The ACA and Healthcare Exchanges

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1 The ACA and Healthcare Exchanges 1

2 Key Healthcare Exchange Dates April 12, Governor Cuomo issued Executive Order #42 to establish Exchanges. December 14, New York Receives Conditional Approval to Operate State-Based Exchange April, 2012 Insurers will begin to decide Exchange offerings. October 1, 2013 Open Enrollment begins for January 1, 2014 coverage. 2

3 NY s Health Benefit Exchange Executive Order 42 Establishes HIX within DOH Requires Exchange to: Facilitate enrollment of qualified health plans and small businesses Enable individuals and small businesses to receive federal tax credits Convene regional advisory committees Become financially self-sustaining by January 1, 2015 as required by ACA 3

4 Anticipated Impact of HIX One million people will gain insurance Exchange enrollment is estimated to be 1.1 million: 615,000 in the Individual Exchange 450,000 in SHOP Exchange ¾ of enrollees will be eligible for subsidies NYS will save $2.3 billion per year as a result of enhanced federal Medicaid support 4

5 Essential Health Benefits The ACA defines certain categories of benefits as "Essential Health Benefits." The categories of essential health benefits are: 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 Pediatric services, including oral and vision care 5

6 Benchmark Plan On October 1, 2012, New York State selected Oxford EPO, the largest small group plan in the state, to serve as a benchmark for the 10 categories of coverage that plans are required to offer in the individual and small group markets both inside and outside Exchanges beginning in New York State will supplement the Oxford plan s current benefits, in order to meet ACA guidelines of 10 required services, in the following areas: Pediatric dental/vision coverage Habilitative services Mental health/substance abuse parity 6

7 Product Availability Products may be available both on and off the Exchange, however, all products must conform to the Essential Health Benefits, actuarial metal levels and have plan Out of Pocket Maximums equivalent to the federal HSA compatible highdeductible health plan regulations (For reference, in 2013: $6,250 single/$12,500 family). 7

8 Plan Metal Tiers New plans will be based on metal levels that correspond to the actuarial value of the plan. QHPs in the exchanges must offer at least a silver and gold level plan. Bronze (60 percent) Silver (70 percent) Gold (80 percent) Platinum (90 percent) 8

9 Tax Credits Tax credits will be available for qualifying small businesses. Credits will be based on the number of employees, average wages and percentage of employee s health insurance paid by employer. Tax Credits will only be available through the Exchange. 9

10 A picture of my kids because insurance talk can be dry. 10

11 Brokers/Producers in the Exchange Brokers play a large and important role in helping small businesses buy health insurance. 88 percent of small group coverage in New York is purchased through brokers. We feel really strongly that brokers are a crucial connection to small business, and we ignore them at our peril " -Troy Oechsner, Deputy Superintendent for Health, DFS 11

12 Brokers/Producers in the Exchange Producers will be invited to enter into agreements with the Exchange to enroll and service employers in qualified health plans and will be required to have an active producer s license and a certification of initial and ongoing SHOP specific education. If a producer s website is used to display the choices of qualified health plans, it must meet certain standards, including that it display all of the qualified health plans offered by the exchange. Web-brokers will not be used in the SHOP Exchange in However, New York is continuing to examine the potential use of web-brokers to distribute Exchange products. 12

13 Compensation Insurers will be required to apply the same commissions to small group products offered either inside or outside of the Exchange. The current average payout runs about 3.5 percent of monthly premiums - HMO policies are capped by law at 4 percent. While there have been assurances by the Exchange that at the outset, the Exchange will not fix producer compensation levels, we are hearing that there are discussions within DFS of capping compensation at 4 percent. 13

14 What will be the role of a broker in the Exchanges? We anticipate that many businesses will continue to purchase their insurance through brokers outside the Exchange. Those that purchase through the Exchange can choose to offer employees benefits in any combination of those offered, there will be no one size fits all ; All products By Insurer By Tier level 14

15 Significant Issues for Producers Small firms may simply offer employees cash to buy insurance on the Exchange defined contribution. This would significantly increase the cost of business if it requires sitting down with each individual employee. Agents and brokers are already the de facto human resources departments for many small companies: There is an expectation that brokers will need to expand services to maintain business. The New York Health Exchange s stated intention is to require all QHPs to offer a dental rider for essential pediatric oral services in any service area. Currently, most New Yorkers who have dental coverage receive that coverage from a standalone plan. 15

16 Good News & Bad News There is a commitment on the part of the Exchange to continue to utilize the valuable work and role of the broker community. Commissions will remain constant inside and outside the Exchange. Brokers will play a greater role and continue to add value, but as the Exchanges must become self-sustaining realities can change. 16

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