Idaho Health Insurance Exchange. Amy Dowd, Executive Director Idaho Health Insurance Exchange 8/15/2013

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1 Idaho Health Insurance Exchange Amy Dowd, Executive Director Idaho Health Insurance Exchange 8/15/2013

2 Idaho Health Insurance Exchange Who is the Idaho Health Insurance Exchange? STAFF Alberto Gonzalez Operations Project Manager Jody Olson Communications and Marketing Director Pat Kelly Finance Director Rick Moran IHIE IT, Medicaid Integration Policy Analyst Open IHIE Reports to 19 member board appointed by the Governor IHIE is not a state agency

3 Idaho Health Insurance Exchange Who is the Idaho Health Insurance Exchange? CONTRACTED FIRMS Gallatin Public Affairs, GS Strategy Group and Burson-Marsteller Conducted brand positioning workshop with community partners from around the state Created a brand name, tagline and logo for the IHIE Developed the new website Developed collateral and marketing materials Development of a comprehensive outreach & education plan Public Consulting Group Working on finalizing the architecture of the In-Person Assister program Identifying in-person assisters Developing training module Finalizing the establishment of the Exchange Call Center Working with the Department of Insurance on Certifying health plans

4 Idaho Health Insurance Exchange What a State-Run Idaho Exchange Means for Idaho Local Control: Idaho stakeholders are able to participate in the design and administration of the Exchange Maintain Regulatory Authority: The Idaho Department of Insurance maintains regulatory authority of Idaho s health insurance marketplace Governed by Local Stakeholders: The Idaho Health Insurance Exchange is separate from the state of Idaho and is governed by a nineteen-member board of Idahoans Lower costs: 1.5% carrier assessment fee year 1 and remains in Idaho vs. a 3.5 assessment fee to the federal government Simple, streamlined, lean processes with low operational costs

5 Idaho Health Insurance Exchange What will the IHIE be in Idaho? We are more than a website A market place where private insurers compete for your business A centralized tool that brings together resources from across Idaho to help Idahoans comparison shop for health plans and navigate purchasing health insurance Starting on October 1, individuals, families and small business looking to buy health insurance can use the tools and resources provided through the website to shop for, make apples-to-apples comparisons of plans and choose from competitively priced health insurance plans The Idaho Health Insurance Exchange is not intended to compete with the existing insurance marketplace. Insurers can sell policies outside of The Idaho Health Insurance Exchange and individuals can purchase health insurance directly from a carrier or licensed agent outside of The Idaho Health Insurance Exchange.

6 Idaho Health Insurance Exchange How will the IHIE benefit Idahoans? Shop. Compare. Choose. Comparison shopping of health plans in an apples-to-apples format to allow you to choose a plan that is right for your family and your budget Determine eligibility for premium assistance. The IHIE is the one place where Idahoans can determine their eligibility for premium assistance. Find trained assistance such as community partners and agents/brokers that can help you shop for plans It is free to use an agent or broker trained to help you decide the plan that is best for you Access for all Idahoans to robust plans that have a similar level of benefits as employer based plans and cover and all cover essential benefits

7 Idaho Health Insurance Exchange Individual Choice: Running the numbers The amount of premium assistance that individuals and families may be eligible for depends on your income, employment status and household size. While the exact amount of premium assistance will vary, some level of premium assistance may be available to individuals earning up to $45,960 a year, couples earning up to $62,000 a year and families of four earning up to $94,200 a year. The exact amount of premium assistance available to Idahoans on The Idaho Health Insurance Exchange will not be known until the Department of Insurance releases the rates of the plans later this year. Using a calculator from the Labor Center at the University of California at Berkley we could estimate: A family of 4 making $32,500 could qualify for $950 a month to pay for their monthly premium. A family of four making $90,000 could qualify for around $350 a month in premium assistance.

8 What does the IHIE mean for Small Businesses? Small business with up to 50 employees will be able to go on the Exchange to make apples-to-apples comparisons of certified health plans and choose what is best for their employees The role of Agents/Brokers in the insurance marketplace will remain the same. Agents and Brokers can still serve the primary point of contact for any questions that small businesses have about purchasing plans, however small business can also self select plans via the IHIE if they wish.

9 SHOP Small Business Health Options Program Starting this fall, small businesses with up to 50 employees will be able to use the Idaho Health Insurance Exchange to compare group plans. The Exchange can help small businesses compare and choose a plan that is right for their employees. For some small businesses with fewer than 25 full-time equivalent employees earning an average of about $50,000 a year or less, your business may be eligible for a small business healthcare tax credit starting in 2014, if you buy your employees an insurance plan on The Exchange. To qualify for the small business healthcare tax credit, business owners must pay at least 50% of their full-time employees' premium costs. You aren t required to offer coverage to your part-time employees or to dependents. The tax credit available for policies beginning on January 1, 2014 is worth up to 50% of your contribution toward employees premium costs, (up to 35% for tax-exempt employers). Small business owners can find more details from the IRS or through consulting their certified public accountant or tax advisor.

10 Idaho Health Insurance Exchange Website Launch planned for 8/20 Website Expectation: General Information Contact for all linkages to exchange Options to apply Referrals to In Person Assister or Agent/Brokers Eligibility for Medicaid & Premium Assistance ( % FPL) Enrollment to Health Coverage & PLANS!!

11 Idaho Health Insurance Exchange Plan Management QHP Certification Standards Essential health benefits Essential community providers Formulary Accreditation Actuarial values Licensure Cost sharing limitations Solvency Plan variants Rating requirements Meaningful differences Non-discrimination Service areas Network adequacy All plans sold on the Exchange will have identical essential benefits Plans will be grouped in four categories: bronze, silver, gold and platinum. A bronze plan will cover roughly 60% of the costs of services it offers, a silver plan 70%, a gold plan 80% and a platinum plan 90%. Plans that cover a larger portion of healthcare costs have a higher monthly premium. source: Idaho Dept of Insurance 11

12 Idaho Health Insurance Exchange Individual Medical Market Plans Overview Zip Codes 832xx 833xx 834xx 835xx 836xx 837xx 838xx Altius Blue Cross BridgeSpan PacificSource SelectHealth Total Unique Plan IDs recommended for certification: SOURCE: Wes Trexler, Product Review Bureau Chief, Dept of Insurance

13 Idaho Health Insurance Exchange Small Group (SHOP) Medical Market Plans Overview Zip Codes 832xx 833xx 834xx 835xx 836xx 837xx 838xx Blue Cross PacificSource SelectHealth Total Unique Plan IDs recommended for certification: 55 SOURCE: Wes Trexler, Product Review Bureau Chief, Dept of Insurance 13

14 Idaho Health Insurance Exchange Individual Dental Market Plans Overview Blue Delta BEST Cross Dental Dentegra PacificSource Renaissance High Low Total Unique Plan IDs recommended for certification: 23 Grey columns indicate companies that requested to be Exchange-certified but to not be sold through the Exchange. SOURCE: Wes Trexler, Product Review Bureau Chief, Dept of Insurance 14

15 Idaho Health Insurance Exchange Small Group (SHOP) Dental Market Plans Overview Ameritas BEST Blue Cross Dentegra Pacific Source Renaissance Standard The Guardian The Lincoln High Low Total Grey columns indicate companies that requested to be Exchange-certified but to not be sold through the Exchange. Unique Plan IDs recommended for certification: SOURCE: Wes Trexler, Product Review Bureau Chief, Dept of Insurance

16 Summary of Unique Plan IDs Recommended for Certification Individual Medical: 79 Small Group Medical: 55 Individual Dental: 23 Small Group Dental: 37 Total Unique Plan IDs: SOURCE: Wes Trexler, Product Review Bureau Chief, Dept of Insurance

17 Idaho Health Insurance Exchange Website Certified Consumer Connectors IHIE Customer Support Services IHIE Licensed Agents and Brokers Customer Support Services Department of Health and Welfare 17

18 IHIE Consumer Connector Roles Agent/Broker Licensed health insurance agents and brokers who may enroll individuals, small employers, and employees in coverage, compensated by the issuer or the consumer. Agents and Brokers will receive Federal Training Navigators Individuals who will play a vital role in assisting consumer prepare applications, including helping individuals find out if they qualify for affordability programs, and if eligible they assist consumers in self enrollment In Person Assisters Perform the same role as navigators but are present in State Based and State Partnership models. The IPA is an optional program the State can set up before its marketplace is self sufficient. IPAs will be trained by the state Certified Application Counselors Individuals and organizations whose primary role will be to educate consumers, provide general information and make referrals

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20 Idaho Health Insurance Exchange Navigators/In Person Assisters have five main duties 1. To conduct public education about the availability of qualified health plans 2. To distribute fair, impartial information about enrollment in qualified plans and about the availability of premium assistance and cost-sharing assistance in the exchange 3. To facilitate self enrollment in qualified plans 4. To refer people who need help resolving a problem with their health plan or with their premium assistance to a consumer assistance or ombudsman program or to another appropriate agency that can help with a grievance or appeal 5. To provide information in a culturally and linguistically appropriate manner to the population being served by an exchange

21 Idaho Health Insurance Exchange Certification Standards Minimum education requirements high school diploma 20 hour IHIE Training Completion of tests with a score of 85 or better Familiarity with the population to be served The Organization and Assisters will agree to a criminal background check in accordance with State and Federal rules The Organization and Assisters are lawfully authorized to work in the US The Organization and Assisters are at least 18 years of age The Organization and Assisters can demonstrate computer and internet skills Annual Re-Certification will be conducted 21

22 Idaho Health Insurance Exchange Consumer Connector Program Design Philosophy Providing Idahoans with the most current and accurate health coverage information Offering the most consumer friendly options to access information, premium assistance, plan comparison and enrollment Recommending a licensed agent/broker/producer to assist them in finding the best health coverage option for their individualized needs Only an agent or broker can make specific recommendations about which plan you should buy. Agents and brokers are licensed and regulated by Idaho s Department of Insurance and typically get payments or commissions from health insurers for enrolling a consumer into a plan. Some agents and brokers may only be able to sell plans from specific health insurers.

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24 2014 Open Enrollment In Person Assister Organizations Idaho Primary Care Association - Represents 13 Community Health Clinics throughout the state Public Health Districts- 7 Community Health Districts providing various services to clients in varying income levels Idaho Association of Counties Represents 44 Counties across the state assisting in applications and services for indigent fund. Not all counties expected to participate Idaho Hospital Association - Represents 42 Hospitals providing vital services to the community Idaho 211 Careline- official 211 Call Center Community Action Partnership of Idaho - Represents 8 CAP Agencies statewide and are private, non-profit association dedicated to fighting the causes and conditions of poverty in Idaho Mountain States Group Agency with presence across the state with focus on Rural Health, Aging Services, Children Services, Mental Health Services, Public Health and Policy, and Refugee Services Will include: TRIBAL GROUPS HISPANIC ORGANIZATIONS REFUGEE ORGANIZATIONS AGENCY STAFF LOCATIONS IPCA IHA PHD IAC Statewide CAPAI 7 7+ MSG 4 4+ TOTAL

25 Idaho Landscape of the Uninsured Uninsured Consumers % FPL Across Counties 25

26 Idaho Landscape of the Uninsured Idaho Hospital Associations 27

27 Idaho Public Health Districts

28 Idaho Landscape of the Uninsured Community Health Centers and Community Action Partnership Agencies 29

29 Proposed Training Schedule for In Person Assisters Late August Early September September Open Enrollment October 1 st Post Open Enrollment Finalize training modules and examination / certification process Begin Training the Trainers Conduct 3 Regional Trainings across the State Trainers begin to train their respective organizations and their Consumer Services Support Staff Begin training Customer Support Services Center Staff on call center operations Proposed make up/ supplementary train the trainer session Continue training efforts Begin to research and selecting on online Learning Management System (LMS) to manage training modules and certification process Finalize LMS Selection and load all training modules and exams into the LMS system Proceed with trainings and certifications through the use of the LMS

30 In Person Assisters: Training the Trainers Train the Trainers Approach meet with Association representatives in 3 separate regions across Idaho Trainers will bring the trainers hours of training will be offered in a train the trainer format in late August and early September in 3 regions across Idaho Trainers will have to complete exams following each module in person (on paper) as a portion of their certification process Training will incorporate 12 modules with topics ranging from Healthcare 101, Privacy and Security, and Ethical Standards etc.

31 In Person Assisters: Trainings Post Open Enrollment Trainings will be incorporated into an online Learning Management System (LMS) System will enables users to log in and conduct a self directed training System will also track certification examinations and produce status reports This system will be utilized as a re-certification process for future trainings and to certify new individuals as turnover is expected

32 In Person Assisters: Proposed Training Modules 1 Healthcare Qualified Health Plan Information 3 Cultural and Linguistic Competencies 4 Small Businesses 5 Ethical Standards 6 Consumer Assistance Resources 7 Public Coverage and Premium Assistance 8 Oversight and Monitoring Process 9 State Privacy and Security Standards 10 Communication Skills 11- IHIE Web Portal 12- Federal Marketplace Web Portal

33 In Person Assisters: Performance Metrics Proposed Performance Metrics* Enrollment Measures 1. Number of individuals assisted 2. Number of individuals from a hard-to-reach population, if available 3. Number of referrals to agents and brokers Administrative 1. Data reported accurately and timely 2. Complaints resolved timely Enrollee Satisfaction 1. Individuals overall satisfaction with Assister and/or Organization 2. Individuals overall satisfaction with the Connector *CCIIO Design Review August 1,

34 Idaho Health Insurance Exchange Consumer Support Center (CSC) For the Marketplace, this includes the call center in addition to customer support services Idaho Health Insurance Exchange (IHIE) Customer Support Center Available to answer Idaho-specific questions Make appropriate referrals Utilize Worldwide Interpreters language line The Healthcare.gov Customer Support Center Based on infrastructure that currently supports Medicare recipients Available 24/7 with English and Spanish live language options and 150 additional languages 35 available through the language line

35 Idaho Health Insurance Exchange Consumer Support Center (CSC) General Information Policy Information Eligibility Plan Information Minimum Requirements Printable Application Appeals and Grievances FAQs Referrals To certified IPA and agents / brokers To DHW To Healthcare.gov Mail Clients without internet access can obtain printed applications by mail Offers mail processing and application referral General mailbox will provide information and referrals as needed. s intended for DHW, Carriers, and Technical Support may come this way and will be redirected accordingly 36

36 Idaho Health Insurance Exchange Consumer Support Center (CSC) Projected Call Estimates Assuming 204,500 potential Uninsured Consumers who may contact the call center 164,000 individuals from % FPL 40,500 individuals from below 100% FPL (50% of total population) No Medicaid Expansion Assume 50% of individuals will call with an average call time of 4.5 minutes Projected call volumes are estimated to be 18,900 per month 37

37 Idaho Health Insurance Exchange Consumer Support Center Costs Quick Ramp Up for 10/1/2013 Customer Support Services Center 10 Contract Staff Equipment (Computers, Office Supplies, Phones) Office Space Indirect Costs Telecommunications Costs 38

38 Idaho Health Insurance Exchange What s Next There is still much to do before we are ready for Open Enrollment to begin on October 1 Over the next six weeks, the Exchange staff, board and vendors will be working tirelessly to ensure that we will have a robust offering of competitively priced plans available for Idahoans to chose from as well as resources available online, over the phone and in person around the state to help individuals, families and small businesses make the choice that best suits their needs Beyond 10/1/2013, IHIE has a lot of work ahead and decisions to be made to ensure long-term sustainability We need YOUR FEEDBACK, IDEAS, and CONCERNS Phase 2

39 Idaho Health Insurance Exchange FAQs

40 Common Questions Do I have to buy health insurance from the Idaho Health Exchange? No. The Idaho Health Insurance Exchange is not intended to compete with the existing insurance marketplace. Insurers can sell policies outside of the Exchange and individuals can purchase health insurance directly from a carrier or licensed agent outside of the Exchange. However, The Idaho Health Insurance Exchange is the one place where you can go to receive premium assistance to lower the cost of premiums if you or your family is eligible to receive it. Also if you currently have health insurance and are happy with your plan, you do not need to do anything. What if I have a pre-existing health condition, will I be denied coverage? No. Starting in 2014, no insurer can deny anyone health insurance based on health status. The Idaho Health Insurance Exchange will allow you to comparison shop for the health plans that meet your needs regardless of your health status. Will I get to keep my doctor if I buy through the Exchange? It depends on which plan that you choose to buy and if your doctor is a part of that network. When comparing plans on The Idaho Health Insurance Exchange, you will see a link to a list of doctors in each plan s network. If staying with your current doctor is important to you, you can check to see if they are included in the network before choosing a plan. It will be up to you to look for your doctor in the offered plans and choose the option that works best for you.

41 Common Questions If I shop on the Exchange, will my personal financial and health information be secure? State and federal laws already protect this type of information. You can also be assured that the Exchange will protect your privacy. This will be built into our online system as well as into every part of the financial and business operation. With the establishment of the Exchange will I still be able to buy insurance from my agent and broker. Yes, and there is no cost to you. Can I shop on The Idaho Health Insurance Exchange if I am not eligible to receive financial assistance? Yes, Idahoans can shop on The Idaho Health Insurance Exchange regardless of whether they are eligible for financial assistance.

42 Common Questions What are the essential health benefits that health plans on The Idaho Health Insurance Exchange will cover? All Qualified Health Plans (QHPs) that are sold on The Idaho Health Insurance Exchange have been certified by the Idaho Department of Insurance that they meet the minimum coverage requirements called the essential health benefits. These plans will include items and services within at least the following 10 general categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care

43 Common Questions Do I have to buy health insurance if I am currently uninsured? It s your choice. However, starting in January 2014, federal law will require most Americans 18 and older to have health insurance or pay a penalty. If you choose not to purchase a health insurance plan with basic minimum standards you could face a penalty of either $95 a year or 1% of your taxable income, whichever is greater. This penalty will increase over time: In 2015, it will be the greater of $325 per adult or 2 percent of taxable income. (Whichever is greater) In 2016, it will be the greater of $695 per adult or 2.5 percent of taxable income. (Whichever is greater) After 2016, the tax penalty increases annually based on a cost-of-living adjustment. Are there any exemptions to the penalty if I do not have a health insurance plan with basic minimum standards? The uninsured will not have to pay a penalty if they: Are uninsured less that 3 months of the year Are determined to be low income and coverage is considered unaffordable Not required to file a tax return because their income is too low Are a member of a federally recognized tribe

44 Common Questions Will The Idaho Health Insurance Exchange consumer assistance center be able to help Idahoans with limited English proficiency? Yes the consumer assistance center will handle inquiries and assist Idahoans in English, Spanish and have the capability to assist Idahoans in 150 other languages. How does The Idaho Health Insurance Exchange differ from websites that sell insurance now? The Idaho Health Insurance Exchange is an independent and central location where multiple insurance companies offer plans and compete for your business. Additionally, The Idaho Health Insurance Exchange is the one place where you can go to receive premium assistance to lower the cost of premiums if you or your family need it and are eligible to receive it.

45 Common Questions Who will pay for The Idaho Health Insurance Exchange? The implementation of The Idaho Health Insurance Exchange is funded by grants through the U.S Department of Health and Human Services. To date, Idaho has received $20.3 million dollars of grant money. Starting in 2016, The Idaho Health Insurance Exchange will be self-sustaining primarily through assessments. Why should I buy a health insurance plan for my family? Unexpected illness or accidents that require a visit to a doctor or hospital can happen to anyone regardless of age. Having health insurance can offer you protection from large medical bills which can give you and your family peace of mind.

46 Idaho Health Insurance Exchange QUESTIONS? Amy Dowd