Transcript Slide 1

Marcia Benshoof
Strategic Business Development
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What is a Health Benefit Exchange?
An online marketplace for individuals and small employers:
Shop features of plans containing the same base benefits
Compare information regarding cost and quality
Determine eligibility for tax credits (premium relief)
Call or sit down with someone for help
Enroll in a plan
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Colorado’s Healthcare Story
Rising health care costs are unsustainable for businesses
Approximately 800,000 Coloradans are uninsured
Roughly half of uninsured Americans are small business
owners, their families and employees
Improving healthcare system and lowering costs are key
to business growth and Colorado’s competitiveness
Blue Ribbon Commission for Healthcare Reform
SB11-200: The Colorado Health Benefit
Exchange Act of 2011
• Passed in May 2011
• SB 200 establishes the
framework for the state
Exchange
• Governed by a Board of
Directors
• Legislative Implementation
Review Committee
• Mission is to increase access,
affordability, and choice for
individuals and small
employers purchasing health
insurance in Colorado.
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Stakeholder Engagement
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Open Board and Committee meetings
Advisory Groups
Ad hoc meetings
Outreach
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Key Features
• Exchange will be a new gateway to the marketplace
• Two marketplaces: Individual and SHOP (for
businesses with up to 50 employees)
• This is not a new government healthcare system
• Coloradans can still buy outside the Exchange and
inside or outside of the Exchange through brokers
• Plans cost same inside and outside the Exchange
• Only the Exchange will provide subsidies
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Premium Subsidies
Access to financial help to reduce the cost of premiums
• Subsidy applied up-front for individuals and families
• Individuals and families earning from 133% to 400%
of the federal poverty level
• Subsidy is higher for older Coloradans
• Available to small businesses and non-profits with
fewer than 25 employees earning less than $50,000
- sliding scale up to 50% of the premium
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Cost Reductions for Individuals
and Families
Financial help to reduce the cost of premiums
– Individual earning between $15,282 to $45,960/year
– Couple earning between $20,628 to $62,040/year
– Family of 4 earning $31,322 to $94,200/year
• Tax credit applied up-front by IRS
• Tax credit is higher for Coloradans ages 55-64
Financial help to reduce out of pocket costs (co-pays and
deductibles)
• Individuals earning $15,282 to $28,725/year
• Family of 4 earning $31,322 to $58,875/year
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Example
• Bill is a 40 year old male making $30,000 per year
• Bill enters the marketplace through the website and applies
for assistance paying for his coverage.
• Bill qualifies for $166 per month in premium reduction (tax
credit).
• Bill shops for and compares health plans with the same base
benefits.
• Bill finds a plan that costs $375 per month. The tax credit
brings his total cost to $209 per month.
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Qualified Health Plans
Plans sold in the Exchange will be organized in tiers:
Platinum: Plan covers 90% of average medical costs;
consumer pays 10%
Gold: 80% -- 20%
Silver: 70% -- 30%
Bronze: 60% -- 40%
Impact to Businesses
GUARANTEED ISSUE
In 2014, all health plans must guarantee the availability and renewal of
coverage regardless of health status (can’t be turned down because of
pre-existing condition)
GRANDFATHERED PLANS
Existing plans that are kept in 2014 are exempt from new requirements
(EHBs and covering preventive services without cost sharing)
PENALTIES
Businesses with fewer than 50 combined Full-Time and FTE employees
are exempt from penalties related to mandate for coverage
There is no penalty for part-time employees not offered coverage
Impact to Businesses
• Employers who currently provide insurance don’t
need to change unless coverage is unaffordable
• SHOP will provide employers with opportunity to
give employees more choice of plans
• SHOP will provide administrative services, such as
premium aggregation, to reduce burden on
employers
Opportunities for Large Employers
• Re-think your COBRA strategy
– COBRA participants as a group have a disproportionate
effect on loss ratios
– Represent a disproportionate administrative load
– More likely to qualify for premium subsidies
– Likely to have greater choice in the Exchange
– May still use the tax benefits of HSAs
• Rethink your early retirement strategy
• Consider assistance and education for Part-Time employees
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COHBE Update
• One of first six states to receive approval from federal
government in December to open in October
• Annual Report presented to General Assembly on
January 24, posted on website
• Board approved new name: Connect for Health Colorado
(to be launched in Spring with marketing campaign)
• Board completed dozens of policy decisions
• Convened about 100 public meetings in 2012 (Board,
board committees, advisory groups, joint stakeholder
feedback meetings)
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2013 Key Activities
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Review Applications for Navigator Entities
Work with DOI to certify health plans
Open Customer Service Phone Center
Launch broad marketing and outreach campaign
Apply for Level 2 Grant from federal government
Test technology systems and back-office functions
Train thousands of navigators, brokers, customer service
representatives, partners
• Open October 1
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Coming in May 2013…
2012-2014 Exchange Timeline
Create policies for
finance, audit, and
prevention of fraud
2012
Develop,
implement
and test
web portal
and
customer
service
functions
Test all
systems
2014
Coverage
Begins
2013
Certify
benefits
and
health
plans
Exchange
launch
(Oct. 2013)
Implement
Navigator
program
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www.getcoveredco.org
• Unsubscribe
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Contact
James L. Sugden, SHOP Exchange Manager
[email protected]
www.getcoveredco.org
@COHBE
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