A service of Maryland Health Benefit Exchange Greater Washington Association of Health Underwriters...
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Transcript of A service of Maryland Health Benefit Exchange Greater Washington Association of Health Underwriters...
A service of Maryland Health Benefit Exchange
Greater Washington Association of Health Underwriters
February 13, 2013
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What is a Health Insurance Exchange?
Maryland Health Connection– Individual Consumers– Small Business Health Options Program (SHOP)
Large Employer Implications
The Role of Producers
Implementation Update
Ways to Get Involved
Today’s Agenda
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The Patient Protection and Affordable Care Act requires each state to establish
a “health insurance exchange” by 2014
A marketplace where individuals and small businesses explore, compare and
enroll in private health insurance and public assistance programs, as well as
access federal tax credits and cost-sharing subsidies
States had a choice to establish a state-based exchange, join a partnership or
the federally-facilitated exchange; Maryland opted to establish a state-based
health insurance exchange
What it is NOT:
The state-based health insurance exchange is NOT an insurer or issuer of health insurance plans.
What is a State-Based Health Insurance Exchange?
Why It’s Important to Maryland
Expands access to health insurance for 730,000 Marylanders (13% of Maryland) currently without health insurance– Gives individuals access to primary care physicians,
preventive services
Provides federal subsidies for individuals up to 400% of FPL to pay for health insurance premiums– Infuses $600 million in federal subsidies into the State of
Maryland by 2015 NEW funds in health care system
Lowers uncompensated care costs in the healthcare system
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Guiding Principles
Informed by public input seven principles guide the policy decisions of MHBE to ensure that the state-based health insurance exchange serves the health care needs of Maryland individuals, families, employers and employees:
Accessibility: reduce the number of Marylanders without health insurance and improve access for all Marylanders.
Affordability: the affordability of coverage, within the Exchange and within the state, is essential to improving Maryland’s health care system and economy.
Sustainability: The Exchange will need to be sustainable in order to succeed in the long run.
Stability: promote solutions that respect existing strengths of our state’s health care system and promote stability
Health Equity: The Exchange should work to address longstanding, unjust disparities in health access and health outcomes in Maryland.
Flexibility: be nimble and flexible in responding to the quickly changing insurance market, health care delivery system, and general economic conditions in Maryland, while being sensitive and responsive to consumer demands.
Transparency: MHBE is accountable to the public, and its activities should be transparent, its services easily available, and its information easily understandable by the populations it assists
Maryland Health Connection – a service of the Maryland Health Benefit Exchange
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Maryland Health Connection is the name for Maryland’s health insurance marketplace
Maryland Health Connection is a marketplace where individuals, families and small businesses can:– Compare health insurance options – Calculate total out-of-pocket costs based on eligible subsidies or tax
credits– Enroll in the health plan that’s best suited for their needs
Maryland Health Connection will have many assistance resources for consumers and small businesses:– MarylandHealthConnection.gov: the eligibility and enrollment portal– In-person assistance through navigators and insurance producers– Consolidated Services Center
What is the Maryland Health Connection?
Individuals & Families
Maryland Health Connection – Individuals & Families
One single entry point for commercial insurance and Medicaid– No wrong door approach
Offers tax subsidies and cost sharing reductions to individuals and families – Only place individuals can access subsidies– Federal government will pay a portion of costs for health
insurance for people who earn up to 400% of FPL– Cost sharing reductions are available to individuals under
250% of FPL
Open Enrollment Period Begins: Oct. 2013
Coverage Effective: Jan. 2014
Small Business Health Options Program (SHOP)
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Small Businesses Health Options Program (SHOP)
Maryland Health Connection will have a Small Business Health Options Program (SHOP) dedicated portal for small businesses and their employees
Small businesses (including non-profits) with up to 50 employees may participate
In 2016, the ACA modifies the definition of small group to 100 employees
SHOP supports the existing market (does not replace it), small employers will still be able to purchase insurance outside of the SHOP
Carriers above a minimum threshold must offer products in the SHOP
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Why Consider the SHOP?
Tax Credits for Health Insurance will only be available through MarylandHealthConnection.gov beginning October 1, 2013
Employer Benefits– Innovative plan options that are easy to administer– Access to tax credits to offset the cost of employee premiums– Employee choice model– Ability to work with producers and third party administrators
Employee Benefits– A wider choice of plans that suit their individual needs– Online enrollment– Ability to manage their accounts online
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SHOP Plan Set-Up & Enrollment
Employer Plan Set-up
Estimated Quote
Employee Enrollment
Eligibility Determination
Validate Group
Notify Carriers
Employer is evaluated for eligibility to purchase QHP based on demographic information
Employer selects a metal level (Employee Choice) or a carrier (Employer Choice) and sets defined contribution amount; can designate a producer
SHOP provides an estimated quote based on employer choices and employee census (age, income, etc.)
Employees make plan selections with information on employer contribution and their expected cost
Validate that all requirements for the employer (e.g. minimum participation, creditable coverage for employees) have been met
Notify carriers to contract with employer and start coverage for employees
SHOP Administration• Premium aggregation and billing• Carrier payment• On-going eligibility / enrollment management
(employee adds, deletes, life changes, etc.)• Enrollment and funds flow reconciliation
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Two Options for Small Employers:Employer vs. Employee Choice
Employee Choice
Em
plo
yer Ch
oice
Gold
Silver
Bronze
Platinum
CarrierA
CarrierB
CarrierC
CarrierD
CarrierE
CarrierF
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Counting Methodology Comparisons
The employee counting methodology impacts whether a group will be eligible to purchase on the SHOP
The Maryland Exchange Board approved the FTE aggregation method consistent with federal rules for tax subsidies
Employers can decide whether to offer coverage to full time employees only or all employees
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2010-2013: Maximum tax credit for small employers is 35% of the qualified premium for health insurance for employees– Maximum tax credit for small tax-exempt employers
(charities) is 25%
January 1, 2014, rate increases to:– 50% tax credit for small employers– 35% for small tax-exempt employers (charities)
Tax Credit Eligibility– Fewer than 25 full-time equivalents, with average
wages of less than $50,000 per year– Provide 50% of single (not family) coverage for each
employee– Calculations are made on a sliding scale– Tool available on IRS website
Small Business Tax Credit
Large Employers
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Large Employers
Must offer coverage to their employees– Must meet minimum essential value– Cannot be less than 60% actuarial value– Cannot be more than 9.5% of employee’s income
If coverage isn’t offered and 1 person gets subsidies– Will be assessed $2000 for each FTE over 30 employees
If offer coverage but fails the tests above and 1 person gets assistance– Will be assessed $3000 per assisted employee or $2000
for all employees over 30 – whichever is less
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MHBE Role in Large Groups
Maryland Health Connection must report all individuals receiving subsidies to federal government through hub
Maryland Health Connection will capture employer information during enrollment process– Anyone eligible for coverage through employer?– Anyone currently enrolled through employer?– Employer group plan information
• Employer name• EIN• FTE status• Address• Lowest cost plan• Employee contribution for self-only coverage• Frequency of contribution
The Role of Producers
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MHBE expects to have multiple resources available for consumers who need assistance with understanding insurance options. – Outreach and Education
• Advertising• Events and Business Outreach
– Online at www.MarylandHealthConnection.gov
– In Person & Telephonic Assistance: • Producers• Connector Entities/Navigators• Call Center
Consumer Assistance
The Role of Producers
Maryland has designed a prominent role for producers as it works to create Maryland Health Connection.
Producers will be key partners to help individuals and small businesses get access to plans offered on Maryland Health Connection.
MHBE is designing a Producer Services Program to ensure producers receive information and can provide input. – Communication Tools– Training & Authorization Program – Producer Advisory Council
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Producer Input
Council members will be asked to comment on:– Strategies to maximize the participation of producers– Strategies to educate small businesses and develop
outreach tactics– Content for producer training– Authorization procedures for selling exchange plans– Marketing tools for producers– Support services for producers
Producer Advisory Council
Implementation Update
25
What’s Next?
Federal Certification: Maryland Received Conditional Certification on December 10, 2012 (among 1st six states)
Continued development of IT system
Staffing MHBE– Producer Services Manager– TPA Services Manager
Outreach & Education: Q2 2013
Consolidated Services Center (Call Center): July 2013
Producer Training: Starting mid-late July 2013
Open Enrollment: October 1, 2013 - March 31, 2014
Ways to Get Involved Now!
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Online Resources
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Sign Up for Email Updates
Sign Up for Text Updates: Text “Connected” to 69302
Get information on insurance resources available to help now
Link to details on meetings and reports
MarylandHealthConnection.gov
MarylandHBE.com
Meeting Information
RFP Announcements
Job Information
For questions on the information contained in this presentation,
please contact:
Tequila Terry
Director, Plan & Partner Management
Maryland Health Benefit Exchange
Email: [email protected]
www.MarylandHealthConnection.gov
Thank you!
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