Patient Protection and A ffordable C are A ct (Open Enrollment)

1. Patient Protection and Affordable Care Act (Open Enrollment) Presented by Dr. Michael B. Brinkos Assistant Executive Director Operations and Educational Services

2. Requirements of the Law (Open Enrollment) For group health plan coverage, the regulations provide that, for disclosures with respect to participants and beneficiaries who enroll or re-enroll through an open enrollment period (including late enrollees and re-enrollees), the Summary of Benefits and Coverage (SBC) must be provided beginning on the first dayof the first open enrollment period that begins on or after September 23, 2012. For disclosures with respect to participants and beneficiaries who enroll in coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the SBC must be provided beginning on the first day of the first plan year that begins on or after September 23, 2012.

3. Open Enrollment • What Open Enrollment Means: • Period of time when your eligible employees and their eligible dependents have the opportunity to enroll or make changes to their existing coverage. • Enrollment Dates: • May 15ththrough June 15th as set by the ACSHIC.

4. District Considerations in Preparation for Open Enrollment • Review Insurance Plans Offered • Review Eligible Employees • Review Collective Bargaining Agreements / Employment Agreements • Contributions to Health Insurance • Effective Date of Contributions • Plans Offered • Post Retirement Benefits

5. AIU Process Three (3) Stage Process: Stage 1: Notifying employees of the requirements of the law. Stage 2: Providing the information and the Summary of Benefits and Coverage (SBC): • Consistent Appearance • Uniform • Comparison/Decision Making • Sample of SBC Refer to Tabs II and III Stage 3: Implementation of Open Enrollment.

6. Stage One (1): Notification • Notification to all ELIGIBLE employees of the requirements of the law for Open Enrollment. • Example Letter: Refer to Tab IV

7. Stage Two (2): Summary of Benefits and Coverage (SBC) • Review of Summary of Benefits and Coverage (SBC) • Summary of Benefits and Coverage (SBC) needs to be sent to all ELIGIBLE employees. • Mandatory notification per the Affordable Care Act. • http://www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf • Example Letter: Refer to Tab IV

8. Stage Three (3): Implementation of Open Enrollment

9. Conducting Open Enrollment • May 15th through June 15th. Any changes made during Open Enrollment will be effective July 1, 2013. • Example Letter: Refer to Tab IV • During Open Enrollment employees will have the ability to take the following actions: • Current eligible employees can enroll (if not currently enrolled) • Add/Remove Dependents (Requires Documentation) • Change plans, if applicable • Opt out of a plan

10. Qualifying Life Events • Marriage • Documentation – Copy of Marriage Certificate plus one of the following: a Federal Tax Return, Mortgage Statement, Bank Statement, Utility Bill, Rental or Lease Agreement with employee’s and spouse’s names. • Divorce • Documentation – Copy of Divorce Decree • Newly Eligible Dependents (Age 26 or younger) • Documentation – Birth Certificate or Adoption Certificate • Dependents under Age 26 and disabled dependents, may be eligible for insurance. • Loss of Coverage from a Spouse • Documentation – Letter from Spouse’s insurance provider stating the employee and any of the employee’s dependents are no longer covered by their insurance plan.

11. References / FAQ • Department of Labor • http://www.dol.gov/ebsa/faqs/faq-aca8.html