UPDATE: Small Business Marketplace. September, 2013

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1 UPDATE: Small Business Marketplace September, 2013

2 Agenda 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 2

3 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)

4 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

5 Who Will Enroll In NY State Of Health? Health Plan Marketplace enrollment is estimated to be 1.1 million New Yorkers Individual Marketplace (58%) 450, ,000 Small Business Marketplace (42%)

6 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, 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

7 Online Through the Exchange portal for new applications and administrative renewals Webchat for assistance In Person In Person Assistors and Navigators Agents and Brokers Informal Assistors Assistance available in many languages Phone Consumer Assistance Leverage current public program call center Assistance available in most languages 7

8 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

9 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 9

10 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 10

11 3 Types of In-Person Assistors 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 Insurance Brokers More than 2,000 brokers have already completed continuing education for the Marketplace Certified Application Counselors Hospitals, healthcare providers, health plans, others

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14 Qualified Health Plans 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Actuarial Values for Levels of Coverage 90% 80% 70% 60% Bronze Silver Gold Platinum

15 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

16 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 16

17 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 Contribution Options 76% of respondents believe this feature helps predict costs. 17

18 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 18

19 Small Business Health Care Tax Credit 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 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 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 19

20 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 20

21 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

22 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: 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.

23 Available Resources Website (Now) 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.)

24 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 updates

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26 NY Health Plan Marketplace Contacts Heather Rankin Small Business Marketplace Get regular updates at:

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