Individual Healthcare Marketplace 2016

Transcription

1 Individual Healthcare Marketplace 2016 This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does not constitute legal, tax, compliance or other advice or guidance. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2 Training Requirement to Sell Individual In order for a producer to sell Health Insurance Marketplace plans (and receive compensation) in Texas, a producer must register as an agent/broker with the Federally Facilitated Marketplace. This process is managed by the Centers for Medicare and Medicaid Services (CMS). 1. Producers who are CMS-certified in the Individual Marketplace can sell and receive compensation for both Marketplace retail plans and non-marketplace retail plans. 2. Producers who are NOT CMS-certified in the Individual Marketplace can only sell and receive compensation for non-marketplace retail plans. The training that follows includes important product and benefit information to ensure your success when helping clients with 2016 products. 2

3 Training Topics Products Product Overview Naming Structure Plan Design Components Major Medical Products Marketplace Plans Comparison Charts Non-Marketplace Plans Comparison Charts Catastrophic Plans Out-of-pocket Costs Deductibles Out-of-Pocket Limits Copayments Network Information Network Coverage Out of Network Benefits Rates & Pricing Dental/ Ancillary Products Pediatric Vision Benefits Dental Benefits Wellness Benefits Rules Affecting Rates 1. Age Bands 2. Family Demographics 3. Benefit Design 4. Tobacco Use 5. Geographic Rating Areas Retail Shopping Cart (RSC) Marketplace Shopping Non-Marketplace Shopping Retail Shopping Cart Videos Pharmacy Benefits Benefit Structure How to Read Drug List Prior Authorization Step Therapy Preferred Pharmacy Network 3

4 Product Overview

5 Product Overview Naming Structure BCBSTX is offering several new major medical products in the under 65 retail market. These products were developed to give consumers many options. The naming structure will help you find the product best suited for your clients. For the product named, Blue Choice Silver PPO 004, the naming structure breakdown is as follows: Blue Choice Silver PPO 004 Branding All names start with Blue Network Name Indicates the name of the network Metallic Level Indicates the metal level of the product: Bronze, Silver, Gold or Platinum. Catastrophic products are also available Modifier Differentiates between plans on the same network in the same metal level Network Type HMO, PPO 5

6 Product Overview Plan Design Components 1. Essential Health Benefits 2. Deductibles 3. Out-of-Pocket Costs 4. Per Occurrence Deductible 5. Out-of-Network Benefits 6. Copayments 7. Prescription Drug Tiers Name Ded OPX Coins OV / SPC ER RX Sample Plan $2000 $4,000 30% $40/$60 $600 $0 / $10 / $50 / $100 / 30% 6

7 Major Medical Products

8 Major Medical Products for BCBSTX On Exchange Plans Metallic Plan # Ded OPX Coins OV/SPC copay ER Per Occurrence Deductible** IP Per Occurrence Deductible** OP Per Occurrence Deductible** Rx Gold Blue Advantage Gold HMO 101 $500 $5,250 70%* $20 / $40 $500 $300 $200 Gold Blue Advantage Gold Plus 101 $2,750 $3,500 80%* $10 / $20 $400 $200 $200 Silver Blue Advantage Silver HMO 102 $2,000 $6,850 70%* $40/$60 $600 $500 $300 Silver Blue Advantage Silver HMO 103 $3,500 $3, %* 100%* 100%* 100%* 100%* $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* 100%* 100%* Silver *After Deductible Blue Advantage Silver Plus 102- Three $0 PCP visits $3,250 $6,850 80%* 80%* after free visits $600 $400 $300 **Per Occurence Deductible then Annual Deductible and Coinsurance $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* 8

9 Major Medical Products for BCBSTX On Exchange Plans Metallic Plan # Ded OPX Coins Bronze Blue Advantage Plus One $0 PCP Visit $6,800 $6,850 80%* OV/SPC copay 80%* after free visit ER Per Occurrence Deductible** $950 IP Per Occurrence Deductible** OP Per Occurrence Deductible** $750 $400 Rx $12/80%*/70%*/60%*/50%* $17/75%*/60%*/50%*/50%* Bronze Blue Advantage Plus Bronze 104 $4,500 $6,450 70%* 70%* 70%* 70%* 70%* Bronze Blue Advantage Bronze HMO 006 $6,000 $6, %* 100%* 100%* 100%* 100%* Bronze *After Deductible Blue Advantage Bronze HMO Two $40 PCP Visits $6,750 $6,850 70%* 70%* after $40 visits 70%* 70%* 70%* **Per Occurence Deductible then Annual Deductible and Coinsurance 80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%* 100%* 100%* 80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%* 9

10 Major Medical Products for BCBSTX Off Exchange Plans Metallic Plan # Ded OPX Coins OV/SPC copay ER Per Occurrence Deductible** IP Per Occurrence Deductible** OP Per Occurrence Deductible** Rx Gold OFF Exchange only: Blue Advantage Gold HMO 111 $0 $6, %* $40 / $70 $750 copay $1,500 copay per day $500 copay $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* Gold Blue Advantage Gold HMO 101 $500 $5,250 70%* $20 / $40 $500 $300 $200 Gold Blue Advantage Gold Plus 101 $2,750 $3,500 80%* $10 / $20 $400 $200 $200 Silver Blue Advantage Silver HMO 102 $2,000 $6,850 70%* $40/$60 $600 $500 $300 Silver Blue Advantage Silver HMO 103 $3,500 $3, %* 100%* 100%* 100%* 100%* $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* 100%* 100%* Silver *After Deductible Blue Advantage Silver Plus 102- Three $0 PCP visits $3,250 $6,850 80%* 80%* after free visits $600 $400 $300 **Per Occurence Deductible then Annual Deductible and Coinsurance $0/$10/$50/$100/70%* $5/$15/$60/$110/70%* 10

11 Major Medical Products for BCBSTX Off Exchange Plans Metallic Plan # Ded OPX Coins Bronze Blue Advantage Plus One $0 PCP Visit $6,800 $6,850 80%* OV/SPC copay 80%* after free visit ER Per Occurrence Deductible** $950 IP Per Occurrence Deductible** OP Per Occurrence Deductible** $750 $400 Rx $12/80%*/70%*/60%*/50%* $17/75%*/60%*/50%*/50%* Bronze Blue Advantage Plus Bronze 104 $4,500 $6,450 70%* 70%* 70%* 70%* 70%* Bronze Blue Advantage Bronze HMO 006 $6,000 $6, %* 100%* 100%* 100%* 100%* Bronze *After Deductible Blue Advantage Bronze HMO Two $40 PCP Visits $6,750 $6,850 70%* 70%* after $40 visits 70%* 70%* 70%* **Per Occurence Deductible then Annual Deductible and Coinsurance 80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%* 100%* 100%* 80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%* 11

12 Catastrophic Plans Eligibility requirements remain the same: Under 30 years of age OR receive hardship exemption from Marketplace Catastrophic plans meet QHP requirements Only covers 3 PCP visits at copay per year (then deductible coinsurance) Monthly premium is lower, but out-ofpocket may be higher Available On- and Off-Exchange 12

13 Out-of-Pocket Costs

14 Out-of-Pocket Costs What counts toward Deductibles and Out-of-Pocket Maximums? Deductibles (In-Network) All Medical expenses excluding Copayments and Per-Occurrence Deductibles Out-of-Pocket Maximums (In-Network) Deductibles Per-Occurrence Deductibles Copayments (including Rx) Coinsurance What is excluded from Deductibles and Out-of-Pocket Maximums? > Premiums > Claims for uncovered services > Preauthorization penalties 14

15 Deductible and Out-of-Pocket Limits In 2016, the ACA mandated maximum out-of-pocket limits are: Individual: $6,850 Family: $13,700 Family deductible and OPX will be 2-3x individual When a family OPX has been met, all members are considered to have met the OPX regardless of whether an individual has met their deductible When an individual hits their own deductible, their coinsurance benefits kick in even if a member has family coverage Pediatric dental deductible and OPX are separate from medical, no cross accumulation

16 Network Information

17 Member Out-of-Pocket Expenses Remember, copays and per occurrence deductibles do not feed into the deductible. All other claims feed into the deductible. Out-of-Pocket (OPX) includes: Annual Plan Deductibles Per Occurrence Deductibles Medical Plan Copays Coinsurance amounts RX Covered pharmacy costs; particularly helpful for chronic conditions including asthma, diabetes, etc In the ACA world, the OPX is more critical to the average customer than the deductible is. 17

18 Network Information for BCBSTX Network Coverage Network Offering Service Area Marketplace or Non Marketplace Metallic Levels Blue Advantage HMO (Introducing New HMO Plus products which includes out of network benefits) Statewide Both Gold, Silver, Bronze 18

19 2016 BCBSTX Plan Changes BCBSTX will not be offering the Blue Choice PPO for retail members enrolled in an ACA-compliant plan (those individual members who buy their own insurance and are not enrolled in a grandfathered plan). Members currently in the ACA-compliant PPO plans will have their plan discontinued and will be transitioned to another plan. In addition to our Blue Advantage HMO product, we will be adding an HMO Plus product with benefits for out-of-network care, called Blue Advantage Plus. There are some providers who were in our individual PPO plan that will no longer be an in-network option for our individual HMO members. The HMO Plus product is different from the HMO and you should be clear when selling it. 19

20 Out-of-Network Benefit Changes Significant changes for 2016 Out-of-Network deductibles and coinsurance amounts are higher Members utilizing Out-of-Network Services will incur higher cost sharing Out-of-Network Services will not be capped at an out-of-pocket maximum Members utilizing Out-of-Network Services will incur expenses up to the amount actually charged Applies to PPO plans HMO plans do not have Out-of-Network benefits except for emergencies 20

21 HMO Plus Product What is it? HMO In-Network with Out-of-Network benefits available Member s chooses PCP Referrals required to see specialists Member may receive care from non-network providers but will incur greater out-of-pocket costs 21

22 HMO Plus Product Blue Advantage HMO Plus On and Off Exchange In-network utilization maximizing lower cost-sharing for members PCP referrals for service receive in-network benefits Leverages existing Blue Advantage HMO network Plan name only includes Blue Advantage Plus 22

23 PPO vs. HMO vs. HMO Plus 23

24 Pharmacy Benefits

25 Prescription Drug Benefit Structure Drug Card or Coinsurance after medical deductible One drug list (also known as formulary) Generics Plus, with drug exclusions Generics Plus Drug List: A generics plus drug list is essentially a leaner version of the standard drug list (less choices in the preferred brand category) We are utilizing a five-tier prescription benefit structure, with two of those tiers for generics (preferred and non-preferred) The five-tier structure drives utilization towards generic prescriptions Prescription Tiers Cost Example 1 Generic: Preferred $0 Hydrochlorathiazide 2 Generic: Non-Preferred $10 Valsartan-Hydrochlorathiazide 3 Brand: Formulary $35 Crestor 4 Brand: Non-Formulary $75 Advair 5 Specialty $150 Humira 25

26 How to Read the Drug List 26

27 How to Read the Drug List 27

28 How to Read the Drug List Generic pravastatin Tier 1 (generics in small bold) Brand PRAVACHOL Tier 4 (brands CAPITALS) +Step Therapy 28

29 Prior Authorization (PA) Designed to promote patient safety and use of the drug as intended by the manufacturer and the FDA Requires members to meet certain criteria before particular drugs are covered Physicians are required to obtain certification of medical necessity prior to drug dispensing Existing prior authorizations for current members will be transitioned If member has previous approval will look for approval and enter override Members who were with other carriers need to go through the PA process No coverage if request is denied 29

30 Step Therapy Encourages use of safe, clinically appropriate and most costeffective drugs Program requires that a member use a generic/formulary product before other agents will be covered Example: pravastatin tried and failed before Crestor If member cannot take first line agent or has tried and failed, their doctor can request authorization Members who have received previous authorization will not need to go through the program except for PPI, Pain and glucose test strip programs No coverage if request is denied 30

31 Quantity/Dispensing Limits Limits placed to promote appropriate use and prevent stockpiling, e.g., Ambien: 30 tablets per 30 days Limits are based on: FDA approved dosing Drug manufacturer dosing recommendations National published guidelines Package size Evidence from peer-reviewed literature Limits are approved by a committee of physicians and pharmacists from a variety of specialties A dispensing limits drug list is posted on our website and member can submit a letter of medical necessity if they need a larger quantity 31

32 Specialty Pharmacy Program Specialty medications are used to treat conditions such as multiple sclerosis, rheumatoid arthritis, cancer and cystic fibrosis Medications are limited to a 30-day supply Self-administered products are standardly covered under the pharmacy benefit while physician administered products are covered under the medical benefit 50% out of network penalty if members do not use Prime Specialty Pharmacy 32

33 Member Pay the Difference Program (MPTD) Requires members who fill a brand name prescription for which there is an exact generic equivalent to pay the brand copay or coinsurance plus the difference in cost between the brand and generic drug Only impacts drugs with an EXACT generic equivalent MPTD applies to deductible if plan has deductible shared with medical benefit (bronze plans) Penalty applies to the OPX: once OPX met no penalty is charged 33

34 One Drug List/Formulary for All Plans All exchange plans will be moving to the Generics Plus Drug List/Formulary Generics Plus Formulary: A generics plus formulary is essentially a leaner version of the standard formulary and includes both non-specialty and specialty drugs for all major therapeutic categories. Less choices in the preferred brand category Members who were on the Standard Drug List/Formulary may be impacted by certain drugs changing from a preferred brand status to a non-preferred brand status 34

35 Top Impacted Drugs (moving to Non-Preferred) Top Impacted Drugs Vyvanse Advair Diskus Lyrica Ciprodex Pataday Voltaren Lialda Vigamox Benicar Colcrys Xarelto Benicar HCT Prednisone Solution Androgel Pump Lotemax Linzess Dulera Suboxone Vesicare Lumigan 35

36 Preferred Pharmacy Network/ESN Benefits will now contain a preferred retail pharmacy network (except IL HMO and 100% cost sharing plans) A preferred retail pharmacy network allows members to pay the lowest copayments/coinsurance at a network of pharmacies designated as preferred Members would pay a higher copay/coinsurance at non preferred pharmacies (any pharmacy in the network not designated as preferred) 90 day supply at retail will only be available at the preferred network pharmacies 36

37 Preferred Pharmacy Network/ESN Texas CVS Walmart HEB Brookshire s Access Health 37

38 Medical versus Pharmacy Coverage Self administered medications (including self injectables) covered under the pharmacy benefit Physician administered medications (including infused medications) covered under the medical benefit Specialty drugs are either pharmacy benefit or a medical benefit If a specialty medication is not on the drug list then refer to the medical benefit for possible coverage 38

39 90-Day Delivery Options Limited Extended Supply Network (ESN) Members can obtain a retail 90-day supply at a limited network of pharmacies Align limited ESN with preferred pharmacies only Available at three times the retail copay Mail Order Program Members can obtain up to a 90-day supply of maintenance medications through the mail Prim is the mail order pharmacy Available at three times the retail copay 39

40 Other Benefit Exclusions The following items are excluded from the pharmacy benefit: Compound drugs Weight loss Impotency Infertility OTC equivalents Repackaged medications Any drug not listed in the Drug List (also known as formulary) 40

41 Other Benefit Considerations Insulin/syringes: copay applies for both even if filled on the same day Oral oncology $0 copay for oral cancer medications 30 day supply limit at retail/ 90 days at mail 50% out of network penalty retail (No OON for HMO) Vaccines covered at retail pharmacies 41

42 Dental/Ancillary Products

43 Pediatric Vision Pediatric Vision Benefits Available to children up to age 19; up through age 18 Embedded in each medical product, premium is included in medical rate Davis Vision will administer vision products and adjudicate all claims Vision offerings are based off of FED VIP benchmark plans identified by HHS. They include: Offerings include Eye Exams (one annually) and Frames (one pair in a category of frames) or Contact Lenses No member cost sharing for vision services, except for HSA plans with cost sharing for frames and contact lenses 43

44 Ancillary Products: Dental Dental Products Overview Family and child-only dental products are available. Marketplace dental products and non-marketplace dental products available. Dental product deductibles and out-of-pocket maximums are separate from major medical product deductibles and out-of-pocket maximums. There is no cross accumulation. Pediatric dental benefits available to children up to age 21 44

45 Ancillary Products: Dental Pediatric Dental Rules The following benefits are covered for both Family and Pediatric products and are subject to coinsurance and deductibles. Routine Dental Services Diagnostic evaluation Diagnostic radiograph Preventative Basic Dental Care Miscellaneous preventive services Basic restorative Non-surgical extractions Non-surgical perio Adjunctive services Endodontics Oral surgery Surgical perio Major Dental Care Major restorative Prosthodontics Miscellaneous restorative and Prosthodontic services Orthodontia Added Provisions with Pediatric Dental Unlimited annual and lifetime maximums applied both in and out of network No waiting periods for in network benefits Medically necessary orthodontia Out-of-pocket maximum applied for in network only 45

46 Ancillary Products: Dental Pediatric Dental Rules Marketplace Dental Plans We will offer family and child only dental products. Plans are available on the FFM through BCBSIL or other issuers Non-Marketplace Dental Plans After a buyer selects a medical plan, he/she will have the option to purchase a stand-alone dental plan. If a buyer chooses not to purchase a stand-alone dental plan then reasonable assurance must be captured that he/she already has an ACA compliant pediatric dental plan. A child only dental plan (pediatric benefits) will be added with the medical product if we do not receive reasonable assurance from the buyer that they already have an ACA compliant dental plan. Once we receive the confirmation that they have an ACA compliant pediatric dental plan, the child only product will be removed. Dental products can be purchased without purchasing medical Marketplace plans or non- Marketplace plans. 46

47 Ancillary Products: Dental Dental Pricing 2016 Dental Product will continue to with member-based rating Maximum of 3 dependents (age 0-21) will be rated on a family plan, additional children are added at no charge 47

48 Wellness Benefits Wellness Offerings (Non HMOI plans) Well ontarget Member Wellness Portal: Health Assessment Blue points program Health trackers Self-directed wellness courses Fitness Program: Discounted gym membership to a nationwide network of fitness centers 24/7 Nurseline: Around the clock, toll-free access to registered nurses for health information, as well as an audio library Utilization Management: Pre-authorization, notification, prospective review concurrent review, discharge planning, and post-service review CCEI A skilled team of CCEI clinicians reaches out to the identified members before, during, and after a hospital admission and offer education and support as needed HMOI plans: Well ontarget, Fitness Program, and Behavioral Health Condition Management: Health professionals work with members and physicians to help better manage the following targeted conditions: asthma, diabetes, coronary artery disease and low back pain Longitudinal Care Management: Proactive, longer-term management of members with complex but relatively stable conditions to prevent health deterioration and adverse events (such as hospitalizations). Special Beginnings: Gives expectant moms support and education from early pregnancy to six weeks after delivery. Case Management: Services include alerts (emergency room/transportation), potential and actual high dollar claimants, Integrated Grand Rounds, chronic kidney disease/end stage renal disease, hip/knee replacement and multiple comorbidities (three or more). Behavioral Health: Licensed behavioral health professionals help members access services and offer support for conditions like anxiety, depression, eating disorders, substance abuse and other mental health disorders. 48

49 Rules Affecting Rates

50 Rules Affecting Rates Rating Characteristics 1. Age Bands Ages 0-20 have a single age band Ages have their own, individual year age bands Ages 64+ have a single age band 3:1 age rating ratio for adults age 21 and older Premium for a 64 year-old can be rated no more than 3 times the premium of a 21 year-old 2. Family Demographics The maximum number of dependents (age 0-20) that will be rated on a family plan is capped at 3 Dependents age 21+ do not count toward the cap Spouses under age 21 do not count toward the cap 3. Benefit Design Metallic Level & Actuarial Value Cost Sharing Network 50

51 Rules Affecting Rates Rating Characteristics 4. Tobacco Use Two tiers: tobacco use vs. non-tobacco use 6 month look back for tobacco use Issuers are permitted to rate for tobacco use within a ratio of 1.5:1 Our tobacco use rates are 10-33% higher than our non-tobacco use rates 5. Geographic Rating Areas Geographic rating will be by county, not zip code Based on the address of the primary insured, even if any member on a policy has a different address than the primary insured To see state-specific Geographic Rating Areas, visit Initiatives/Health-Insurance-Market-Reforms/stategra.html 51

52 Retail Shopping Cart (RSC)

53 Retail Shopping Cart Marketplace Shopping: Two Pathways Producers intending to work with consumers in Texas, which is a Federal Partnership Marketplace state, will be able to assist consumers to apply for and purchase Marketplace plans in two ways: (a) an issuer-based pathway, through which a producer uses an issuer s website, such as the BCBSTX Retail Shopping Cart, to assist the consumer, or (b) a Marketplace pathway, through which a producer assists the consumer by directly accessing the Federally Facilitated Marketplace (FFM) Both pathways transmit producer identifying information to us so that you will be compensated for sales of BCBSTX Marketplace plans. Both pathways allow a producer to assist a qualified individual with initial enrollment and changes during the coverage year, including changes that impact eligibility. 53

54 Retail Shopping Cart Before You Begin: What Your Clients Need for Marketplace plan shopping 1. Social Security Numbers or document numbers for legal immigrants (proof of U.S. citizenship or legally present) 2. Current Blue Cross Blue Shield plan information (if applicable) 3. Valid address is highly encouraged (required if using debit/credit card) 4. Primary Care Physician (PCP) information (if choosing an HMO product) 5. Payment Information (debit, credit, check or money order) 54

55 Retail Shopping Cart Express Link works with the Retail Shopping Cart and supports enrolling consumers in both Marketplace and non-marketplace plans. Process when shopping Marketplace products during Special Enrollment Period Process when shopping Non-Marketplace products during Special Enrollment Period Window shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans. Create a shopping account with us. We ll take you to the Marketplace where you ll get your results and complete your enrollment. We ll send you a bill. Shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans. Create a shopping account with us. Complete enrollment and payment at BCBSTX.com. 55

56 Retail Shopping Cart Express Link works with the Retail Shopping Cart and supports enrolling consumers in both Marketplace and non-marketplace plans. Process when shopping Marketplace products during Open Enrollment Period Process when shopping Non-Marketplace products during Open Enrollment Period Window shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans. Create a shopping account with us. We ll take you to the Marketplace. Apply for your credit and get your results. Come back to our site and submit your payment. Shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans. Create a shopping account with us. Complete enrollment and payment at BCBSTX.com. 56

57 Retail Shopping Cart: Shopping During Special Enrollment This Flow Chart Illustrates a Producer-Led or Producer-Generated process from Express Link through Enrollment Express Link Connect Member to RSC Retail Shopping Cart Census Page User enters Census Data Tax Credit Estimate Plan Results User shops and compares Off Exchange Confirm & Enroll Complete Enrollment and Payment through RSC On Exchange Enrollment Official Determination from Healthcare.gov Direct Enrollment Process

58 Retail Shopping Cart: Shopping During Open Enrollment This Flow Chart Illustrates a Producer-Led or Producer-Generated process from Express Link through Enrollment Express Link Connect Member to RSC Retail Shopping Cart Census Page User enters Census Data Tax Credit Estimate Plan Results User shops and compares Off Exchange Confirm & Enroll Complete Enrollment and Payment through RSC On Exchange Enrollment Official Determination from Healthcare.gov Direct Enrollment Process

59 Retail Shopping Cart BCBSTX Pathway for Open Enrollment Period Consumers complete the Marketplace eligibility application process. When complete, they are moved back to the BCBSTX shopping website to complete payment, please see wireframes on next slides. 59

60 Direct Enrollment Users are connected to Healthcare.gov from Retail Shopping Cart. Users obtain their eligibility via HC.gov then return to Retail Shopping Cart to shop and enroll for an On Exchange Plan. 60

61 My Account Returning from Healthcare.gov users will be promoted to sign into their RSC account. Users will then be able to view their applicant s as well as their eligibility results from Healthcare.gov. 61

62 Plan Results After clicking on view plans users will be navigated to the plan results page. On plan results users can view the new plan premium with their official APTC applied to the premium. 62

63 Confirm and Enroll After users select an OnX plan on plan results they will be navigated to the OnX Confirm and Enroll. On this page users can select an OnX dental plan and view their selected plan details, then click enroll to begin the enrollment process. 63

64 Attestation The attestation page is the first page of direct enrollment. The tax payer must read and attest to the statement prior to moving forward in the enrollment process. 64

65 Terms The second page of the direct enrollment process is the terms page. On this page users read all of our terms & agreement, acknowledgements, etc. After accepting all the terns the user can move to the next page. 65

66 Other Information The other information page gathers information from users regarding any other BCBS plans, replacement coverage and special communication needs. 66

67 Payment The payment page gathers the users payment information, payment & billing preference as well as billing information. The payment page is broken down into 5 pages and is available in Spanish. 67

68 Review and Sign On the Review and Sign page users can verify their plan, applicant, payment details and PCP/MG selection are correct. If all the items look correct, they user can sign and submit their application. 68

69 Finish The finished page is the last page of web enrollment. It informs the user of what is to come, i.e. welcome kit, as well as other useful links about being a Member of Blue Cross Blue Shield and items for their records. 69

70 Payment Redirect Page

71 Finished Page

72 Retail Shopping Cart View Retail Shopping Cart videos For more details on the Retail Shopping Cart, go to the BCBSTX Blue Access for Producers SM website. Log in to your account. 1. Click on the Individual icon. 2. Select the Training and Administration link. 3. Scroll to the Individual Products Training link and find the Retail Shopping Cart (RSC) Recorded Demo videos, which are accessed via Dropbox. 72