11/20/ Individual Exchange Navigator Training Indiana ACA Overview License:
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1 Indiana Qualified Health Plans in the Marketplace United Healthcare Nov. 6, 2014, updated Nov. 19,2014 Brad Lacey Director Exchange Operations IN / OH United Healthcare 2015 Individual Exchange Navigator Training Indiana Introduction to Exchange Lead Brad Lacey has been evolving with the health insurance industry for nearly 10 years. Brad has been instrumental in growing UnitedHealthcare individual broker line of business. Brad has also been able to run the fourth largest brokerage operation in the under 65 health insurance market for the past 2 years, increasing the company s profitability by 35% and issued premium by 53%. Now Brad is back home at UnitedHealthcare being a catalyst in offering a trusted name in the healthcare industry through the state exchanges in Indiana and Ohio. Agenda Overview Affordable Act (ACA) ACA Plans 3. Additional Provisions 4. UnitedHealthcare Resources Brad credits all of his success to his faith in God, supportive wife Cindi, and energetic boys named Noah and Elijah. 3 IN Individual ACA Health Plans 2015 Overview 2015 ACA Overview License: All Savers Insurance Company (ASIC) Exchange Model: The healthcare marketplace is approved, regulated and managed by the Federal Government
2 Outside the Marketplace vs. Marketplace Essential Health Benefits 2015 UnitedHealthcare Individual Exchange Health Plans Plans may appear different but certain attributes must be the same. Out-of-pocket Maximums Actuarial Value 7 8 Indiana Top Counties 1. Tippecanoe 2. Marion 3. Vanderburgh 4. Morgan 5. Monroe 6. Allen 7. Hendricks 8. Hamilton 9. Johnson 10. Madison 11. Delaware Indiana Network UnitedHealthcare Choice Provides freedom to choose from any network healthcare professional. Broad statewide coverage A Primary Physician is not required. Referrals to see a specialist are not required. In-network coverage only. On Exchange plan availability 9 10 Sample ID Card The Metallic Plan Levels Bronze Plan pays 60% Premium cost: Insured Cost: Per visit/ Prescription Plan pays 70% Gold Plan pays 80% Platinum Plan pays 90% $$$$ $$$$ $$$$ $$$$ $$$$ $$$$ $$$$ $$$$ May be a good fit for your client who: Rarely uses medical services. Wants to balance monthly premium cost with out-ofpocket expenses. Will manage monthly premium costs and reduced out-ofpocket expenses. Will manage higher premium costs for greater plan coverage. Lower cost option: Catastrophic A plan for individuals under age 30 or Exchange cover is deemed unaffordable (cost of health insurance exceeds 8% of the insured s income after subsidies)
3 ACA Provisions Portfolio Overview Essential Health Benefits (10 Categories) 1. Ambulatory Patient Services 2. Emergency Services 3. Hospitalization 4. Maternity & Newborn 5. Mental Health and Substance Abuse 6. Prescription Drugs 7. Rehabilitative & Habilitative 8. Laboratory Services 9. Preventive and Wellness Services and Chronic Disease Management 10. Pediatric Dental and Vision Must be Included in Plan States Define Coverage Traditional Copay HSA Catastrophic Plan Types Traditional style plans pay covered expenses after the client has met his or her calendar-year deductible. Convenience of set copays for doctor visits and prescriptions. Plans that include the option of a tax-advantaged savings account. Catastrophic plans for insureds under 30 or for those who are exempt from the ACA mandate HSA Contributions Level Cost-Sharing Reduction Plans (CSR) Single Plan: $3,350 Family Plan: $6, and Over: $1,000 Annually Member of FDIC 1 Million Health Savings Accounts $2 billion in assets Online banking Pre-paid Debit Card at no extra charge Easy account management For individuals and families whose income does not exceed 250% of the Federal Poverty Limit (FPL), there are special cost-sharing reduction versions of plans. These cost-sharing reduction (CSR) health insurance plans reduce the out-of-pocket expenses enrollees pay toward deductibles, copayments, and coinsurance. There are three different levels of -CSR Plans. All depend on income eligibility. As the table below demonstrates, the lower the enrollee s income, the higher the cost-sharing reductions the enrollee will receive. CSR Plan for Enrollees with Incomes up to 150% FPL CSR Plan for CSR Plan for Enrollees with Enrollees with Incomes up from Incomes from 151% 201% FPL to 250% FPL to 200% FPL FPL Standard Plan Portion of medical expenses typically paid by the health plan (i.e. actuarial value) Portion of medical expenses paid for by typical enrollee 94% 87% 73% 70% 6% 13% 27% 30%
4 In-Network Preventive All Plans Applies to all UnitedHealthcare ACA On-Exchange Health Insurance Plans: Copay Traditional HSA Catastrophic Plans Pediatric Vision & Dental In Network Bronze Copay 2000 Gold 1250 Gold 500 Platinum 250 Coinsurance per Plan: Bronze 4900 HSA % 20% 20% 30% 10% 20% 10% 0% 0% 0% Plan Benefits Apply with: No waiting period No deductible No coinsurance No plan copays Covered Services: Immunizations Routine Physical Exams Routine Health Screenings Routine Cancer Screenings Women s Preventive Services Contraceptives Tier 1 RX Prenatal if service qualifies as preventive care Covered Benefits Eye Exam Glasses Dental Check-up Member s Cost Deduct/Coins Limited to 1 exam every 12 months. Deduct/Coins Limited to 1 pair every 12 months. Deduct/Coins Limited to 2 cleanings every 12 months. 1 exam every 12 months Narrow Network Prescription Drug Plan What is it? Over 700 pharmacy locations in Indiana Pharmacy Chains include: Access Health Good Neighbor Kroger Leader Drug Stores Rite Aid SHOPKO Target Walgreens Wal-Mart IN Pricing Competitiveness Pricing Competitiveness Summary Indiana Market Individual Business Estimated 1/1/2015 On Exchange Lowest Plan Premium* by Rating Area Indiana, Single Age 40 As of 10/23/2014. Lowest vs Rating Area UHC On (01) Gary MSA 22% (02) South Bend MSA 8% (03) Elkhart Goshen MSA 16% (04) Fort Wayne MSA 19% (05) Non MSA, Northwest 9% (06) Kokomo MSA 15% (07) Lafayette MSA 11% (08) Muncie MSA 13% (09) Terre Haute MSA 15% (10) Indianapolis MSA 18% UHC On Source Anthem MDwise Assurant UHC On Source Anthem MDwise Assurant UHC On Anthem MDwise Assurant UHC On MDwise Anthem Assurant UHC On Source Anthem MDwise IU Health Plans Assurant UHC On Anthem MDwise Assurant UHC On Source Anthem MDwise IU Health Plans Assurant UHC On Source Anthem MDwise IU Health Plans Assurant UHC On Anthem MDwise Assurant UHC On Source Anthem MDwise IU Health Plans Assurant * Competitor rates reflect 2015 rate filing information (may not be approved/final rates) and are subject to change
5 Pricing Competitiveness Summary Indiana Market Provider Search Individual Business Estimated 1/1/2015 On Exchange Lowest Plan Premium* by Rating Area Indiana, Single Age 40 As of 10/23/2014. Lowest vs Rating Area UHC On UHC On Source Anthem MDwise IU Health Plans Assurant (11) Non MSA, East 15% UHC On Source Anthem SE Indiana MDwise Assurant (12) Non MSA, Southeast 6% Health SE Indiana UHC On Source Anthem MDwise IU Health Plans Assurant (13) Bloomington MSA 10% Health UHC On Source Anthem Assurant (14) Cincinnati MSA 18% UHC On Anthem Source MDwise IU Health Plans Assurant (15) Non MSA, Southwest 18% SE Indiana UHC On Source Anthem MDwise Assurant (16) Louisville MSA 30% Health UHC On Anthem MDwise Assurant (17) Evansville MSA 7% * Competitor rates reflect 2015 rate filing information (may not be approved/final rates) and are subject to change Additional Provisions Open Enrollment Special Enrollment Enrollment Dates ACA Plan Enrollment 2015 Application Date Effective Date Purchasing Time Frames Open Enrollment Dates November 15, 2014 February 15, 2015 Enrollment dates are significant to the plan effective date. 1 st 15 th of Month 1 st of Following month 16 th End of Month 1 st of Second Month after that
6 Special Enrollment ACA Plan Enrollment 2015 Purchasing Time Frames Special Enrollment Dates February 16, 2015 Next Open Enrollment period. A qualifying event is required to purchase health insurance during special enrollment. When Open Enrollment is over for the 2015 plan year, you may have clients without insurance coverage meeting federal guidelines. Special Enrollment Period 60 days following the qualified special event Qualifying Life Events Include Loss of Medical Coverage due to: Marriage Birth Death of Spouse/Dependent Adoption Maximum age Eligibility Location and Moving Eligibility Applying for Coverage An individual must reside in the state in which they are applying for the coverage. Moving to a Different State The current plan should be canceled by the customer. The client will enroll in a new plan in the new resident state. Special Enrollment Moving to a new state = Qualified Life Event Eligible Child The Client s or Client s Spouses Child Under age 26 Natural or Adopted Child Legal Guardianship Newborns are automatically covered from birth for 90 days. Written notice required within 90 days of birth Premium Payment After Open Enrollment, you may have clients without coverage that meet the federal guidelines. This document provides information to assist you when you have questions regarding Qualifying Life Events and enrollment timeframes. Initial Premium After the Enrollment file is received an invoice is sent to the applicant for the initial premium payment. The plan can be activated when payment is received. Ongoing Premium/Forms of Payment Payment by Phone Checking Account Payment Web Portal Credit Card Checking Account Payment Mail in Payment
7 2015 No-Coverage Penalty The No-Coverage Penalty for 2015 is the Greater of: 2% of Your Client s Income or $325 per Adult/$ per Child UnitedHealthcare Resources The Penalty applies per month that your client does not have health insurance. The Penalty does not apply to individuals who are uninsured less than 3 months. The Penalty payment is made on the Federal Tax Return Why UnitedHealthcare? myhealthcare Cost Estimator Broad Network Brand Recognition Company Financial stability Simplicity to enroll Broad Product Offering Consumer Transparency Tools Helps members easily find personalized information before seeing a doctor, helping them to "take charge of their health care and know more. Estimates used are based on available fee schedules or contracted rates (when fee schedules/contracted rates are not available, estimates are based on claims averages for the particular provider) Fully integrated with customer service and clinical support Once members know the 4 Ps Procedure, Provider, Price and Place there's no telling how far they can go in improving their health and increasing their savings Health4Me App Smart Patient App UnitedHealthcare Health4Me is designed to make managing a member s health a lot simpler Members can easily Share their ID card Check H.S.A. account balance Check claim status Access my Healthcare Cost Estimator Members can use their mobile device to get the most from their doctor visit Track the five numbers that are keys to good health Blood pressure Blood sugar Body mass index (BMI) Cholesterol Waist circumference Keep track of medical appointments Checklists to use at doctor visit Store text or voice notes Video tips
8 UHCtv Collaterals to Educate and Inform Consumers and Business Partners of UHC IHX Products and Services UHC TV is an online television network that presents relevant, focused, educational and entertaining video programs about good health and living well to help people get inspired to grow healthy and live better. From expert advice on healthy living to side-splitting comedy, it's available online anytime. Producer Guide Tri fold Pocket Guide Enroll Now Flyer Display Consumer Guide Live 11/15/2014 Navigator Guide Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Thank You This is a project of ACA Marketplace Stakeholders in Indiana, which invited all health insurance organizations participating in the ACA Health Insurance Exchange Marketplace to provide a quick overview of their plan options. We want to affirm that no preference is given to any provider, as the same template format and opportunity is provided to each of the health plan organizations. We d like to thank the following organizations for their support: Open Enrollment: November 15, February 15, 2015 Questions: Navigator Hotline uhc.com/navigator 45 uhc.com/join The ASPIN Health Navigator Project is supported by Funding Opportunity Numbers CA-NAV from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of oral, written, and electronic communications are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies unless cited otherwise. The UWW/IaUW Navigator was supported by Funding Opportunity Number CA-NAV from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 8
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