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
1974
1975
1986
1988
1990
1991
1993
1998
1999
2002
2004
2006
Entrust Family
of Companies
EnCore Systems
Professionals, Inc
Claim Adjudication
Software & Consulting
Entrust Agencies
License Holder
EnFormed
Benefit
Communications
Entrust, Inc.
TPA
Entrust Risk
Mgmt. Services
Consulting
Proprietary
Data Warehouse
TPAC Underwriters
Managing General
Underwriter
RX Concepts, LLC
Prescription Plan
Consulting/Risk
Management
Medical Helpline, Inc
PreCert / UR
Case Management
Nurse Triage
What sets Entrust apart…
Alternative
Funding
Methods
Flexible Plan
Design
Insurance Cost
Engineering
(ICE)
Health
Management
Employee
Communication
• 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.
…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 decisionmaking 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 Series
1.
2.
3.
4.
•
RealCare Advantage Series
1.
2.
3.
•
Preventive MEC
Doc MEC
Doc MEC w/Genric Rx
Transitional MEC
Basic MEC
MEC Plus
Essential Value
RealCare Secure Series
1.
2.
3.
4.
Hospital MEC
Patient’s Choice MV HD
Patient’s Choice MV MD
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)