Health Insurance Options for Small Businesses

Transcription

1 Health Insurance Options for Small Businesses 1

2 Presentation Outline Benefits of Offering Health Insurance to Employees Understanding Health Insurance Products - Health Insurance Models - Terminology Small Group Health Insurance Market - Health Benefit Exchanges - Membership Organizations - Healthy NY (Program Sunsets in 2014) 2

3 Benefits of Offering Health Insurance to Employees 3

4 Tax Credits Employer tax credits are currently available for up to 35% of premium costs Credits increase to 50% in 2014 for coverage purchased on the NYS Health Benefit Exchange Requirements: Less than 25 full-time employees Average annual wages of less than $50,000 Employer pays at least 50% of premium cost Non-profits also eligible 4

5 Lower Insurance Costs Businesses or organizations with up to 50 employees can obtain small group health coverage Group coverage is cheaper than individual coverage Spreading Risk = LOWER Costs! Allows employer and her family to obtain coverage at a group rate 5

6 Protections for Small Groups Guaranteed Issue - Can t be turned down based on health status of group Rate Restrictions - Premiums based on community rating and not on health status, age, gender, etc. Pre-existing Condition Exclusion - No exclusions for children (<19) and no exclusions for everyone else by 2014 Rate Review - Insurers must submit proposed rate increases for review to the Department of Financial Services 6

7 Stronger Workforce Health insurance can lead to employees being - Healthier - Happier - Committed Greater commitment leads to less employee turnover Retention of talented employees 7

8 Understanding Health Insurance Products 8

9 Private Health Insurance Models Indemnity or Fee-for-Service Managed Care - Preferred Provider Organization (PPO) - Health Maintenance Organization (HMO) - Point of Service (POS) Consumer Directed Health Arrangements - High Deductible Health Plans Health Savings Account Health Reimbursements Arrangements 9

10 Terminology Premium - Cost of coverage, paid on a regular basis whether insured is sick or not Co-payment - A flat fee paid for each medical service received Deductible - Set amount of money paid before an insurance starts paying for covered benefits Co-insurance - A set percentage paid for covered services received 10

11 Terminology (continued) Out-of-pocket limit - Maximum out-of-pocket amount beneficiary will pay for covered benefits in a year Annual coverage limit - Maximum amount insurance will pay in a year Lifetime maximum o $2 million cap (as of September 2012) o No maximum cap come 2014! - Maximum amount insurance plan will pay for covered expenses in the course of beneficiary s lifetime 11

12 Cost Sharing Who Pays? Individual Insurance Company Deductible Co-Insurance Out-of-pocket limit Annual Coverage limit (until 2014) $0 $1,000 $2,000 $100,000 $2 million Source: Modified from ehealthinsurance: How Health Insurance Works video 12

13 Small Group Coverage Options 13

14 Small Group Market Finding Coverage Independent Brokers - Experienced and knowledgeable on plan designs - Enrollment assistance NYC Health Insurance Link: nyc.gov/hilink - New York City coverage options - Web Interface to compare plans - Contact information to enroll directly with insurers Healthcare.gov: finder.healthcare.gov - Web interface to compare plans - Contact information to enroll directly with insurers 14

15 Health Benefit Exchanges Online marketplaces where small businesses can purchase insurance products Buyers can compare plans apples-to-apples Diverse health plan options Streamlined application Single bill for employers More choices for employees Lower administrative costs 15

16 NY SHOP Exchange Basics New York State administers the Small Business Health Options Program (SHOP) Exchange Initial open enrollment: October 1, 2013 March 31, 2014 Coverage begins January 1, 2014 Tax credits up to 50% for small businesses purchasing coverage on the SHOP Marketplace like Orbitz with an interface like Turbo Tax Only for small businesses (with up to 50 employees) Up to 100 employees in ,000 small business employees expected to get coverage 16

17 NYS SHOP Objectives Reduce burden of administering health benefits - Simple application - Clear options - One bill Robust customer support - By phone - Online - In person Enrollment Assistance - In Person Assistors/Navigators - Brokers 17

18 A One-Stop SHOP Registers with the SHOP Selects plans Sets premium contribution Manages account Eligibility request Employee receives invitation Registers Select plan & coverage Enrolled Eligibility verification Display eligible plans & rates Enrollment completed

19 Private Exchanges HealthPass Serving NYC, Long Island, Westchester, Rockland, Orange, Putnam, Dutchess, Sullivan and Ulster Long Island Association Health Alliance Serving Long Island, NYC, Westchester and Rockland Bright Choices Exchange Serving New York State, except North Country, with coverage primarily in Western NY, Hudson Valley and NYC 19

20 Membership Organizations Potential Health Insurance Partners Chambers of commerce, unions, alumni, trade, and professional associations may offer insurance products Membership is usually required Must meet requirements set by the organization Research is required to find organizations you and/or your employees can participate in and obtain coverage from Tip: Think broadly and look under an organization s benefits section 20

21 Healthy NY Subsidized Coverage: Small Business Eligibility Business located in NY State 1-50 eligible employees At least 30% of employees earn $40K or less No group health insurance in last 12 months 50% of the eligible employees will participate Employer contributes at least 50% of premium Must be offered to all employees working 20+ hours per week and earning $40K or less Sole proprietor plans also available 21

22 Healthy NY Subsidized Coverage: Benefits and Cost High deductible for new enrollees - $1,250 (individual) / $2,500 (family) Covers most medical services, with copays Drug Coverage optional EXCLUSIONS: Mental Health; Substance Abuse; Chiropractor; Hospice; Ambulance; Vision; Dental; DME Can exclude pre-existing conditions - If applicant uninsured more than 62 days (two months) $250-$500/month for one person. Prices vary by plan and county. 22

23 Healthy NY Subsidized Coverage: Program Future Healthy NY program will conclude for individuals and sole proprietors on December 31, 2013 January 1, 2014 sole proprietors will be moved to the individual market Small businesses with 2 50 will be transitioned to ACA compliant plans 23

24 Help For All New Yorkers Assistance for Small Businesses and Consumers 24

25 More Resources NY State Health Benefit Exchange: Health Care For All New York: Community Health Advocates: Hotline: (888) HHS Information: Congressional Budget Office: Kaiser Family Foundation: Community Catalyst: ACA: 25

26 The End / Questions 26