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1 Download this presentation on InformedOnReform.com under Reform News Welcome to the Cigna Health Care Reform Webinar March 27, 2012

2 PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA) Download this presentation on InformedOnReform.com under Reform News Rolling Out the Summary of Benefits and Coverage March 27,

3 Download this presentation on InformedOnReform.com under Reform News AGENDA Policy and Politics Update Summary of Benefits and Coverage Final Rule Questions Bill Hoagland Vice President Federal Affairs Kathy Vaccaro Vice President Health Care Reform 3

4 Download this presentation on InformedOnReform.com under Reform News HEALTH CARE REFORM: POLICY AND POLITICS An update 4

5 Download this presentation on InformedOnReform.com under Reform News FEDERAL BUDGET Update and outlook 5

6 TOTAL BUDGET SURPLUS/DEFICIT Download this presentation on InformedOnReform.com under Reform News CBO Baseline - Alternative Baseline President s Budget FY Surplus Actual Alternative Projections Deficit Trend Recession as announced by National Bureau of Economic Research 22 Sources: The Budget and Economic Outlook: Fiscal Years 2012 to 2022, CBO, January An Analysis of the President s 2013 Budget, CBO, March

7 Download this presentation on InformedOnReform.com under Reform News BUDGET OUTLOOK FY (In Billions of Dollars % of GDP) President s FY 2013 Budget (CBO Estimated) 2011 Actual 2012 Est 2013 Proj % Annual Receipts 2,303 2,394 2,741 3,105 3,413 3,657 3, % Spending 3,603 3,647 3,717 3,807 3,952 4,186 4, % Deficits % of GDP 1, % 1, % % % % % % NA NA Public Debt % of GDP 10,128 68% 11,427 74% 12,517 79% 13,331 80% 13,982 79% 14,618 78% 15,215 77% + 5.9% Debt Subject Limit* % of GDP 14,747 98% 16, % 17, % 18, % 19, % 20, % 21, % +5.4% Nominal GDP estimated to increase 4.9 % annually Source: CBO, An Analysis of the President s 2013 Budget. March 16,

8 MAJOR COMPONENTS OF FEDERAL EXPENDITURES % of GDP Download this presentation on InformedOnReform.com under Reform News 14% 12% Healthcare 10% 8% 6% Social Security Discretionary Spending 4% 2% Other Mandatory Spending 0% Source: Congressional Budget Office. 8

9 Download this presentation on InformedOnReform.com under Reform News LEGISLATIVE AND REGULATORY OUTLOOK 9

10 Download this presentation on InformedOnReform.com under Reform News 112th CONGRESS: 2nd SESSION LEGISLATIVE UPDATE Select Health Care Legislative Policy Agenda 54 Days House & Senate in Session Concurrently before Elections December 31, 2011: Expiration of AMT, R&E Tax Credits, etc.(continue to expire) February 13 President s FY 2013 Budget submitted February 29 Medicare Payment to Physicians Doc Fix ; payroll tax reduction; long-term unemployment (Extended to December 31) March House Congressional Budget Blueprint (March Medicare Madness) March 21 Repeal IPAB/Malpractice Reform (House passed) Repeal CLASS Act (House passed) Congressional effort Brokers Commissions/MLR repeal or modification Post Election Government Funding FY 2013 (Likely Continuing Resolution Expires) December 31 Expiration 2001, 2003, 2009 and 2010 tax provisions December 31 Doc Fix ; payroll tax reduction; unemployment expiration January 2, 2013 Spending reductions: $1.2 trillion Late 2012 or Early 2013 Debt Limit increase 10

11 Download this presentation on InformedOnReform.com under Reform News February 18, 2012 Jon Berkeley and The Economist Health Care Regulations: 12,260 pages to date. 11

12 Download this presentation on InformedOnReform.com under Reform News JUDICIAL OUTLOOK 12

13 PUBLIC OPINION: INDIVIDUAL MANDATE USA Today/Gallup February 20-21, 2012 Download this presentation on InformedOnReform.com under Reform News Q: Regardless of whether you favor or oppose the health care reform law, do you think the requirement that every American must buy health insurance or pay a fine is constitutional or unconstitutional? % Constitutional % Unconstitutional All Americans Democrats Independents Republicans 6 94 Think health care law good Think health care law bad

14 PUBLIC ATTITUDES ON JUDICIAL MATTERS COMPARED TO SUPREME COURT JUSTICES Higher points on scale connote more conservative ideological position. Public Justices Stevens Sotomayor Ginsburg Souter Breyer O Connor Appointed 2009 Kennedy Active Retired *Justice Kagan appointed in 2010 Replacing Stevens Download this presentation on InformedOnReform.com under Reform News Roberts Alito Scalia Thomas Ideal Point Estimates (95% confidence interval, horizontal line) Notes: Top panel plots density of 1,500 respondents on ideological positions on 10 cases decided between October 2005 and June 2010 contrasted with lower panel that scales the ideological position of each justice, excluding Justice Kagan who was appointed to replace Justice Stevens and did not decide any cases in the 2009/10 term. Unpublished paper: Ideological Proximity and Support for the Supreme Court, Stephen Jessee, The University of Texas and Neil Malhotra, Stanford University. 14

15 Download this presentation on InformedOnReform.com under Reform News POLITICAL SETTING 15

16 VIEWS ON HEALTH REFORM REMAIN DIVIDED Download this presentation on InformedOnReform.com under Reform News Question: As you may know, a health reform bill was signed into law in Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it? 80% Favorable Unfavorable Don't know/refused 60% 40% 46% 40% 44% 42% 48% 50% 41% 35% 45% 43% 49% 40% 44% 42% 42% 42% 40% 41% 50% 48% 46% 41% 44% 46% 43% 44% 43% 41% 43% 42% 41% 42% 42% 42% 39% 41% 51% 34% 44% 43% 44% 43% 41% 42% 37% 37% 41% 40% 20% 14% 14% 10% 14% 12% 11% 15% 18% 18% 9% 8% 13% 18% 14% 12% 15% 17% 16% 15% 19% 17% 19% 15% 19% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Source: Kaiser Family Foundation Health Tracking Polls 16

17 2012 REPUBLICAN CALENDAR AND DELEGATE COUNT 1,144 needed to win nomination PHASE 1 PRE-SUPER TUESDAY (before March 6) PHASE 2 SUPER TUESDAY (March 6) Download this presentation on InformedOnReform.com under Reform News As of March 21: Romney 416; Santorum 170; Gingrich 133; Paul 26; Unbound 304 PHASE 3 POST-SUPER TUESDAY (after March 6) Date Event Delegates Date Event Delegates Date Event Delegates Jan. 3 Iowa Caucus 28 Jan. 10 Jan. 21 New Hampshire Primary South Carolina Primary Jan. 31 Florida Primary 50 Feb Maine Caucus 24 March 6 Alaska Caucus 27 Georgia Primary 76 Idaho Caucus 32 Massachusetts Primary North Dakota Caucus March March April 3, 24 AL, MS, MO, KS, HI, Territories 186 IL, LA, PR 138 CT, DC, DE, MD, NY, PA, RI and WI Primary 329 Feb. 4 Nevada Caucus 28 Feb. 7 Colorado Caucus 36 Minnesota Caucus 40 Ohio Primary 66 Oklahoma Primary 43 Tennessee Primary 58 May 8-29 AR, IN, KY, NC, NE, OR, TX and WV Primary 431 Feb. 28 Arizona Primary 29 Michigan Primary 30 March 3 Washington Caucus 43 Vermont Primary 17 Virginia Primary 49 June 5, 26 CA, MT, NJ, NM, SD and UT Primary 339 TOTAL 345 TOTAL 437 TOTAL 1,426 Source: The Rhodes Vcook Letter, March

18 PRESIDENT OBAMA VS. REPUBLICAN CANDIDATES Real Clear Politics Poll General Election Download this presentation on InformedOnReform.com under Reform News DATE President Obama Republicans SPREAD 3/4-3/ /4-3/ /4-3/ /4-3/

19 POLITICAL ENVIRONMENT 2012 ELECTIONS 33 U.S. SENATE ELECTIONS 23 D AND 10 R Ratings Based on Polls as of February 2012: S=Solid P=Probable L=Lean TU=Toss Up Incumbent Republicans (7) Incumbent Democrats (16) Download this presentation on InformedOnReform.com under Reform News Barrasso (WY) Brown (MA) Corker (TN) Hatch (UT) Lugar (IN) Wicker (MS) Heller (NV) S TU S S P S TU Brown (OH) L Cantwell (WA) P Cardin (MD) S Carper (DE) S Casey (PA) P Feinstein (CA) S Gillibrand (NY) S Klobuchar (MN) S Manchin (WV) TU Menendez (NJ) S McCaskill (MO) TU Nelson (FL) L Sanders (VT) S Stabenow (MI) P Tester (MT) TU Whitehouse (RI) S Retiring Republicans (3) Retiring Democrats (7) Snowe (ME) TU Hutchison (TX) P Kyl (AZ) P Akaka (HI) S Bingaman (NM) TU Conrad (ND) Likely R Nelson (NE) TU Kohl (WI) Lieberman (CT) Webb (VA) TU P TU 7 Republican incumbents 3 Retiring Republicans 16 Democratic incumbents 7 Retiring Democrats No election * Cook Political Report March

20 2012 GUBERNATORIAL RACE RATINGS Governor Lineup (4 Republicans, 8 Democrats) Download this presentation on InformedOnReform.com under Reform News Ratings Based on Polls as of February 2012: S=Solid P=Probable L=Lean TU=Toss Up Nationwide 2012: 29 Republican Governors 20 Democratic Governors 1 Independent Incumbent Republicans (4) Incumbent Democrats (8} Daniels* (IN) P Dalrymple (ND) S Herbert (UT) S Walker (WI) TU Markell (DE) S Shumlin (VT) P Gregoire* (WA) L Lynch* (NH) TU Tomblin (WV) L Nixon (MO) TU Schweitzer* (MT) TU Perdue (NC)* L Republican 3 Republican incumbents 1 Retiring Republican 4 Democratic incumbents 4 Retiring Democrats No election * Cook Political Report March

21 STATE LEGISLATURES 2011/12 Download this presentation on InformedOnReform.com under Reform News Nationwide: 99 State Legislative Chambers 86 Chambers will hold elections in 2012 Game Changer: California State Senate, if Democrats gain 2 seats will have 2/3 rd supermajority. Relative to 2010: Democrat Republican Divided Nonpartisan Down 9 from 2010 Up 11 from 2010 No Change From

22 Download this presentation on InformedOnReform.com under Reform News SUMMARY OF BENEFITS AND COVERAGE (SBC) FINAL RULE Overview Compliance/Logistics Preparation 22

23 Download this presentation on InformedOnReform.com under Reform News OVERVIEW: SUMMARY OF BENEFITS AND COVERAGE Intent Provide individuals and employers with HHS-defined standard information to review plans, compare carriers and make decisions Four-Page Benefit Summaries Coverage Examples Customer Service and Website & Glossary Impact Health insurers, employers and selfinsured group health plans; individual plans Retiree-only, Medicare, Stand-alone Dental/Vision Penalty $1,000 per enrollee for willful noncompliance Effective For plan or policy years and open enrollments, and post enrollment for content changes, beginning on or after September 23, 2012 Challenge Condensed timeline to implement from final rule; Cigna/industry advocated for months 23

24 Download this presentation on InformedOnReform.com under Reform News OVERVIEW: DIFFERENCES BETWEEN NPRM AND FINAL RULE Feature NPRM Final Rule/FAQ Upon Request 7 calendar days 7 business days Coverage Tier SBC required by plan AND coverage tier One SBC permitted showing all coverage tier cost-sharing Appearance Content Delivery 12 point Times New Roman font SBC template verbiage only Must include premium 3 standard coverage examples Electronic delivery permitted and individuals to acknowledge receipt Still 12 point no font specified Must use template, but best efforts allowed for plan terms that can t easily be described consistent with the instructions (e.g., wellness) Premium not required 2 standard coverage examples (more may be added) Acknowledgement not required Effective Date 3/23/12 for all employees 9/23/12 based on open enrollment and plan year 24

25 Download this presentation on InformedOnReform.com under Reform News OVERVIEW: MANDATORY SBC TEMPLATE 25

26 OVERVIEW: MANDATORY SBC TEMPLATE, PAGE 2 Download this presentation on InformedOnReform.com under Reform News 26

27 OVERVIEW: MANDATORY SBC COVERAGE EXAMPLES Download this presentation on InformedOnReform.com under Reform News 27

28 Download this presentation on InformedOnReform.com under Reform News COMPLIANCE/LOGISTICS: TRIGGERS, TIMING AND TO WHOM Who Trigger Timing Requirements Individual Plan Shoppers Upon application or request Within 7 business days Employer Shoppers Upon application or request Within 7 business days New employee Mid-year enrollment With enrollment materials Special Enrollee HIPAA special enrollment event Within 90 days after enrollment Current employee / Individual policyholder Application/ Renewal/Anniversary Active enrollment/manual renewal: With open enrollment materials Passive enrollment/automatic renewal: 30 days prior to first day of policy year 28

29 COMPLIANCE/LOGISTICS: PLAN MODIFICATIONS Download this presentation on InformedOnReform.com under Reform News Modified before first day of plan year SBC had been provided with OE Reissue SBC 29

30 COMPLIANCE/LOGISTICS: DISTRIBUTION EXAMPLES Download this presentation on InformedOnReform.com under Reform News SBC for New Hire/ Special Enrollee? Plan Year: New or Renewal Open Enrollment (OE) Period SBC during OE? Yes No 10/1/12 8/1 to 8/15/12 No 10/1/12 or later 9/23/12 9/30/12 11/1/12 9/1/12 to 9/25/12 No 11/1/12 or later 9/23/12 10/31/12 1/1/13 10/1/12 to 10/25/12 Yes 1/1/13 or later 9/23/12 12/31/12 30

31 COMPLIANCE/LOGISTICS: ROLES AND RESPONSIBILITIES Download this presentation on InformedOnReform.com under Reform News Roles and Responsibilities Responsible for creating and delivering the SBC Liable for penalty Fully insured employers Health insurer and employer Health insurer and employer Can be delegated to one to avoid duplication Self-insured employers The employer or plan administrator The employer or plan administrator Individual / family policies Health insurer Health insurer 31

32 Download this presentation on InformedOnReform.com under Reform News PREPARATION: WHAT CIGNA IS DOING It s a significant work effort but we will be ready. We are: Developing business processes Upgrading systems, as necessary Preparing to support all clients 32

33 Download this presentation on InformedOnReform.com under Reform News PREPARATION: CIGNA S TOOLKIT/SUGGESTIONS FOR YOU Although there is no formal requirement to notify employees, Cigna is developing a toolkit to help you communicate key messages In addition, we suggest you Incorporate SBC into HR/Benefits open enrollment training Integrate SBC with open enrollment materials Help familiarize employees with the SBC through your other communication channels 33

34 NEXT STEPS AND QUESTIONS Download this presentation on InformedOnReform.com under Reform News Visit our website, InformedOnReform.com, or through Cigna.com Today s presentation is posted under Reform News. Our next webinar will take place in May. Topic will be Exchanges. 34

35 "Cigna" is a registered service mark and the "Tree of Life" logo is a service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only. 03/12. Some content provided under license. 35