Transcript Document

Delaware’s Health
Insurance
Marketplace:
Update on Activity
Delaware Health Care Commission, December 16, 2013
Secretary Rita Landgraf, Department of Health and Social Services
Agenda
• Updates since last Health Care Commission meeting
• Enrollment activity
• Marketing and website update
• Marketplace Guide update
• Stories from the ground
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Recent National Updates
• Healthcare.gov reports improvements since Nov. 30th
• More detailed “window shopping”
• “Remove” function added; some users can
remove problem applications
• Increased capacity
• More completed enrollments
• HHS announced a change in the last date to enroll for
coverage to begin Jan. 1, 2014 – individuals must be
enrolled by Dec. 23, 2013
• It is advised that the first month’s premium also be
paid by this date to ensure coverage Jan. 1
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Extension of PCIP Update
• On December 12th, President Obama announced a
one-month extension of the Pre-Existing Condition
Insurance Plan (PCIP)
• Individuals currently enrolled can remain in PCIP until
January 31, 2014, if they have not yet secured other
health coverage to ensure they do not experience a
lapse in coverage
• Delaware has almost 300 people in this program
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“834” File Transmission Update
• There have been problems with so-called “834” enrollment
files that provide detailed information from HealthCare.gov
to insurance companies about new subscribers
• While improvements have been made, many insurance
companies are still seeing problems with the 834
transmissions. Some of the remaining problems include:
• Files with duplicative information
• Files that include missing or inaccurate information
• Files that fail to transfer from Federally Facilitated
Marketplace (FFM) to the insurance company
• CMS and insurance companies report that they are
working daily to resolve the technical problems and
address the back-log of outstanding cases
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Discontinued Policies Update
• On November 14th, President Obama announced he would allow
states to decide whether insurance companies could offer
renewals of plans that did not meet the requirements of the ACA.
• On November 25th, Delaware’s Insurance Commissioner
announced that the DOI had reached an agreement with the
health insurance companies to offer early renewals for current
policies whose term of coverage was to end on or before March
31, 2014.
 Consumers that are affected by this agreement and take
advantage of this option must renew their policy on or before
December 31, 2013.
 All policies with an effective date after January 1, 2014, must
be in compliance with Delaware law.
 The insurance companies have indicated that individuals with
questions regarding their policies should direct those
questions to their agent or broker.
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SHOP Update
On November 27th, CMS announced a yearlong delay of online
enrollment for small business through the SHOP portal
• Small employers can enroll in a SHOP QHP directly with the insurance
company or through an agent/broker and do not need to wait for an eligibility
determination from the SHOP in order to enroll in a QHP.
• Employers who have already sent in a paper application do not have to
wait to receive an eligibility determination before contacting an
insurance company or agent/broker to enroll.
• If an employer is later determined to be ineligible for the SHOP but the
group is already enrolled, the insurance company is not required to
terminate coverage. However, that employer will not be able to claim the
Small Business Health Care Tax Credit if they are ineligible.
• Enhanced Federally Facilitated SHOP Tools for Small Employers
• New Premium Estimation tool
• Expanded Plan Compare tool expected in December
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Marketplace Enrollment Update
• Number of Delawareans that have selected a
Marketplace QHP as of November 30th reported by the
U.S. Dept. of Health and Human Services: 431
• Delaware enrollments through the HealthCare.gov as
reported by the QHP issuers as of December 12th: 793
• This number represents consumers who have
both selected a QHP only as well as those who
have paid the first month's premium to the Issuers
in order to fully effectuate enrollment in the health
plan.)
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Medicaid Update
• Number of individuals assessed eligible for Medicaid/CHIP by the
Marketplace by the U.S. Dept. of HHS = 2,950
• Some individuals have been flagged by the federal Marketplace
as being potentially eligible for Medicaid when their household
income is above the threshold.
• When the FFM sends these individuals to the State, the file does
not contain all the information necessary to complete an eligibility
determination. Eligibility workers will contact individuals to
complete this process.
• If individuals are eligible for Medicaid, coverage is effective the
1st day of the month in which the application was submitted.
• If individuals are not eligible for Medicaid, they will be directed
back to the Marketplace.
• Advanced Resolution Center is available for cases needing
additional assistance.
ChooseHealthDE.com (English version):
• As of Dec. 11, 2013, there have been 127,512 visits
• Visitors are staying an average of 2 minutes, 22 seconds
Health-Care/Espanol
ChooseHealthDE.com (Spanish version):
• As of Dec. 11, 2013, there have been 8,525 visits.
• Visitors are staying an average of 2 minutes, 48 seconds.
HEALTHCARE.GOV
Traffic from ChooseHealthDE.com to HealthCare.gov:
As of Dec. 11, 2013, ChooseHealthDE.com has directed 24,706 visits to
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HealthCare.gov.
Marketing Updates
• ChooseHealthDE.com updates and enhancements
• Robust calendar of events where Marketplace
Guides are available
• In The News section includes up to date notices
for consumers
• Currently planning 2014 marketing activities
• Increased focus on targeted populations including
18-29 year olds, Hispanic citizens, Sussex County
Marketplace Guide Activities to Date
• As of December 12, 2013:
• There are 73 fully certified Marketplace Guides and
Navigators
• There are 105 total positions (both part- and full-time),
which make up 68 FTEs
• 710 outreach activities conducted
• 25,362 total consumers reached
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Outreach and Education
• During the first two months of open enrollment,
Marketplace Guides have geared their activity primarily
toward:
• Making consumers aware of the Marketplace and the
various ways to enroll
• Answering questions about eligibility, available assistance
and coverage options
• Talking consumers through their individual
circumstances, including looking at specific plan
information, to prepare them to apply and enroll
• Referring consumers to Medicaid as appropriate
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Enrollment Support
• Now that significant improvements have been made to
HealthCare.gov, the Guides have shifted their efforts to
focus on assisting consumers to apply and enroll
• Guide organizations are holding special enrollment
events throughout the state this week to help consumers
meet the Dec. 23 deadline for coverage that begins
Jan.1:
• Schools across the state
• Westside Family Healthcare sites
• Wilmington Hospital
• Dr. Joann Fields’ Office, Felton
• Full schedule is available on www.ChooseHealthDE.com
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Other Considerations
• Many consumers that seek assistance from a Guide prefer to
complete the enrollment on their own at a later time (e.g. after
taking time to shop and compare) and Guides are actively
following up in these cases to ensure that the consumer gets
connected to coverage
• The Federal government is still advising against the use of paper
applications due to expected delays in processing these and a
less seamless enrollment process
• Insurance companies are now offering direct enrollment through
their sites, but consumers still need to complete an application at
HealthCare.gov to qualify for financial assistance
• For consumers with more difficult cases, the Federal government
has established an advanced resolution center. Consumers can
reach this through the Federal Contact Center at 1-800-318-2596
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Plan Enrollment Verification
•
Insurance companies require payment of the first month’s premium before the
consumer is considered fully enrolled in a plan and prior to the start of benefit
coverage.
• To ensure that coverage is able to begin Jan. 1, 2014, CMS recommends that
consumers select, enroll and pay the first premium by Dec. 23, 2013.
•
For those who select and enroll through the Marketplace:
• Contact the insurance company directly two days after selection of QHP through
the Marketplace, to verify that enrollment information has been properly received
• Consumers are encouraged to have the following information ready when verifying
enrollment with the insurance company:
• Name of plan enrollee, Marketplace Account ID, full Plan Name, names of
anyone included on the Plan, date the enrollee completed transaction through
the Marketplace
• If the insurance company is unable to confirm the enrollment, consumers are
urged to contact the Federal Contact Center immediately to determine if there are
any issues regarding their selection/enrollment transaction.
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Get help from the QHP Insurance Companies
The table below provides links to each of the
Delaware QHP Issuer Customer Service Centers.
Insurance Company
Customer Service Weblink
Customer
Service Phone
Coventry Health and Life
Insurance Company
http://www.coventryone.com/
855-449-2889
Coventry Health Care of Delaware
http://www.coventryone.com/
855-449-2889
Highmark Blue Cross Blue Shield
of Delaware
https://www.highmarkbcbs.com/chmptl/chm/js
p/contactus.do?oid=13447&submitbutton=custserv
800-294-9568
Delta Dental Insurance Company
http://www.deltadentalins.com/about/contact/c
ontactUs_midatl.html
800-932-0783
717-766-8500
Dentegra Insurance Company
https://www.dentegra.com/contact-us
877-280-4204
TTY: 711
Dominion Dental Services, Inc.
https://www.dominiondental.com/contact
888-518-5388
888-681-5100
Stories from the Ground
• With the help of a Marketplace
Guide from Brandywine
Women’s Health Associates, a
Newark woman was able to
enroll. “This insurance is a
blessing to me,” said the
woman who lost her job 3
years ago, was on COBRA for
18 months and was without
insurance the last 18 months.
• A Wilmington woman will save
more than $500 a month with
her Marketplace policy.
Stories from the Ground
• After initially applying Oct. 8, a Glasgow man was
able to enroll Dec. 3 – with assistance from an MPG –
by “removing” his application and starting over. His
new application flowed right through.
• A Dover man, whose application was flagged by the
Marketplace as being potentially eligible for Medicaid
even though his income is above the threshold, is
working with Sen. Coons’ office to fix the error.
Stories from the Ground
• Before enrolling in a gold plan, a
37-year-old Wilmington woman
was able to learn that her
prescriptions are in the plan’s
formulary and her doctor is in the
provider network.
• A woman from Bear with cancer,
who is finishing her enrollment, is
eligible for a tax credit.
• A Marketplace Guide assisted a
woman who is legally blind with her
enrollment. The woman’s employer
doesn’t offer insurance – and with
the subsidies she is eligible for –
she will pay $43 per month for her
medical coverage.
Stories from the Ground
• Westside Guides Adrian and Kristen
talked with young people at the
Delaware Sports League’s Flag Football
Tournament.
•
A Rehoboth Beach man, whose
application had been stuck, received
help from the Call Center and now just
needs to decide on a plan before Dec.
23.
• A 53-year-old Wilmington man, who
hasn’t had insurance in 5 years, signed
up for medical and dental coverage.
Significant Dates
• December 23, 2013 – Last day to enroll for coverage
beginning on January 1, 2014
• March 31, 2014 – Must be enrolled in minimum
essential coverage by this date to avoid penalty
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