Affordable Care Act Tax Reduction Solutions

September 2013

Affordable Care Act Tax Reduction Solutions

September 2013

Who is Entrust?

• One of the first Third Party Administrator’s licensed after the passage of ERISA in 1974 with corporate headquarters located in Houston, Texas.

• Considered as one of the top Third Party Administrators (TPA) among its peers and selected to sit on the Board of Directors of the National and Texas professional associations.

• Commonly sought after to speak nationally at professional associations, legislative functions and industry roundtables.

• Authors of a nationally-recognized “white paper” on restructuring universal healthcare financing in America.

• Texas Governor Rick Perry Appoints Robyn Jacobson, COO of Entrust to new Texas Health Institute in 2012 and 2013

About Entrust…

• Over thirty years of serving clients and plan participants nationwide, with literally thousands of plans on their proprietary system.

• A focus on a high-level “concierge” approach to serving customer service needs while providing accurate and timely claim payments

• Dedicated Account Management to satisfy the on-going needs of any group.

• Prepared with a seasoned staff that is innovative, creative, professional, and focused on personalized service.

Partial List of Entrust Professional Service's…

• Plan Design – PPO, Medicare Allowable Open Access, Cash Payment, RealCare Series

• Compliance Services and Training – ACA Compliance Services, HIPAA, COBRA, MED Part D, W2 Reporting, HITECCH Act, The Children’s Health Insurance Program Reauthorization Act of 2009, etc…..

• Actuarial Risk Management Services

• Re-insurance Selection and Pre-Underwriting

• Benefit Videos, Employee Communication Tools, and Web Claim Portal

Professional Service's Continued…

• Data Warehouse Analysis and Plan Forecasting

• Patient Support Services

• Employee Benefit Plan Trust Accounting

• Enrollment and Automated Premium Collection Services

• Consolidated Billing (Transamerica Products)

• Capitated Rx Program and PBM Coordination

• Plan Modeling Capabilities

Entrust Family of Companies

Entrust, Inc.TPA

Entrust RiskMgmt. Services

Consulting

Entrust AgenciesLicense Holder

EnCore Systems Professionals, IncClaim Adjudication

Software & Consulting

TPAC UnderwritersManaging General

Underwriter

RX Concepts, LLCPrescription PlanConsulting/Risk

Management

Medical Helpline, IncPreCert / UR

Case ManagementNurse Triage

Entrust Family of Companies

1975 1986 1988 1990 1993 1998 1999 2002 2004 20061974 1991

Proprietary Data Warehouse

EnFormedBenefit

Communications

What sets Entrust apart…

• Our ability to assist employer groups to maximize cost savings through the use of our Signature concepts in plan design and plan management while focusing on the goals and budget objectives of our clients.

Alternative FundingMethods

Insurance CostEngineering

(ICE)

Employee Communicatio

n

HealthManagement

Flexible PlanDesign

…State-of-the-Art Technology

Reporting Capabilities

• Budget Analysis and Reporting

• Full Trust Accounting and Reporting

• Plan Utilization Analysis

• Benchmark Analysis

• Custom Analytics

…Reporting

• Plan analysis reports are provided to the client quarterly.

• Allows the client to be involved in the financial performance of the plan throughout the year, not solely at renewal.

• Data analysis allows for easy decision-making on plan design alternatives.

The Entrust Professional Advantage

• The Society of Professional Benefit Administrators (SPBA)- COO is 2012 Chairman of the Board Directors & active members since inception

• Texas Association of Benefit Administrators (TABA)– 2012 Immediate Past President & Legislative & Transparency Task Force Chair

• Select MGU’s – That have an understanding of underwriting for our Signature concepts and plan designs.

• EnCore Systems Professionals – Number one rated claims processing system with over 2.5 million lives

The Self-Insured ERISA Plan & ACA

• Self-insured plans do not have to cover all Essential Health Benefits

• Self-insured plans do not have to comply with deductible cost sharing limits. (They must comply with co-insurance cost sharing limits.)

• Self-insured plans preempt state mandates; which makes it convenient to write employer groups with multi-state employees

Entrust and the RealCare Series – REAL Solutions for the Affordable Care Act!

• RealCare Essential Series1. Preventive MEC

2. Doc MEC

3. Doc MEC w/Genric Rx

4. Transitional MEC

• RealCare Advantage Series1. Basic MEC

2. MEC Plus

3. Essential Value

• RealCare Secure Series1. Hospital MEC

2. Patient’s Choice MV HD

3. Patient’s Choice MV MD

4. Patient’s Choice MV PP

…Funding Method Concepts

Self funding strategies with the opportunity for building reserves

• Traditional Specific and Aggregate Contracts

• Spaggregate

• Capitated Risk Carve Outs– RX– Behavioral Health/EAP– Transplants

Compliance/Legal Services

• COBRA

• American Recovery and Reinvestment Act of 2009 (ARRA)

• Paul Wellstone and Pete Dominci Mental Health Parity & Addiction Equity Act of 2008

• The Children’s Health Insurance Program Reauthorization Act of 2009

• Michelle’s Law

• Genetic Information Non-Discrimination Act (GINA)

• New HIPAA Privacy and Security Rules, including HITECH ACT

• Compensation and Fee Disclosure Regulations

• CMS Section 111 Mandatory Reporting

• Never Events

• Texas House Bill 2015

• Texas House Bill 620

ACA Management Services

• Employer Gap Analysis – Pay or Play

• Enrollment/Waiver Maintenance

• PCORI Fee Report – Patient Centered Outcomes Research Institute

• IRS 720 Form (Quarterly Excise Tax)

• Re-insurance Fee Report

• Exchange Notices – Information Forms

• IRS 6055 & 6056 (TBD)