Nevada Health Link

May 15, 2013

Northern Nevada Association of Health Underwriters

Operated by the Silver State Health Insurance Exchange

Agenda 1. What is an online marketplace?

• Elements of the Nevada Health Link web portal

2. Goals of the Exchange

3. Status of Implementation

4. Finance and Sustainability Plan

5. Outreach and Education

6. Tax Implications

What is an online marketplace? • Farmer’s market for health insurance • Web portal

- Select and enroll in health insurance - Aggregate premiums - Determine eligibility for individual tax credit

• Policies to balance: - Needs of consumers/businesses and insurers - Consumer protections and cost

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Snapshot of Sample Portal

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Goals of the Exchange • Increase the number of insured persons in Nevada

• Facilitate the purchase and sale of health insurance

• Assist qualified employers in the enrollment and purchase of health coverage and the application for subsidies for enrollees

• Provide consumer education on matters relating to enrollment in and effective use of health insurance

• Assist residents of Nevada with access to programs, premium assistance tax credits and cost-sharing reductions

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• Nevada has received Conditional Certification from the Secretary of U.S. HHS to operate a State-Based Exchange

• The Exchange Board has approved 35 substantial recommendations of the Advisory Committees

• IT Implementation is on-time: Eligibility Engine (DWSS/Deloitte) and Business Operations Solution (Exchange/Xerox) will meet the October 1, 2013 deadline for operability

• Coordination efforts between the Exchange and Division of Insurance continue to provide a safe and seamless transition for Nevada’s citizens

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Status of the Development and Implementation of Nevada Health Link

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Oct Jan Mar May Jul

= Xerox Team Activity Duration and Name (parenthesis indicate anticipated roles, responsibilities and other descriptions)

IMPLEMENTATION MANAGEMENT

DecNov Feb Apr Jun

INFRASTRUCTURE Production Environments Online

Las Vegas Service Center Buildout and Move-in Complete

SOLUTION – RELEASE A

Release Test (Xerox Team with DWSS, Exchange SME clarification)

SOLUTION – RELEASE BSprints 4 and 5 (same as Release A)

Story Development and System Design (same as Release A)

Release Test (same as Release A)

Las Vegas Service Center Lease Executed

SOLUTION – RELEASE C Requirements and Configuration Sessions (same as Release A)

OPERATIONAL PROCESSES

INTEGRATED VALIDATION

DEPLOYMENT Dry Run v1.0 (Xerox Team in UAT Environment)

Baseline Schedule

Oct Jan Mar May JulDecNov Feb Apr Jun

Portal Dev/Test Environments Online

Release B Processes Release C Processes

Silver State Health Insurance Exchange – BOS Schedule Detail Roadmap – March 7, 2013(Partial View – Contract Start through July 2013)

Roadmap reflects Xerox/BOS Project Schedule as of 3/7/2013; Schedule Roadmap visual aligns with the underlying Schedule Gantt Chart, but there may be summarizations depicted here that do not exactly map to a Gantt Chart task name (for more information, please consult the NV Exchange)

TODAY

Proof of Concept Connection between BOS and DWSS/HCR

Xerox Project Management Plan (Xerox development of narrative/processes, NV Exchange approval)Requirements Validation Review (Joint Xerox/NV Exchange review)

Carson City Project Office CompleteImplementation Plan (Xerox/Exchange – Certification Checklist)

Baseline Infrastructure à UX2014 Look and Feel à Account Creation à BOS/DWSS Interface Standards

Sprints 1, 2 and 3 (Xerox Team with DWSS, Exchange clarification)

Disaster Recovery Environments Online

Core CMS Functions: SHOP à Individual and Family à BOS/DWSS Exchanges à Generic QHPs à Enrollment

Story Development and System Design (same as Release A)

Technical Processes (Service Management, Support Escalation, Operations and Maintenance Manuals)

Core CMS Functions: SHOP à Individual and Family à BOS/DWSS Exchanges à Generic QHPs à Premium Calculator à Billing à IVR à BOS/DOI/Carrier Exchanges

Release A ProcessesBusiness Processes (Release-based/Iterative Service Center Manual, Workflow, and Training Development)

Performance Test (Xerox Team with DWSS, NV Exchange or additional SME clarification)System Integration Test (Xerox Team with DWSS, NV Exchange or additional SME clarification)

Operations Staff UAT/ORT Training and Preparation (includes State staff as needed)

= Complete Green Bar with Green Font indicates activity is complete and milestone is met; if Green Bar is to the right of TODAY line, Activity was completed ahead of schedule= Partial Green indicates Activity is in Progress, but not yet Compete

= Partial Green with Yellow Milestone indicates Activity is in Progress, not Complete and Behind ScheduleRoadmap reflects October 2012 through July 2013 schedule bars to configure to 8 ½” x 11" paper; Arrows at end of bars indicate activities continue past July 2013

Requirements and Configuration Sessions (Joint DWSS, Exchange, Xerox and additional SMEs)Story Development and System Design (Xerox Team with DWSS, Exchange SME clarification)

Requirements and Configuration Sessions (same as Release A)

Sprints 6 and 7 (same as Release A)

Integrated Application and Operations Validation (UAT conducted by State staff with Xerox Team support, ORT conducted by Xerox Team with State staff review)

ININ/Telephony Dev/Test Environment Online

Remaining Functions: QHP Load, Shop and Compare à Consumer Support (CRM, Imaging/Document Repository, Email, Fax, Chat) à Fulfillment à ReportingSOLUTION – RELEASE D Story Development and System Design (same as Release A)

Sprints 8, 9 and 10 (same as Release A)

Release D Processes

User Acceptance Test (UAT conducted by State staff with Xerox Team support)

TIMELINE

TIMELINEFRAMEWORK AREA

• ACA Federal Establishment Grants – Funding available through December 2014 • Fees Charged to Carriers for Exchange Enrollment

- Beginning 1/1/14, funds Navigators and Reserves - Beginning 1/1/15, funds all Exchange operations

• Advertising

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Finance and Sustainability Plan

Outreach and Education • Plan for Navigators, Enrollment Assisters and Producers

- 44% of enrollees will use Exchange Enrollment Facilitators • Certified by the DOI – AB425 • Navigators - $370,000, ~34 individuals in FY 2014 • Enrollment Assisters - $1,826,000, ~169 individuals, FY 2014 • Certified Application Counselors – volunteers

- 22% of enrollees will use Brokers and Agents • Paid by carriers

- 30% of enrollees will use Web Portal with the help of a Call Center • 50 plus individuals in Las Vegas (staff size flexes with

demand) - 4% of enrollees will use Web Portal alone

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Marketing/Branding/Outreach

• $5,419,900 budget for 15 months

• Contract began January 2013

• Goal: Enroll 118,000 persons, mainly in 138% to 400% of FPL

• Reach hundreds of thousands of Nevadans directly with outreach

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To Date:

• Extensive research on/with target population

• Pre-campaign surveys to gauge awareness and perceptions

• Name, logo and tagline decisions by board completed in April

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Media Campaign

• Advertising for education phase begins July 1

• Call to action phase begins at open enrollment date, October 2013

• Urgent call to action campaign prior to enrollment closing, first quarter of 2014

• Separate campaign for B2B/SHOP Exchange

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Outreach

• Partnering with numerous non profits serving this population

• Presence at events, festivals, neighborhood venues

• Outreach presentations

• Door to door campaign

• Grassroots, person to person approach is critical

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Overview of Marketing/Outreach

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Tax Implications Individual Subsidy Annual Income at 100% of the Federal Poverty Level

and Other Levels (Calendar Year 2013)

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Family Size 100% FPL

138% FPL

200% FPL

300% FPL

400% FPL

1 $11,490 $15,856 $22,980 $34,470 $45,960

2 $15,510 $21,404 $31,020 $46,530 $62,040

3 $19,530 $26,951 $39,060 $58,590 $78,120

4 $23,550 $32,499 $47,100 $70,650 $94,200

5 $27,570 $38,047 $55,140 $82,710 $110,280

For each additional person add $4,020 $5,548 $8,040 $12,060 $16,080

Tax Implications Individual Subsidy Monthly Premiums Under the Second Least Expensive

Silver Level Plan (Calendar Year 2013)

Family Size 100% FPL

138% FPL

200% FPL

300% FPL

400% FPL

Percent of Income 2.0% 3.29% 6.3% 9.5% 9.5%

1 $19.15 $43.53 $120.65 $272.89 $363.85

2 $25.85 $58.76 $162.86 $368.36 $491.15

3 $32.55 $73.98 $205.07 $463.84 $618.45

4 $39.25 $89.21 $247.28 $559.31 $745.75

5 $45.95 $104.44 $289.49 $654.79 $873.05

For each additional person add $6.70 $15.23 $42.21 $95.48 $127.30

Metal Tiers

• Catastrophic plan enrollment is limited

• The Advance Premium Tax Credit is based on the second least expensive silver plan

• Actuarial Value (AV) is the average cost paid by the insurer

• Deductibles are interpolated from reports from the Kaiser Family Foundation, rounded and based on 20% coinsurance

What the Actuarial Values in the Affordable Care Act Mean, April 2011

Patient Cost-Sharing Under the Affordable Care Act, April 2012

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Tier Cost AV Estimated Deductible Platinum Most Expensive 90% $200

Gold More Expensive 80% $1,000 Silver Base 70% $2,000 (CSRs applied)

Bronze Less Expensive 60% $4,000 Catastrophic Least Expensive <60%

Tax Implications Individual Subsidy

Assume:

• Second cheapest silver plan in Reno is $1,000 per month for a given family of four.

• Second cheapest silver plan in Las Vegas is $800 per month for the same family of four.

The Advance Premium Tax Credit is adjusted so the cost for that family is the same (based only on income) for the second cheapest silver plan.

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*

* Illustrative costs

$247.28 $247.28

$1,000.00

$800.00

$752.72 $552.72

*

APTC is adjusted

Family share is fixed

Premium illustration for family of 4 with an annual income of $47,100 (200% FPL)

Assume:

• Second cheapest silver plan in Las Vegas is $800 per month for the same family of four.

• The family, in Las Vegas, wants to purchase a gold plan that costs $900.

The Advance Premium Tax Credit is based on the second cheapest silver plan. The family must pay (or save) the difference.

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$247.28

$752.72

*

Tax Implications Individual Subsidy Premium illustration for family of 4 with an annual income of $47,100 (200% FPL)

$900.00 * Illustrative

costs

$247.28

$800.00

$552.72

*

APTC is adjusted

Family share is fixed

$347.28

$552.72

Tax Implications Individual Penalty

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Family Size 100% FPL 138% FPL 200% FPL 300% FPL 400% FPL

1 adult $115 $159 $230 $345 $460

1 adult / 1 child $155 $214 $310 $465 $620

2 adults $195 $270 $391 $586 $781

1 adult / 2 children $236 $325 $471 $707 $942

2 adults / 1 child $276 $380 $551 $827 $1,103

2 adult / 2 children $316 $436 $632 $948 $1,264

For each additional person add $40 $55 $80 $121 $161

Estimated Calendar Year 2014 Annual Tax Penalty (1.0%; $95; based on the FPL for 2013)

Tax Implications Individual Penalty

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Family Size 100% FPL 138% FPL 200% FPL 300% FPL 400% FPL

1 adult $695 $695 $695 $862 $1,149

1 adult / 1 child $1,043 $1,043 $1,043 $1,163 $1,551

2 adults $1,390 $1,390 $1,390 $1,465 $1,953

1 adult / 2 children $1,390 $1,390 $1,390 $1,766 $2,355

2 adults / 1 child $1,738 $1,738 $1,738 $2,068 $2,757

2 adult / 2 children $2,085 $2,085 $2,085 $2,369 $3,159

For each additional person add

$101 after 13 $139 after 8

$201 after 3

$302 $402

Estimated Calendar Year 2016 Annual Tax Penalty (2.5%; $695; based on the FPL for 2012)

Impact on Business Tax Credit • Fewer than 25 full time equivalent employees

• Cover at least 50% of the cost of employee coverage (not family)

• Average wages less than $50,000/year

• Available now, goes up in 2014

- Must be on SHOP Exchange

• Contact your tax preparer

- Form 8941

- Line 44f of Form 990-T (for Exempt Orgs)

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Impact on Business Tax Penalty • No tax penalty for small business

• For companies with more than 50 full time equivalent employees (FTE) and at least one employee receives an individual tax credit:

- No coverage offered: $2,000 x ( FTE – 30 ) per year

- Coverage offered but not affordable (9.5% income) or minimum essential coverage (bronze plan), lesser of above or: $3,000 x FTEs that receive a premium credit

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Nevada Health Link Operated by the Silver State Health Insurance Exchange

2310 South Carson Street, Suite 2 Carson City, NV 89701 (775) 687-9939 contact@exchange.nv.gov www.exchange.nv.gov