Transcript UPDATE:Small Business Marketplace - Balcony

UPDATE:
Small Business Marketplace
September, 2013
Agenda
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What is the NY State of Health
Eligibility and Enrollment
Consumer Assistance
Qualified Health Plans
Small Business Marketplace
– Policy changes to the existing market
– Value of the Marketplace for the employer
– Small Business Tax Credit
Financial Assistance for Individuals
Broker Engagement
Resources
Next Steps for Small Businesses
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What is NY State of Health?
• Organized marketplace
– One-stop shopping for subsidized and unsubsidized coverage
– Easily compare health plan options
– The only place to check eligibility and apply for financial
assistance
– Enroll in qualified health plans
• Two programs
– Individual Marketplace (individuals and families, sole
proprietors)
– Small Business Marketplace (businesses with 50 or fewer
employees)
Who is Eligible?
You will be eligible to purchase a health plan through
the Marketplace if you:
• Live in New York
• Are a citizen or lawfully present immigrant (different
immigration rules may apply if you are eligible for
Child Health Plus or Medicaid)
• Own or work for a small business with 50 or fewer
eligible employees
Who Will Enroll In NY State Of Health?
Health Plan Marketplace enrollment is estimated to be
1.1 million New Yorkers
Individual Marketplace
(58%)
Small Business
Marketplace (42%)
450,000
615,000
NY State of Health Enrollment
• Open Enrollment begins on October 1, 2013
• Coverage Starts on January 1, 2014
• Individuals
– May enroll in health plans during open enrollment: October
1, 2013 - March 31, 2014 (or with a qualifying event)
– Individuals who qualify for Medicaid/CHP may enroll any
month of the year
• Small employers
– May choose open enrollment dates for their employees any
month of the year
Consumer Assistance
• Online
– Through the Exchange portal for new applications and administrative
renewals
– Webchat for assistance
• In Person
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In Person Assistors and Navigators
Agents and Brokers
Informal Assistors
Assistance available in many languages
• Phone
– Leverage current public program call center
– Assistance available in most languages
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Online Enrollment
• One portal will process applications for:
– Medicaid
– Child Health Plus
– Individual Marketplace
– Small Business Marketplace
• System in rigorous testing for October 1 open
enrollment
Customer Service Call Center
• Assistance available in over 170 languages
– Many staff will be bilingual and oral interpretation will
be available for remaining languages.
• Will take applications over the phone starting in
October
• Can refer to in-person assistors
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3 Types of In-Person Assistors
IPA/Navigators
• Complete Applications
• Compensation from DOH grant program
• Training and certification required
• Serve Individuals and Small Business Marketplace
Insurance
Brokers/Agents
• Complete Applications
• Commission-based compensation
• Training and certification required
• Choose to certify in Small Business Marketplace, Individual, or
both
Certified
Application
Counselors
• Complete Applications
• No compensation from Marketplace
• Training and certification required
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3 Types of In-Person Assistors
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50 Navigator organizations throughout the state
 Hundreds of trained individuals that speak 48 different languages
 Site schedules will be publicly available
 5 day training and certification course
http://www.healthbenefitexchange.ny.gov/IPANavigatorMap
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Insurance Brokers
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More than 2,000 brokers have already completed continuing
education for the Marketplace
Certified Application Counselors
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Hospitals, healthcare providers, health plans, others
http://www.nystateofhealth.ny.gov/PlansMap
http://www.nystateofhealth.ny.gov/PlansMap
Qualified Health Plans
Actuarial Values for Levels of Coverage
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
90%
80%
70%
60%
Bronze
Silver
Gold
Platinum
Required Ten Essential Health Benefits
1. Ambulatory patient services
2. Emergency room services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse disorders
6. Prescription drugs
7. Rehabilitation and habilitation services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease
management
10. Pediatric services, including oral and vision
Key Policy Decisions
Related to the Small Business Marketplace
• Small Group Market Size
− 50 or fewer eligible employees in 2014 (will raise to 100 full time
equivalent employees by 2016)
• Market Merger
− NY will leave the individual and small group markets separate
− Staring on January 1, 2014 Sole Proprietors will access coverage through
the Individual Marketplace
• Standard Plan Selection
− All carriers have to offer a standard product in each metal level
− Premium rates will be the same both inside and outside of the exchange
for the same product
• No Minimum Participation or Minimum Contribution
− NYS will not require a minimum number of employees be enrolled in a
QHP nor require an employer to contribute an amount towards premium
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Small Business Marketplace:
Value for Small Employers
Choice
• Employers and employees regard expanded choice as a key
advantage to using the Marketplace.
Administrative Simplicity
• The Marketplace provides monthly billing to employers along
with other administrative simplifications.
Tax Credits
• The Marketplace will be the exclusive place to access small
business tax credits in 2014.
Contribution Options
• 76% of respondents believe this feature helps predict costs.
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Employer Coverage and
Contribution Options
Employer Coverage
Options
1) Select among QHPs
offered by a specific
carrier
2) Select specific QHPs
offered by multiple
carriers
Employer Contribution Options
1) Uncapped percentage
(e.g., employer pays 55% of premium)
2) Capped percentage
(e.g., employer pays 55% of premium, up to $300)
3) Defined dollar amount
(e.g., employer pays $300/month)
3) Select a metal tier of
coverage
4) Allow employees to
select any Marketplace
QHP
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Small Business Health Care Tax Credit
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Internal Revenue Code - 45R
A tax credit of up to 35% (25% for tax-exempt) is available now to
small businesses that offer insurance coverage to employees:
– Must have fewer than 25 employees with an average annual salary of $50k or
less
– Employer must contribute at least 50% of premium
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In 2014, the tax credit will increase:
– Up to 50% of employer contribution (35% for tax-exempt)
– The maximum tax credit of 50% may be claimed by businesses that have 10 or
fewer employees with an average annual salary of $25k or less
– As the number of employees and average salary increases, the credit
decreases
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Exchange will be the only place to access the tax credit after 2013
Exchange will provide real-time estimate of credit at time of
application for those who qualify
Advised to work with tax advisor for tax information
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Financial Assistance for Individuals
• Many individuals and families will be eligible for financial
assistance to reduce the cost of coverage
• Financial assistance is available in 2 forms
– Tax credits will reduce the cost of premiums for most single
adults earning less than $45,960 and for families of 4 earning
less than $94,200
– Cost-sharing reductions will lower co-payments and deductibles
for those earning less than $28,725 for single adults and families
of 4 earning $58,875
• Tax credits and cost sharing reductions are estimated at the
time of application and applied immediately
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Broker Engagement
• Brokers will be a primary distribution channel for small group
enrollment in the Small Business Marketplace
− 88% of NYS small group coverage currently sold through brokers
• Brokers must be certified to sell products in the Marketplace
• Brokers will have the support of a dedicated online portal to facilitate
applications and renewals
− Broker can also serve as employer proxy in employer portal
• Marketplace will support brokers with a full customer service center
• Commissions will be paid directly from carriers
– Commissions must be the same inside and outside the Marketplace
Broker Certification
• The Department of Financial Services (DFS) has approved the
certification course for the Small Business Marketplace.
– A certification course to sell insurance through the Individual
Marketplace is forthcoming.
– Small Business Marketplace certification is a prerequisite to
Individual Marketplace certification.
• Course training schedule and list of approved vendors:
– http://www.dfs.ny.gov/insurance/agbrok/ab_shop.htm
• Agents/Brokers completing these courses will earn continuing
education credits toward the renewal of their insurance licenses.
• These are the only approved courses for certification to sell
insurance through the Marketplace.
Available Resources
• Website (Now)
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Fact Sheets & Newsletter templates
Navigator Map
Health Plan Map
Financial Assistance Calculator
• Materials (Oct.)
• Rack cards and Fact Sheets
• Posters
• Customer Service Center Phone Line (Sept 16 opens to
answer questions)
• In-person Assistance–Local Navigators (Oct.)
Next Steps for Small Businesses
• Talk with your insurance broker about how they
can help you make the best choices for
employees.
• Ask your tax advisor if your business may qualify
for the Small Business Health Care Tax Credit
• Visit the Exchange website for latest information
for small business
• Sign up for email updates
– http://www.nystateofhealth.ny.gov/
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NY Health Plan Marketplace Contacts
Heather Rankin
Small Business Marketplace
[email protected]
Get regular updates at: www.nystateofhealth.ny.gov