AmeriCorps Coverage and Health Care Reform

Southwest National Service Training Conference

July, 2013

CONTENTS
I. II. III. IV. V. Background The Issue and Goal Current Situation Remaining Challenges Minimum Essential Coverage (MEC)

VI. The Case for Minimum Essential Coverage VII. What Now?
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Background
AmeriCorps Provisions Minimum Coverage Requirements (Full Time Members) Low Front End Cost Sharing Annual deductible - $250 or less 80% Coinsurance (50% mental health and substance abuse exception) No more than $1,000 out-of-pocket maximum Wide Array of Benefits Accident and Sickness Physician, hospital, emergency room, prescriptions, lab & xray

A*C Provisions only require a $50,000 per cause maximum benefit

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Background
Patient Protection and Affordable Care Act (ACA) Lifetime and Annual Limits Prohibition of Lifetime Limits Restrictions on Annual Dollar Limits Essential Health Benefits Overlap with AmeriCorps Provisions Expansion Examples: Preventive Care and Rehab Services Limited Medical Benefits Waiver Applicable to Mini-Meds Prevent Loss of Coverage Temporary Individual Mandate Personal Responsibility/Subsidy/Exchanges
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The Issue & The Goal

Affordability vs. Plan Design

Increased Claim Liability = Increased Premium 28% increase is estimated impact Access/Insurer challenges (No employer/employee relationship)
Goal

Compliance with the Affordable Care Act Affordable coverage for grantees Quality benefits for members Provide Minimum Essential Coverage (MEC) Avoid individual mandate penalty for covered members

Current Situation
Limited Medical Plan Waiver

Temporary Expires in 2014 Limitation on new groups

Short Term Limited Duration Coverage

Not subject to the Affordable Care Act Less than 1 Year (364 day policy period) Non-renewable

Remaining Challenges
The Corps Network Plan Short Term Limited Duration Continuity of Coverage Policy Replacement (2013-2014) not yet approved by DC Logistics Second Term of Service - Enforced Break in Coverage Continuation of Coverage - Virtually Eliminated Suspensions/Term Exceeds 364 Days Coverage Terms on after 364 days Establish Minimum Essential Coverage (MEC) Avoid individual mandate shared responsibility penalty

Minimum Essential Coverage (MEC)

Effective January 1, 2014 What is MEC? - Guidance Government sponsored plan E.g., Medicare, Medicaid, CHIP, Tricare, Peace Corps Employer-sponsored plan Generally, all employer plans except limited medical Individual plan Applicability MEC status prevents the shared responsibility penalty Exceptions e.g., 100% of FPL, <3 months, hardship

Minimum Essential Coverage (MEC)

The Corps Network Strategy 3 Plans to gain MEC status February 1, 2013 Proposed Rule Designates AmeriCorps as MEC (not finalized) Apply direct to HHS for MEC status Change plan design to an ACA compliant structure Maintain similar price point to today ACA Compliant Trade off: Low member cost share vs. catastrophic coverage Remove per cause maximum (no lifetime benefit limit) Increase deductible, out-of-pocket maximum

The Case for MEC

Proven Value of The Corps Network Plan Unique AmeriCorps Factors Mandated coverage Young demographic Limited service duration Program budget constraints Member stipend Evidence 95+% of enrollees have less than $2,000 in claims 99.9% of members do not encounter the $50,000 per cause maximum 2013 benefit increases (with policy approval) Advantage over individual market
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What Now?
Secure Policy Replacement

Compliant with Affordable Care Act Affordable to grantees Adequate for members Gain MEC status Three part plan Educate Americas Service Commissions State Commissions Programs Advocate

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Questions
Chris Rooney Vice President Willis of Seattle 1-800-456-1415 x7428 chris.rooney@willis.com

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