The Opportunities

1
The Opportunities Challenges of Health Care
Reform and how it impacts Coaches

• BY AUDREY SNOW

2
How the PPACA is changing the landscape. An
overview

• - Shifting roles for Employers and
  Employees
• - Exchanges
• - Subsidies
• - Mandated Benefits
• - Wellness Incentives (group coverage)
• - Insurance brokers Strategic Partners
• - Think Outside the Box Strategies

3
Ambiguity What happens in Vagueness Stays in
Vagueness

• 2010 Patient Protection Care Affordability Act
  passed 1000 pages
• - Gave HHS powers to establish rules/regs
• - Gave IRS power to tax
• Theres a lot we know and a lot we dont know
  yet about measures of the Reform

4
The Big Shift how Americans are getting their
insurance NOW

• 145 Million Americans get their health insurance
  through their Employers
• 40 Million Americans are covered by Private Plans
• 45 Million are covered by Medicare
• 45 Million are covered through Medicaid
• 40 Million are Uninsured

5
After Health Care Reform 2015 it is predicted
that

• 20 Million will be covered through Employer Group
  plans
• 185 Million will be covered on a Private
  Individual plans
• 47 Million by Medicare
• 45 Million by Medicaid
• 20 Million uninsured

6
Shifting Role of Employer

• Today Selects plan, collects premiums, complies
  w/administrative functions, attracted/retained
  employees
• By 2015 it is predicted that many small to
  mid-size employers wont offer health ins. But
  will put in a Defined Contribution Platform
  instead using HRAs

7
Shifting Role of Employee

• Today No say in Employer plan take it or
  leave it employer deducts premium, few options
• 2014 - Choice of any plan from any insurer, pay
  the insurer directly, more responsibility in
  learning about benefits, options, paperwork

8
PPACA Part 2

• Exchanges, Subsidies, Tax penalties

9
Are you Eligible for a subsidy?

• American Citizen
• Not offered Group Health Insurance
• Earnings less than 400 of Fed Poverty Level
• Must purchase health insurance through State
  Exchange
• 21 page application for insurance
• (63 - 68 of all Americans income level)
• No insurance Tax penalty up to 1 of family
  adjusted gross income

10
Employers /Tax Penalties

• Less than 50 FTE employees no tax penalty
• More than 50 FTEs
• 2000 /3000 tax per employee of if one or
  more employees go to State Exchange and qualify
  for subsidies (the first 30 employees are tax
  free to employer)

11
Big Question for Employers Do I offer group
insurance or not?

• How will it effect my higher compensated
  employees?
• How can I attract and retain employees?
• Prediction under 50 fulltime equivalent
  employees will drop their group coverage
• Larger employers may avoid tax penalties by
  employing less fulltime employees and more part
  time employees

12
Attn Coaches you want to know about this

• Defined Contribution Benefits
• Health Reimbursement Arrangements (HRAs)
• - HRAs provide employers w/ability to
  provide a benefit in the way of funds to help pay
  for non-govt subsidized benefits including
  wellness programs

13
EXCHANGES(a virtual mall)

• Public /Govt /State Exchanges subsidies
• Private Exchanges
• - Insurance Broker
• - Employer
• - Association
• Private exchanges can include wellness programs
  including coaching services

14
Govt Individual Plans

• Metallic Plans
• Platinum 90, Gold 80, Silver 70 and Bronze 60
• Out of pocket limits tied to H.S.A. limits 3350
  single/12700 family next year
• Mandated Benefits (maternity, pediatric
  dental/vision.)

15
Example of subsidys impact

• Employee Family 4 income 55k
• Employer cost of insurance single
• 5400 annual / Cost family 14,000
• Employer pays 50 single 2700
• Employee pays 11,300
• If employer does not offer insurance employee is
  eligible for subsidy of 9865 / if employer does
  offer health insurance employee is eligible for
  0 subsidy

16
Employers Pay or Play

• Decisions Decisions Decisions
• Do I offer health insurance?
• If I do who is it hurting?
• If I dont who is it hurting?
• Loop holes how can I reduce my tax liability?
• How can I recruit /retrain good employees in the
  future?

17
PPACA PART 3

• As a Health Coach whats in it for me?
• Marketing/promotion, positioning, new business

18
Wellness Incentives /Mandated Benefits

• Wellness Driven Benefits
• Preventative Care 100
• 30 - 50 financial incentives for
• voluntarily participating in Wellness
  Programs (Employer group plans, but 10 State
  Exchanges are given the go ahead to include in
  their individual subsidized plans)
• Types of Wellness Programs
• virtual self directed most popular
• Larger Market in house or Wellness Vendor

19
Strategies for Coaches in PrePost Reform

• Presentation by Coach Diane Catrambone
• Presentation by Coach Patty Pavey
• Working with Employer Groups,Wellness
  Organizations,
• Thinking outside the Box marketing strategies
  for coaches

20
Your New Reform Strategic Partner

• Health insurance agents
• - Driving force of health ins.
• - Private Exchanges
• - Health insurance
• - Wellness
• - Other lines of insurance

21
How does PPACA Impact Agents

• More advisory roles
• Lower commissions
• More volume
• Focus on other lines of benefits to help defray
  loss of health insurance income
• Leaving the health insurance market

22
How do I find my new strategic partner?

• National Associations
• - NAHU.org
• State and Local Chapters
• Employers
• Insurance Agencies
• Networking Business Groups
• Payroll Companies
• State Dept of Insurance

23
Educate your strategic partner

• Most health insurance agents have never had the
  privilege of experiencing the power of coaching
  offer to give them a free demo
• Be prepared to explain how your coaching services
  differ from the free stuff embedded in
  insurers plan

24
Help Agents Understand your Value Added Services

• Help Agents Strategize w/their clients
• HRAs
• Lunch Learns
• Benefit Fairs
• Become a Provider in their Exchange
• What are you willing to offer an
• Agent for being a service provider
• in their Exchange
• - monetary compensation
• - discounts

25
Two parties to Change Victims and Beneficiaries

• Opportunities Opportunities Opportunities

26
Whats ChangingEverything!

• Govt will be helping millions pay for health
  insurance
• Employers and Employees Roles are Shifting
• Defined Contribution Benefits will be the new
  way many employers provide benefits
• HRAs provide money to help pay for benefits
• Wellness Programs will provide stronger
  incentives for employees to participate

27
Your new strategic partner insurance
professionals

• Get involved in local Health Underwriters
  Association
• Conduct a Lunch Learn for Agents how Coaches
  can impact their bottom line
• Volunteer to be a health fair participant

28
An Exchange is like an affiliate marketing site
for you

• It will require that your website is set up to
  handle leads and indirect interaction with
  prospects

29
Think Outside the Box

• Distinguish yourself as the go to person for
  Wellness Coaching w/Insurance Professionals
• Create a niche that compliments the free wellness
  programs
• Attend business networking groups meet the
  insurance agents of the group

30
Other Considerations

• An Exchange can be a Private Employer benefit
  plan /tailored to meet that particular employers
  budget and service needs which can include your
  coaching tailored for that employers specific
  needs

31
For more information on PPACA

• www.healthcare.gov
• www.nahu.org
• www.healthreform.kff.org (my favorite)
• www.nrf.org (National Retail Federation)
• www.retailmeansjobs.com/health-care-calculator
  (helps employers will be subj to tax penalties)
• Audreysnow_at_att.net my email address
• 561-523-8021 Audrey Snow
• THANK YOU FOR ATTENDING!!!

32
BONUS MATERIAL

• How to find money for your health coaching
  business through health care reform initiatives

33
PPACA

• The government subsides that will help over 60
  of Americans pay for health insurance
• Section 152 Bonus (Employer incentives)
• HRAs in more detail

34
The 9.5 rule for employers

• Can only charge employees 9.5 of their W2 wage
  of the least expensive group plan they offer for
  single coverage if employee is making less than
  400 of Federal Poverty Limit (FPL) or approx.
  43,560 annual single /89,400 Family of 4 (see
  Addendums 1 and 2)
• This affects employers w/50 Fulltime employees
  who offer group health insurance
• Employees who are charged more than 9.5 of their
  W2 can elect to go to the State Exchange and
  apply for subsidy

35
Why is this important to you as a coach?

• Currently employees may be in a position where
  they pay more than 9.5 of their wages for group
  health insurance this could free up monies to
  help pay for coaching in certain situations
  Esp. for employees who cover dependents

36
The 8 rule

• Individuals who must purchase health insurance
  who have no access to employer group plans and
  whose income is over 400 of FPL will be
  protected as well from paying a tax if the cost
  of health insurance for the Silver Plan (70
  plan) exceeds 8 of their W2

37
Section 152 Bonus Employer strategy

• Employers who want to reward employees can use
  Sect 152 of IRS Code to bonus monies to employees
  this is not new and a strategy that can be
  suggested for key employees for example to
  participate in your coaching program.
• The bonus monies are taxable to employees but a
  tax write-off to employer
• Bonuses can vary by amount and by employee It
  can be discriminatory

38
Health Reimbursement Arrangements more detail

• Employers can provide monies to employees for
  non-govt subsidized benefits amounts can vary
  for job classification
• Coaching services can be a qualified benefit
  however must be recommended by a physician and an
  approved benefit by the employer (would require
  coaches to establish strategic partnerships/allian
  ces w/physicians