View this powerpoint delivered by Roger Kirtley, a Risk Management Advisor with Lyons Companies about the Health Care Reform Legislation. This presentation was given on June 2, 2010 at the Delaware State Chamber of Commerce's End-of-Session Legislative Brunch at Dover Downs.

1. Health Care Reform

2. Market Overview
Average Health Insurance Premiums 1999-2009
$13,375
131%
Premium
Increase
$9,860
$5,791
128% Worker
Contribution
$4,247 Increase
$3,515
$1,543
1999 2009
Note: The average worker contribution and the average employer contribution
Employer Contribution
may not add to the average total premium due to rounding.
Worker Contribution
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009.

3. What is Driving the Costs?
Cost Population
80% 10%
20% 90%

4. What is Driving the Costs?
Cost Population
30% 2%
50% 8%
20% 90%

5. Health Risks
• According to the CDC, chronic diseases are the most
common and costly of all health problems, but they
are also the most preventable.
– Four common, health-damaging, but modifiable behaviors -
tobacco use, insufficient physical activity, poor eating
habits, and excessive alcohol use - are responsible for
much of the illness, disability, and premature death related
to chronic diseases.
• We are doing it to ourselves

6. Changes Effective in 2010
• Increase dependent age to 26
• Elimination of annual and lifetime limits
• Prohibit insurers from rescinding coverage
except in cases of fraud
• Eliminate pre-existing condition exclusions for
children.

7. Changes Effective in 2010 (cont.)
• Require qualified health plans to provide at a
minimum coverage without cost-sharing for
preventative services
– Recommended immunizations, preventative care
for infants, children, and adolescents, and
additional preventative care and screenings for
women.

8. Changes Effective in 2010 (cont.)
• Provide tax credits to small employers with no
more than 25 employees and average annual
wages of less than $50,000 that purchase
health insurance for employees

9. Changes Effective in 2010 (cont.)
• Require health plans to report the proportion of
premium dollars spent on clinical services,
quality and other costs and provide rebates to
consumers for the amount of premium spent on
clinical services and quality that is less than
85% for plans in the large group market and
80% for plans in the individual and small group
markets. (Requirement to report medical loss
ratio effective plan year 2010; requirement to
provide rebates effective 1/1/11)

10. Changes Effective in 2010 (cont.)
• Establish a process for reviewing increases in
health plan premiums and require plans to
justify increases. Require states to report on
trends in premium increases and recommend
whether certain plans should be excluded from
Ex-change based on unjustified premium
increases.

11. Changes Effective in 2011
• Exclude the costs for over-the-counter drugs not
prescribed by a doctor from being reimbursed
through an HRA or health FSA and from being
reimbursed on a tax-free basis through an HSA or
Archer Medical Savings Account.
• Increase the tax on distributions from an HSA or
Archer MSA that are not used for qualified medical
expenses to 20%.
• Employers will be required to report the value of
employee’s health benefits on their W-2s.

12. Changes Effective in 2013
• Limit the amount of contributions to a flexible
spending account for medical expenses to
$2,500 per year increased annually by the cost
of living adjustment.

13. Changes Effective in 2014
• Require US Citizens and legal residents to
have qualifying health coverage (phase-in tax
penalty for those without coverage).
• Assess employers with more than 50
employees that do not offer coverage and have
at least one full-time employee who receives a
premium tax credit a fee of $2,000 per full-time
employee, excluding the first 30 employees
from the assessment.

14. Changes Effective in 2014 (cont.)
• Create state-based American Health Benefits
Exchanges and Small Business Health Options
Program (SHOP) Exchanges, administered by
a governmental agency or non-profit
organization, through which individuals and
small businesses with up to 100 employees
can purchase qualified coverage.

15. QUESTIONS & ANSWERS

16. Lyons Companies
• One of the largest independent brokers in the region
• Full Service Consulting/Insurance Brokerage for
Property & Casualty and Employee Benefits
• Traditional / Alternative Funding / Captive Programs
• Partner in Assurex Global
– Represented by 20,000 professionals in over 500
offices around the globe
• Committed to bringing innovative & strategic solutions
to the marketplace.

17. Health Care Reform
Thank You!
For more information visit
www.lyonsinsurance.com
Roger D. Kirtley
Risk Management Advisor
(302) 472-2955
rkirtley@lyonsinsurance.com