force and market new products for 2014

Issue certifications of essential coverage

2011 2012 2013 20142014

NADP & Industry

Dental Plans



states)

Applicability to Separate Dental

Coverage for Children in Exchange


Questions


Imminent Dental Issues ‐ CongressAmend the PPACA (HCR bill) to Implement Stabenow-Lincoln Amendment

Separate Coverage Outside the ExchangeDrafting Issues Inside the Exchange

Maintenance of Congressional RelationshipsMonitoring of Other Technical Changes


Imminent Dental Issues - RegulationFederal

Establish dialogue with HHSClarify applicability of Market ReformsEngage in Regulatory Developments

StateNAICState Exchanges

4/1/2010 15NADP Member's Internal Use Only / Do Not Distribute

Threats to Dental MarketThe Price of Inaction on Regulations

All ‘Improving Coverage’ Reforms Could ApplyTechnical drafting issues can result in varied interpretationsImpacts on Operations

Some changes by 9/23/2010Adjustments to policy forms, claims administrationAssumption of expanded financial risk within current premiums


Threats to Dental MarketThe Price of Inaction on Legislation

Small Group/Individual Market Integrates Children’s Dental into Medical Outside the ExchangeOver Time Medical Coverage May Integrate Adult Dental Benefits

Small Group/Individual MarketLarge Group


Threats to the Dental MarketAbdicating NADP Leadership Role

Technical fix retooled to favor a single industry segment or carrierSubcontracting becomes technical fix


Commitment To DirectionA Crossroads• Board Examination of 2010 Budget Impacts

– Developed Alternatives to Maintain NADP as Industry’s Voice & HCR Leader• Congressional• Federal Regulations

– Alternatives Require Voluntary 2010 Contributions• $800 to $4000 Dependent on Dues Category• 17 Members Contributed• 51 Outstanding


Commitment To DirectionDelegate Ballot

Continue Congressional ActivityInfluence Regulatory Implementation2010 Funding CommitmentWebinar Topics


Commitment To DirectionDeveloping Alternatives for 2011 & Beyond

Additional ServicesDetailed Tracking/Comments on Exchanges from Dental PerspectiveContinued Federal Regulatory/Congressional Activity

Dues Restructuring to Support Funding


Questions


Reminders. . .Delegate return ballotWebinar feedbackMonitor NADP e-Community -- HCR Open Forum ‘Inside the Beltway’ discussion thread


summary & discussion of passed health care reform · 4/1/2010 · 2016. 2017. 2018. nadp...

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