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PPACA Certification Course Modules

Module I - Implementing Healthcare Reform - Overview and Politics of PPACA

After attending this lecture, the student will understand the key components of PPACA and be better prepared to counsel his or her clients on upcoming required healthcare changes and the options that will be available. An overview of regulations already issued will be presented along with an explanation of how the market is likely to change over the next few years. Students will be able to develop client specific timelines and give advice to guide clients in planning for the future. The student will also have the ability to discuss components still pending and the possible implications these components will have on employers.

Module II - Grandfathered Plans and Small-Business Tax Credit

This lecture introduces the concept of grandfathering to participants, paying close attention to the precautions necessary to remain grandfathered, the impact on losing grandfathered status on various mandates, the requirements that impact all plans and updates on the latest guidance provided by the Departments of HHS, Treasury and Labor. This module also provides insight into the small-business tax credit, along with practical advice on how to prepare employers for the decision-making process and various impacts of carrier practices vs. group health plan impacts.

Module III - Medicare Part D & PPACA and Non-Discrimination Rules

This lecture will provide an overview of Part D, the annual election period, improving formularies and the impact of PPACA on Medicare, specifically Part D. The Module drills into the details of non-discrimination, giving the student the ability to identify the control group to be considered for non-discrimination purposes. The goal of both sections is to educate the licensed insurance professional and provide the necessary resources enabling the insurance professional to successfully assist their clients. In addition, the Non-Discrimination IRC 105(h) section is meant to enable the insurance professional to run preliminary non-discrimination tests for employers.

Module IV - Patient Protection under PPACA & Changes to Consumer-Directed Health Plans

During this lecture, students will gain an understanding of the direct and indirect impact of PPACA on consumer-directed health insurance products and account-based plans. This will include how the law will change HSAs, FSAs, HRAs and other account-based plan options. In addition, students will be given the timelines necessary to communicate with their clients on upcoming changes to these plans. Further, students will gain a thorough understanding the patient protections that are incorporated into individual and group health plans under the legislation, with specific insight as to some areas which may require additional guidance to the consumer.

Module V - Medical Loss Ratio Requirements and Tax Implications of PPACA

In this lecture, students will learn about PPACA’s medical loss ratio (MLR) provisions and will be able to explain how the new requirements work, how MLR will be calculated and reported, and how the MLR provisions will impact health insurance plans, agents and brokers. Furthermore, students will gain a detailed understanding of how the MLR provisions will impact individuals and employers and the long-term impact the requirements may have on all health insurance markets as well as some of the strategies being used to meet the MLR requirements. In addition, the variety of tax implications of PPACA will be reviewed with a timeline and to whom the taxes apply.

Module VI - W-2 Reporting, Summary of Benefits & Coverage, Waiting Periods, Essential Health Benefits, Rating Methodology, Auto Enrollment, Deductibles & the Class Act

This one-hour lecture will cover who must comply and what must be included in the aggregate cost of applicable employer-sponsored coverage defined as a group health plan to be reported on Form W-2 and what coverage may be excluded. In addition, the details surround the Summary of Benefits & Coverage and Uniform Glossary will be thoroughly identified with the timing and manner of distribution. Finally, you will also learn about deductible limitations, waiting period limitations, essential health benefits and other market reforms, plus the supporting resource information.

Module VII – High Risk Pools, Pre-Existing Conditions, Guaranteed Availability and Renewability, Enrollment Periods and the Individual Mandate

This one-hour lecture reviews high-risk pools and how and if they will continue to exist. The individual mandate, its rules regarding who is exempt and the penalties for no coverage will be identified in detail. The market reforms surrounding guaranteed issue and modified rating will be not only identified, but also discussed with respect to how they are expected to be implemented and the impact they will have on the health insurance industry and consumers.

Module VIII - Health Insurance Exchanges for Individuals and Small Employers

This one-hour lecture will walk you through exchanges that are required as part of the new health reform law. They’re required as part of Section 1301 in the law, which states that every state shall establish an exchange by January 1st, 2014. If a state chooses not to set up an exchange, the law requires that the federal government come into the state and set up a federally operated or federally facilitated exchange on behalf of the state. The differences between a federally facilitated exchange and a state-run exchange will be reviewed. Discussion regarding individuals accessing coverage through the exchange, as envisioned by the health insurance law, and the access for purchasing assistance or premium subsidies will be a key component of this lecture.

Module IX – Employer Mandates

This one-hour lecture covers the employer responsibility provisions of PPACA. Many people call this particular provision the employer mandate provision. This lecture will discuss to which employers these provisions apply and what those employer requirements are. When does an employer have to offer coverage, and when does it not have to offer coverage? If it does offer coverage, what are the rules of the road? And if it does not offer coverage, are there penalties? Finally, we’ll review what generates a penalty.

Module X – PCORI Fees, Transitional Reinsurance Fees and IRC 6055 and 6056 Reporting

This one-hour lecture covers fees and taxes funding ACAs expanded programs and services and who pays those fees. What is most critical in the wide span of rules and plan applicability – what does and does not apply? Calculations - under all of the optional methods for determining the average number of lives the number of covered lives is based on the first months of the calendar year and more discussion on transitional reinsurance and programs. This discussion will cover in detail Internal Revenue reporting for the individual mandate, employer shared responsibility, form facts, notifications and penalties that applies to 1094/1095 reporting forms for taxable years beginning in 2015.