Connecting with Brokers. Small Business Marketplace Manager Connect for Health Colorado

Transcription

1 Connecting with Brokers Small Business Marketplace Manager Connect for Health Colorado

2 Today s Agenda Where are we now? How will C4HC partner with Brokers What will happen on October 1 st? A vision for the evolving market in 2014 and beyond 2

3 Where are we now? New Branding more connected to our long term mission On target to open on October 1 st Carriers have submitted rates and Plans to DOI July 31 st date for plan/rate approval, rejection or modification 19 Participating Carriers with over 200 plan options All Savers Ins. Co. Anthem Denver Health Cigna ColoradoChoice Colorado HealthOP Humana Kaiser Permanente Rocky Mtn Health Plans SeeChange Health Ins. 10 Individual Health, 6 SHOP Health, 8 Dental Stand-Alone 3

4 Exchange Timeline Create policies for finance, audit, EHBs, and prevention of fraud Develop, implement and test web portal and customer service functions Test all systems Exchange launch (Oct. 2013) Coverage Begins Certify benefits and health plans Implement Certification program 4

5 Where are we now? C4HC Legislation and Funding o HB Passed the legislature and was signed into law Up to $1.80 per month assessment on individual, small group and reinsurance market subscribers - Replaces the CoverColorado assessment - Sunsets in 2016 Ability for Carriers to redirect up to $5,000,000 in Premium Tax o C4HC Exchange Service Fee = 1.4% of premium on exchange policies Accounted for in the claim portion of the MLR C4HC provides services to carriers (Marketing, Customer Service, Aggregated Billing) FFM fee is 3.5% o Federal Grant Funding 62.4 million to date Have requested another 123 million $$$ 5

6 Partnering with Brokers Brokers are a primary Distribution Channel Commissions will be the same inside and outside the exchange Certified brokers will become appointed with all carriers C4HC will support and collaborate with MGAs Brokers will receive extensive training prior to certification Brokers may administer accounts on behalf of their clients Consumers will not be required to use a broker C4HC will provide ongoing marketing ideas and support 6

7 The Certification Process Late June to July Brokers will register (hint - get on our list) August through October Initial Certification classes o o 4 hours of online prep work 16 hours of classroom instruction Classes to be given around the state Special arrangements for out of state brokers Open enrollment for Individual Marketplace 10/1/13 3/31/14 Small Group (SHOP) enrollment on a monthly basis 7

8 Sample Certification Materials Log-in: Brokers will be able to establish and administer client accounts Many function will be available on October 1 st o o o Account set-up and administration Proposals and Employer Applications Enrollment Including online Group Open Enrollments Future enhancements are planned Renewal management Improved Client Communications Data Import and Export Broker Branding 8

9 Web Based Entities The Federally Facilitated Marketplace is developing interface technology to enable Web Based Entities to quote Exchange plans and rates as well as provide initial APTC eligibility screening. Web Based Entities include Subscription Services (Quotit, Norvax, HealthConnect) MGA Quotation Systems Carrier Quotations Systems Large Agency Private Exchanges Private Custom Systems C4HC will be phasing-in connections to WBEs after 10/1/2013 9

10 What Happens on October 1st Website Access and Most Functions Completed Access to Broker, Individual and Employer Account Set-up Client Account Set-up Proposal Generation Individual and Group Enrollment 10

11 Existing In-Force Business Small Group o Shop and enroll on the 15th of any month for the 1st of next month Individual o Review APTC eligibility shop during open enrollment 10/1 3/31 o Facilitated Enrollment Option for existing accounts Full disclosure of consumer rights and ability to access Exchange No Mapping Ability to estimate APTC eligibility Facilitated by Carriers and Brokers Ongoing commissions 11

12 Employer Exchange Notice Oct. 1st View this message in your browser BROKER CONNECT May 21, 2013 Department of Labor Guidance on Employer Notices Earlier this month, the Department of Labor issued guidance regarding the notices that employers must provide to employees about Connect for Health Colorado's new insurance marketplace coverage options. The DOL s Technical Release No also included two model notices for employers: one designed for employers providing health insurance and one for employers that do not offer coverage. The original effective date for employer distribution of these notices was March 1, However, in January, the DOL announced that it would delay the effective date to better align with the opening of Connect for Colorado's marketplace. The new date for employer distribution of notices is October 1, After that date, employers will also be required to provide a copy of the notice to newly hired employees at the time of hiring or within 14 days thereafter. Only employers who are subject to the Fair Labor Standards Act (FLSA) will need to distribute the notice. Click here for exact language on the technical release Click here for a copy of the notice for employers providing insurance Click here for a copy of the notice for employers NOT providing insurance Click here for information on employers not subject to FLSA Jim Sugden Small Business Manager Jessica Dunbar Individual Market Manager Questions may be addressed to: Patti Meyer, small business health plan coordinator,

13 What Happens on January 1st Prohibited Underwriting: Gender SIC Health status Allowed: Age Tobacco Geographic area Family unit size 13

14 What Happens on January 1st Uniform Age Banding Implements the 3:1 aged band and prescribes uniform age bands in both the individual and small group markets o Child age band. Single age band for children age o o Adult age band. One-year age bands for adults, starting at age 21 and ending at age 63. Older adult age band. Single age band for adults aged 64 or older. 14

15 What Happens on January 1st Uniform Age Rating Curve Requirement of a uniform age rating curve in each state that all insurers must follow in setting their age-rated premiums. HHS believes this uniformity will simplify several elements of federal health reform and make them more likely to succeed in their implementation by o o o Enhancing transparency, predictability, and accuracy of the risk adjustment program Aiding in the determination of the second lowest cost silver plan to calculate APTC Making it easier for consumers to compare plans 15

16 What Happens on January 1st Tobacco Surcharge Insurers may impose a premium surcharge of up to 50% on tobacco users. (15% in Colorado) In the small group, this surcharge would be tied to a wellness program so that insurers can impose the charge only if they give enrollees the option of participating in a tobacco cessation program and waive the surcharge for those participants Employers may assign the entire Tobacco Surcharge to employee contributions 16

17 What Happens on January 1st Family Rating Family members age 21 and older are age and tobacco rated separately The first three children (age 0-20) are rated individually under the child age band Any additional children are not rated Example to follow 17

18 Example of Family Rating MOM DAD Adult Child, 24 Child, 20 Child, 17 Child, 14 Child, 10 Child, 5 = Family members included in premium rate

19 What Happens on January 1st Employer Contributions HHS outlines two options to determine employer contributions: 1) The ER pays a fixed percentage of each EE s age-rated premium, or 2) The ER generates a composite or average rate for all employees and then determines ER and EE contributions based on the composite rate *The ER pays a flat dollar amount or Defined Contribution (still some questions) 19

20 What Happens on January 1st Geographic Rating: States can establish up to 7 geographic rating areas within the state Guaranteed Issue: Requirement that issuers offer coverage to individuals and employers without regard to health status (limited exceptions such as fraud) Guaranteed Renewability: Issuers must renew coverage for individuals and employers (limited exceptions) Single Risk Pool: Issuers must treat the claims experience for their entire book of business in the individual market or small group as a single risk pool 20

21 What Happens on January 1st Life Change Events HIPAA Qualifying Events Changes of Income up or down 10% Opens a new consumer shopping period 60 days for individuals 30 days for employees 21

22 The Evolving Market 2014 and Beyond Producer view #1. 22

23 The Evolving Market 2014 and Beyond Producer View #2 23

24 The Emerging Market The Choice is Yours Advantages o Lots to talk about with prospects and clients o New Product Options - expanded options for your clients o New Consumer Opportunities Advanced Premium Tax Credit C4HC Premium Credit Estimator 24

25 The Emerging Market Advantages Individual Medical Guaranteed Issue! 25

26 Emerging Market New Group Opportunities o Employers with existing coverage Tax Credit - Small Business Tax Credit Estimator Enhanced Choice - to drive affordability o Employers without coverage Many will facilitate coverage for employees Pre-Tax Contributions???? 26

27 Emerging Markets Challenges Technology Embrace Invest Exploit Complexity Recommit to lifetime learning Excellence in what you offer to your clients Superb Client Communications Competition? 27

28 Emerging Opportunity Recognize your Unique Value Proposition Trust Creativity Reliability 28

29 Questions? 29