Overview

Affordable Care Act (ACA) basics
What the ACA means to Salesforce
How the U.S. health care system is flawed
Health Insurance Marketplace—“Exchanges”
What you can do to help keep costs down

Affordable Care Act (ACA) basics

In 2010, President Obama signed into law the Affordable Care Act (ACA), also known as health care reform. While there have been other important laws impacting health insurance over the last four decades, the ACA is the most significant change since the 1970s.

Health care reform addresses some important things in the health care system that, because Salesforce already provides generous medical coverage, you may not have known were missing.

ACA changes the health care system in a number of ways:

  • Everyone can get coverage. You rely on your health insurance, especially when you’re managing a health issue. It might sound strange to you if you’ve been on our plan for a long time, but some Americans were either locked out of buying medical insurance because of an illness or couldn’t get help paying bills related to that illness for a significant period of time. As of January 1, 2014, all Americans can join any medical plan without any exclusions for pre-existing health issues.
  • Everyone must get coverage. Now that the door is open to everyone, there’s no reason not to get coverage. In fact, starting January 1, 2014, everyone must have medical coverage or pay a fine (via a tax). There are regulations on the kind of plan you must have—but all Salesforce’s medical plans meet all regulations. So, as long as you stay in a Salesforce-provided medical plan, you’ll meet the minimum requirements for affordable coverage.
  • No more limits. When you’re really sick, bills can add up. And emotional stress can be really high. That’s why we never cap our share of your bills—as long as you’re still juggling bills, the plan features are still in effect. But now all Americans will have this kind of financial security, too. Specifically, there are no annual or lifetime limits on essential health benefits.

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What the ACA means to Salesforce

While the ACA addresses health care issues, at the same time, this law imposes many new requirements on employers. Health care reform impacts Salesforce in three main ways:

  1. Our plans will be more heavily regulated. Health care reform puts in place many new rules. Some are one-time changes, but others require annual monitoring and administrative duties. Both translate into more resources we must channel toward complying with the rules. In other words, we must divert some resources, which then can’t be spent on employees elsewhere.
  2. We have new costs. New taxes on large employers, as well as indirect taxes levied on insurance companies and medical equipment providers, also mean higher overall costs for our plans.
  3. The health care landscape will keep changing. At the same time that health care reform happened, new companies emerged to help you interact with the health care system in a better way. We believe these shifts will bring new opportunities for us to provide you with more valuable tools and benefits, so we’ll be watching them closely.

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How the U.S. health care system is flawed

Despite offering patients the latest medical breakthroughs and access to world-class technology, our health care system is broken. Why?

  • We require more care. Even with our first-world resources, Americans aren’t that healthy. Many of us—from children to middle-aged adults—have chronic conditions that require regular doctor visits or daily prescriptions. Aging baby boomers, who are more susceptible to injury and illness, make up a large percentage of the overall population, adding to demand for care.
  • Too much care, and not always the right care, is common. The price of a common surgery can vary by thousands of dollars. When prices vary so much, it’s natural to assume that the difference is between services-that-cut-corners and services-that-cover-all-the-bases. But without clear data on the best, most cost-effective treatments, it’s hard for doctors or patients to make good decisions. Experts, including physicians, say some patients receive health care they don’t need.
  • The system is imperfect—in a number of ways. First, most doctors and hospitals are paid in accordance with the volume of services they provide, not necessarily for the quality or outcome produced. So providers are incentivized to give more care, even though much of it is unnecessary. Second, patients don’t always seek care at the most efficient or effective location. The most common example is overuse of the emergency room for routine care. Doctor shortages and too many specialists also contribute to this problem. Third, the people seeking care don’t normally pay the full cost of the care, and instead pay a deductible and/or a copayment or coinsurance. So individuals have little understanding of the actual costs and are insulated when prices rise. And when insurance companies, hospitals, or provider groups consolidate, the normal market forces don’t work to bring down costs like in most other economic sectors.
  • Insurance regulation and tax policy have unintended consequences. As you know, your medical plan contributions are deducted from your paycheck before taxes—a tax break that isn’t available to Americans who buy coverage on their own. This uneven playing field distorts costs. At the same time, the risk of being sued by a patient causes many professionals to practice medicine in a defensive way. Doctors or hospital groups may suggest tests and procedures to protect themselves in case they are sued.

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Health Insurance Marketplace—“Exchanges”

Soon you’ll be seeing more and more information about the health insurance marketplace, also called the “exchange.” The marketplace is intended for people who can’t get affordable coverage through their employer, and also for small businesses. You can shop for health care in the marketplace. Since benefits-eligible employees have access to affordable coverage through Salesforce, you may not find a better deal on the exchange.

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What you can do to help keep costs down

Understanding health care reform will take time. As you learn and think about what the law means to you and your family, your everyday actions matter.

  • Take care of yourself. Participate in Salesforce’s wellness program to get rewarded for getting and staying healthy. Use the Wellness Reimbursement Program for fitness activities, massage, nutritional counseling, smoking cessation programs, and weight management programs. And make sure you and your family members get appropriate preventive care.
  • Develop a strong relationship with your doctor. He or she has your best interests at heart but works in an imperfect system. Here’s what primary doctors wish you knew. On the flip side, does your doctor know about these five overused tests or procedures?
  • Keep learning. Stay curious about ways to better interact with the system. When consumers are better informed, change happens. Explore ways to get the most from your benefits, including saving on medical costs and prescription drugs.
  • Understand your benefits. That’s what www.getsalesforcebenefits.com is all about!

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