Washington Health Benefit Exchange

Healthplanfinder Business (SHOP) TACNovember 12, 2015

PACE ACT

▪ “Protecting Affordable Coverage for Employees Act” (PACE)

▪ Amendment to the Affordable Care Act, passed by Congress and signed by the President this fall.

▪ Changes the number of employees eligible for small group coverage from 100 to 50 starting in 2016. ▪ ACA change in small group definition to 100 was slated to go in

to effect 1/1/2016.

▪ This and other ACA mandates take place for coverage starting January 2016

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2016 CHANGES

▪ Federal definition of eligible employees ▪ FTEs vs. employees (bodies)▪ Full-time employee = 30 hours or more per week▪ Calculation = Actual FTEs + sum of hours of non-FTEs divided by

120

▪ Used to determine whether a group is a small vs a large group

▪ Employers will need to attest to their eligibility during the application process

▪ All FT employees must be offered coverage in order to apply for coverage in WA Healthplanfinder Business

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2016 CHANGES

▪ Federal definition of an eligible group includes that a group must have at least one common law employee along with the employer

▪ We will no longer be able to offer coverage to sole proprietors beginning in 2016

▪ Five sole proprietors are currently enrolled

▪ HBE will inform each enrolled individual at the time of their renewal

▪ Outside of the SHOP marketplace (state-based or federally-based), the method of counting eligible employees may differ from inside SHOP

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QUESTIONS ??

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2016 CHANGES

▪ Moda Health is exiting the WA market in both individual and small group & fully-insured large group

▪ WA Healthplanfinder Business▪ 30 plans to be offered instead of 47▪ United Healthcare of WA will provide statewide enrollment ▪ Kaiser Permanente – Clark & Cowlitz counties

▪ HBE is working closely with Moda to inform all customers and brokers of the change

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Committee Members -- update

▪ Kelly Allen, Kelly Allen Insurance▪ Insurance broker, small business owner

▪ Lonnie Goodell, Group Health Cooperative▪ Director, Small Business Group & Producer Relations

▪ Paul Hofmann, Attorney’s Title of Kitsap▪ Owner/President

▪ Troy Nordlund, Pacific NW Insurance Brokerage, Inc.▪ Insurance broker

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