mn.gov/commerce/insurance

Transcription

1 On behalf f Minnesta cnsumers, the Cmmerce Department thrughly reviews prpsed rates and plans frm insurance cmpanies t ensure that the rates are sensible and the plicies cmply with Minnesta and federal law. The Minnesta Department f Cmmerce cmpleted its health insurance rate review fr new plicies available fr Open Enrllment n MNsure Nvember 15, 2014 thrugh February 15, While many states will release final rates in the next few weeks, cmparisns t metrplitan areas already apprved and their 2014 rates indicate that Minnesta s rates will remain the lwest in the cuntry and the Midwest. Cnnect with Minnesta Department f Cmmerce at: mn.gv/cmmerce/insurance In accrdance with the Americans with with Disabilities Act, Act, this this infrmatin is is available in in alternative frms f f cmmunicatin upn cmmunicatin request by calling upn request by calling

2 One f the reasns why rates are lw fr Minnestans can be credited t the strng rate review prcess that has been in place since 1993, bth in the individual and the small grup health insurance marketplaces. Over 20 years f requiring a minimum lss rati has helped keep premium rates dwn and kept Minnesta a natinal leader in health refrm. Further, insurers and health care prviders imprvements in quality and efficiency cntinue t play a large rle in delivering lwer health care csts. Cnnect with Minnesta Department f Cmmerce at: 2 mn.gv/cmmerce/insurance

3 4.5% Average Rate Increase fr 2015 Individual Market The average rate increase fr the fur cmpanies returning t MNsure this year is 4.5%, ranging frm a decrease f percent t increases f 1.8%, 8.12%, and 17.15%. Blue Plus filed rates this year as a newcmer t the MNsure marketplace. This year MNsure will again have five cmpanies cmpeting fr Minnesta cnsumers, with the additin f Blue Plus and the departure f PreferredOne. Minnesta s Rate Review Cmpetitive Rates & Psitive Results fr Cnsumers Minnesta has been a leader in rate review refrm and has been designated by the federal gvernment as a state with an effective rate review prgram. This means that all prpsed rate increases are scrutinized by expert actuaries t make sure that the rates requested are justified. Public health and regulatry experts als review the filings t assure that netwrks are accessible, plans prvide cmprehensive cverage, and that carriers ffer benefit designs that meet federal guidance. Minnesta is ne f 31 states that can deny requested rates based upn whether the rates are justified. The actuarial analysis prvided by the Cmmerce Department in the rate review prcess helps t ensure accuracy, apprpriateness, and cmpetitin, resulting in lwer csts fr individuals, families, and businesses that buy insurance. The Department s actuaries cnduct statistical analyses and clsely scrutinize the assumptins that health insurance cmpanies use t develp rates. Cmmerce Department staff als reviewed all plicy frms t ensure they include the cnsumer prtectins in state law. The new plans available during Open Enrllment include many cnsumer prtectins like making all plicies available t every Minnestan, even thse with pre-existing health prblems and expanded benefit sets that prvide free preventative care. In 2015, all Minnestans will have the cnsumer prtectin and peace f mind t knw that their rates will nt g up based n whether they were sick the previus year the first state in the natin t accmplish this gal. Cnnect with Minnesta Department f Cmmerce at: 3 mn.gv/cmmerce/insurance

4 Access Mnsure Cvers Minnesta Brder-t-brder cverage is available n MNsure. Acrss the state, Minnestans can chse frm up t five insurance cmpanies ffering plans in brnze, silver, gld, and platinum levels. 78% f Minnesta cunties have three r mre health insurance cmpanies ffering plans in their cmmunities, and 67% f Minnesta cunties have fur r mre health carriers ffering plans. Cnsumers in the Twin Cities Metr Area can chse frm five health insurance cmpanies fr their health cverage. Cnnect with Minnesta Department f Cmmerce at: 4 mn.gv/cmmerce/insurance

5 Increased Prduct Offering Acrss All Gegraphic Areas Cmmerce apprved rates fr 150 plans fr MNsure 84 plans fr individuals and 66 fr small emplyers. Mre prduct chices are ffered acrss the state grwing in each regin. Prduct Chices by Regin: 2014 v Cnnect with Minnesta Department f Cmmerce at: 5 mn.gv/cmmerce/insurance

6 Apprved Rates The Starting Pint fr Mre Savings Amng the rates apprved by the Cmmerce Department the fllwing diagram shws the lwest mnthly base rates fr plans in the Minneaplis/St. Paul Metr Area that will be available thrugh MNsure this Open Enrllment, Nvember 15, 2014 t February 15, Minnestans can purchase plans thrugh MNsure t receive financial help and tax credits, which can lwer yur cst. Lwest Mnthly Premium Rates* (Saint Paul/Minneaplis Metr Area) 25 Year-Old 40 Year-Old 60 Year-Old Brnze Silver Gld Platinum $ $ $ $ Brnze Silver Gld Platinum $ $ $ $ Brnze Silver Gld Platinum $ $ $ $ *Listed rates are the base rates and d nt include financial assistance that is available thrugh MNsure. Financial help and tax credits are available n MNsure t help cver the cst f health care insurance premiums fr qualifying individuals. Sme Minnestans may qualify fr lw-cst r free plans. Visit r cntact yur agent r brker fr mre infrmatin. Metal Levels A Cnsumer-Friendly Way t Cmpare Plans Minnesta cnsumers will have the ptin t chse frm fur categries f health insurance plans, als knwn as metal levels brnze, silver, gld, and platinum. The difference in the metal levels is the cst share paid by the insurance cmpany versus the cnsumer. Individuals wh chse a higher metal level will pay a higher mnthly premium, but will pay less in their cpay and deductible. Brnze level the plan must cver 60% f expected csts fr the average individual. Silver level the plan must cver 70% f expected cst fr the average individual. Gld level the plan must cver 80% f expected csts fr the average individual. Platinum level the plan must cver 90% f expected csts fr the average individual. Cnnect with Minnesta Department f Cmmerce at: 6 mn.gv/cmmerce/insurance

7 Small Grup Three cmpanies are apprved t sell small grup health plicies n MNsure Blue Crss and Blue Shield, Blue Plus, and Medica. Small Grup Trend Drps By Mre than 50% 12.00% Annual Rate Increase 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% Small Grup Rates On average, the small grup rates are nly 3-4% higher than This year s rate increase in the small grup plans n MNsure is less than half f the trend experienced by small grup plans previusly. In the years , the average rate increase trend hvered just under 8%. On average, small grup rates in 2014 were abut 2% higher than that yearly trend. Small grup cmpanies have paid ut n average between 81% and 86% f their premium incme in payment fr medical expenses fr plicyhlders. Cmmerce believes the small grup health market will remain stable with gd cmpetitin. Small businesses in Minnesta are experiencing price cnsistency in the new plans available in 2014 due t cmmunity rating, rather than health status, allwing fr year-t-year business planning and financial stability. Individual Market Small Grup Market 1. Blue Crss and Blue Shield f Minnesta 2. Blue Plus 3. Grup Health, Inc. (Health Partners) 4. Medica 5. UCare 1. Blue Crss and Blue Shield f Minnesta 2. Blue Plus 3. Medica Cnnect with Minnesta Department f Cmmerce at: 7 mn.gv/cmmerce/insurance

8 The Chice is Yurs Multiple Plan Optins by Cunty and Rating Area This map shws which health insurance cmpanies are available in yur rating area and cunty. Cnnect with Minnesta Department f Cmmerce at: 8 mn.gv/cmmerce/insurance

9 Rating Area 1 Plans Available in 2015: Blue Crss & Blue Shield and Medica Sme carriers prvided new ptins up t -13.3% less than their plans in 2014 Five times mre prduct fferings fr cnsumers, including platinum plans Regin 1: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 9 mn.gv/cmmerce/insurance

10 Rating Area 2 Plans Available in 2015: Blue Crss & Blue Shield, Health Partners, Medica, and UCare Sme carriers prvided new ptins up t % less than their plans in mre prducts fferings available Regin 2: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 10 mn.gv/cmmerce/insurance

11 Rating Area 3 Plans Available in 2015: Blue Crss & Blue Shield, Blue Plus and Medica - New Cmpany, Blue Plus Sme carriers prvided new ptins up t -2.7% less than their plans in mre prduct fferings available Regin 3: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 11 mn.gv/cmmerce/insurance

12 Rating Area 4 Plans Available in 2015: Blue Crss & Blue Shield, Blue Plus, Health Partners and Medica New Cmpany, Blue Plus 26 mre prduct fferings available in Regin 4: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 12 mn.gv/cmmerce/insurance

13 Rating Area 5 Blue Crss & Blue Shield, Blue Plus, Health Partners, and Medica New Cmpany Blue Plus 26 mre prducts fferings in Regin 5: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 13 mn.gv/cmmerce/insurance

14 Rating Area 6 Blue Crss & Blue Shield, Blue Plus, Health Partners, and Medica New Cmpany Blue Plus 22 mre prduct fferings available in Regin 6: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 14 mn.gv/cmmerce/insurance

15 Rating Area 7 Blue Crss & Blue Shield, Blue Plus, Health Partners, Medica, and Ucare New Cmpany Blue Plus Sme carriers prvided new ptins up t % less than their plans in new prduct fferings available Regin 7: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 15 mn.gv/cmmerce/insurance

16 Rating Area 8 Blue Crss & Blue Shield, Blue Plus, Health Partners, Medica, and UCare New Cmpany Blue Plus Sme carriers prvided new ptins up t % less than their plans in new prduct fferings available Regin 8: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 16 mn.gv/cmmerce/insurance

17 Rating Area 9 Blue Crss & Blue Shield, Blue Plus, Health Partners, Medica New Cmpany Blue Plus 16 new prduct fferings available Regin 9: Number f Health Prduct Optins Cnnect with Minnesta Department f Cmmerce at: 17 mn.gv/cmmerce/insurance

18 Greater Benefits, Added Value Starting last year, Minnestans health plans cntained additinal value. Cnsumers d nt have t wrry abut lsing cverage due t their health r pre-existing cnditins. Cnsumers cannt be charged based n their health status. Cnsumer benefits are cvered under the new plans t keep Minnestans healthy. What new benefits are included in plans n MNsure? The health insurance plans ffered thrugh MNsure and in the standard insurance market are guaranteed t prvide basic levels f cverage and prvide cnsumer prtectins including the 10 categries f essential health benefits: 1. Ambulatry patient services 2. Emergency services 3. Hspitalizatin 4. Maternity and newbrn care 5. Mental health and substance use disrder services, including behaviral health treatment 6. Prescriptin drugs 7. Rehabilitative and habilitative services and devices 8. Labratry services 9. Preventive and wellness services and chrnic disease management 10. Pediatric services Plans n MNsure ffer many chices Minnestans can cmpare metal levels, netwrks, benefits, mnthly premium cst, and deductibles all priced cmpetitively t allw cnsumers t chse the health cverage that fits their financial and health needs. Cnnect with Minnesta Department f Cmmerce at: 18 mn.gv/cmmerce/insurance

19 Health Insurance Rate Review Frequently Asked Questins What are the Nine Rating Areas? Area 1 Ddge Fillmre Freebrn Gdhue Hustn Mwer Olmsted Steele Wabasha Winna Area 2 Carltn Ck Itasca Kchiching Lake Lake f the Wds St. Luis Area 3 Blue Earth Faribault Waseca Le Sueur Martin Nicllet Rice Watnwan Area 4 Brwn Cttnwd Jacksn Lincln Murray Nbles Pipestne Redwd Rck Area 5 Big Stne Chippewa Kandiyhi Lac Qui Parle Lyn McLed Meeker Renville Sibley Swift Yellw Medicine Area 6 Becker Clay Duglas Grant Otter Tail Ppe Stevens Traverse Wilkin Area 7 Aitkin Beltrami Cass Chisag Crw Wing Hubbard Isanti Kanabec Mille Lacs Mrrisn Pine Rseau Tdd Wadena Area 8 Anka Bentn Carver Dakta Hennepin Ramsey Sctt Sherburne Stearns Washingtn Wright Area 9 Clearwater Kittsn Mahnmen Marshall Nrman Penningtn Plk Red Lake Cnnect with Minnesta Department f Cmmerce at: 19 mn.gv/cmmerce/insurance

20 What is an "effective" rate review prgram? Minnesta has been designated by the federal gvernment as a state with an effective rate review prgram. This means that all prpsed rate increases are scrutinized by expert actuaries in the public interest t make sure the rates requested are justified. This analysis helps t mderate premium hikes, which results in lwer csts fr individuals, families, and businesses that buy insurance. Hw des an "effective" rate review system perate? An effective rate review system perating t review rates fr 2014 and later must d the fllwing: Receive sufficient data and dcumentatin cncerning rate increases t cnduct an examinatin f reasnableness f the prpsed increases. Cnsider the factrs belw as they apply t the rates: Medical cst trend changes by majr service categries Changes in utilizatin f services (i.e., hspital care, pharmaceuticals, dctrs ffice visits) by majr service categries Cst-sharing changes by majr service categries Changes in benefits Changes in enrllee risk prfile Impact f ver- r under-estimate f medical trend in previus years n the current rate Reserve needs Administrative csts related t prgrams that imprve health care quality Other administrative csts related t prgrams that imprve health care quality Other administrative csts Applicable taxes and licensing r regulatry fees Medical lss rati The impacts f gegraphic factrs and variatins The impact f changes within a single risk pl t all prducts r plans within the risk pl; and The impact f reinsurance and risk adjustment payments and charges under sectins 1341 and 1343 f the Affrdable Care Act. Make a determinatin f reasnableness f the rate increase under a standard set frth in state statute r regulatin. Pst any rate filings that increase rates 10% r mre n their websites r pst a link t the preliminary justificatins that appear n the CMS website: Prvide a mechanism fr receiving public cmments n prpsed rate increases. Reprt results f rate review t CMS fr rate increases subject t review. Cnnect with Minnesta Department f Cmmerce at: 20 mn.gv/cmmerce/insurance

21 What was the timeline fr reviewing 2015 prpsed rates? June 27, 2014 Minnesta insurance carriers rate filings were submitted fr review by the Minnesta Department f Cmmerce, Insurance Divisin. Sixty Days After Filing The rate reviewer has 60 days t review and issue a decisin n all health insurance rates filed with the Department. If the rates meet the requirements f Minnesta Law, they are apprved. If the rate filing is unjustified, an bjectin letter is sent t the insurance carrier requesting clarificatin and/r additinal infrmatin. As stated under Minnesta Statutes sectin 60A.08, subd. 15, health insurance rate filings are available fr the public t view after they are apprved and becme effective. Nvember 15, 2014 Rate filings are effective fr mst health insurance plans with benefits that begin in Rate filings are psted fr the public t view n the Cmmerce Department website nce they are effective. Wh reviews the rates? Health insurance rates are reviewed by the experts in the actuarial unit at the Minnesta Department f Cmmerce. The Cmmerce Department als reviews the rates submitted by Health Maintenance Organizatins (HMOs) under an interagency agreement with the Department f Health. Must health insurance cmpanies submit rate filings each year? Health insurance cmpanies need t submit rate filings fr new plans and if they are requesting change in rates fr an existing plan. What plans are reviewed? All health insurance rates must be apprved by the Minnesta Department f Cmmerce r the Minnesta Department f Health prir t becming effective, as required in Minnesta Statute sectin 62A.02. Are any health plan rates nt subject t review? Rates that stay the same frm year-t-year are nt generally subject t review if the health insurance plan has nt changed. Any rates that have increased r are new must be apprved by the Department f Cmmerce r Department f Health. Hw des rate review affect my premium? The terms rate and premium are ften used interchangeably when discussing insurance. Hwever, thse terms represent tw different things. Rate: A rate is the average an insurance cmpany charges fr a defined package f health Cnnect with Minnesta Department f Cmmerce at: 21 mn.gv/cmmerce/insurance

22 insurance plans. Fr example, the rate fr yur insurance might be $300 per persn per mnth. Premium: The amunt that yu and/r yur emplyer pay fr health insurance. Fr example, if a plan cvers five peple at a rate f $300 per persn per mnth, the premium is $1500 per mnth. Hw ften can premiums g up? In 2014 and later, rates fr individual health plans will change nce a year, n January 1. Rates fr small emplyer grup cverage will change nce a year, n the grup's plicy anniversary. What factrs affect rates? Individual and small grup health insurance rates are determined fr a particular plan f benefits frm a particular netwrk f dctrs and hspitals based n the cmbined medical csts f everyne in that cmpany s market fr a particular age, tbacc use, and gegraphic area. This is called cmmunity rating the rates are based n the csts f the entire cmmunity. The rising cst f medical care impacts rates. With cmmunity rating, yur premium may g up even if yu haven t received any medical services, if the average cst f services has increased. What factrs affect my premiums? In general, hw much a health plan cmpany charges depends n the fllwing: Yur age and the age f any family members in yur plan; Whether r nt each persn 18 r lder uses tbacc; Where yu live; and The benefits in yur health plan. Hw d health plan cmpanies develp rates? Health plan cmpanies develp rates using estimates f future claim csts, administrative expenses, and hw much reserves they need t hld. Claim csts: The amunt a cmpany expects t pay fr health care services and gds, such as physician services, hspital fees, and prescriptin drugs, n behalf f all plicyhlders with similar plicies. Administrative expenses: The cst f running a health plan. These csts can include: salaries f emplyees; csts t maintain cmputer systems t pay claims; csts t manage the prvider netwrk (signing up dctrs, setting payment rates, etc.); cmmissins fr agents and brkers (called prducers ); rent; taxes, fees, and assessments that health plans pay t the State r federal gvernment; and ther csts t administer the plicy (fr example, fraud detectin and preventin activities). Cntributin t reserves: Mney that an insurance cmpany has left after paying fr claims and administrative expenses. The reserves are needed t pay fr claims and administrative expenses in years when the plans d nt cllect enugh premiums t cver thse csts. Cnnect with Minnesta Department f Cmmerce at: 22 mn.gv/cmmerce/insurance

23 What d yu cnsider when reviewing a rate request? All health plan rate filings must meet these criteria: Lifetime and anticipated lss rati meets the state's minimum f 71% t 82%; Rates are sufficient t cver expected claims and expenses; Rates prvide a reasnable value t the insured; and The filing is cmplete, crrect, and understandable In rder t demnstrate that the abve criteria are met, the filing must include at least the fllwing infrmatin: Histrical infrmatin, such as when issued, any changes in benefits, rates, r prfitability; Histrical experience including premiums, claims, enrllment, and duratinal/seasnal patterns since inceptin f plicy frms; Statistical reliability f histrical experience; Assumptins used in prjecting the future lss rati anticipated changes in claim cst per persn and enrllment. The reasns fr a rate increase, such as benefit changes, ppulatin changes, tax and fee changes. Hw des the Department f Cmmerce decide whether t apprve r bject t a requested rate change? Apprved- If the filing is clear and justifies the filed rates, the filing is apprved and the health plan cmpany is ntified that the rates may be used. Objectin- If the infrmatin in the filing is nt clear r des nt justify the filed rates r rate increase, the Department f Cmmerce sends an bjectin letter t the filing cmpany. This bjectin must be sent within 60 days f when the Cmmerce Department receives the filing. If n bjectins are sent within 60 days the rates are deemed apprved, which means the cmpany can g ahead and use them. The filing cmpany then has 30 days t prvide a cmplete filing, r the filing may be clsed withut apprval. If the filing cmpany fails t justify the filing within the 30 days r any lnger perid apprved by Minnesta Department f Cmmerce, the filing is permanently clsed. After the filing is clsed, the cmpany can make anther rate filing. D rate changes always get apprved? N. A decisin is made fr each filing as t whether the rate is apprved r nt apprved. What if the health plan cmpany disagrees with the decisin? The health plan cmpany can request a hearing, and have a judge decide whether the Department's decisin nt t apprve a filing was reasnable r unreasnable. Will my premiums g up as a result f health refrm? Many health plan changes will ccur because f health care refrm. New plans will be available Cnnect with Minnesta Department f Cmmerce at: 23 mn.gv/cmmerce/insurance

24 and cmpanies must accept everyne fr cverage regardless f their health r any pre-existing diagnses. Because f these changes, insurance is likely t cst mre fr sme peple and less fr thers. T make cverage affrdable, many peple wh buy cverage n their wn in the individual market will be eligible fr financial help t buy a plan. Peple yunger than 30 years ld wh cannt affrd cverage can buy a catastrphic plan, which cvers less and csts less. The Affrdable Care Act (ACA) helps individuals in the fllwing ways: Yu may get better cverage and pay less ut f pcket in deductibles and cpays. Yu will n lnger be denied cverage by insurance cmpanies if yu have a health cnditin. What causes my premium t increase at a different rate than thers with the same insurance plicy? If yu buy yur wn health insurance r have cverage thrugh yur emplyer, yur premium may change each year because yu have: Reached a higher age; Added a new family member t the plicy r drpped cverage fr a family member; Mved t a different lcatin; r Changed benefits. In additin, if yu have cverage thrugh yur emplyer, yur premium may change due t: Changes in the average age r family size f the grup as a whle; r Yur emplyer is paying mre r less f the ttal premium. If yur rate increased, and yu buy yur wn health insurance, check with yur insurance carrier t find ut the exact cause. If yu have cverage thrugh yur emplyer, yur human resurces benefits ffice may be able t prvide this infrmatin. Why did my health insurance premiums g up when I didn t have any claims (didn t see a dctr, g t the hspital r get any prescriptins)? Yur premium will nt g up slely because yu have claims, just as it will nt g dwn slely because yu d nt have claims. Insurance is a pling f risks, s individuals pay a share f the pled experience in exchange fr nt assuming the full risk f their wn medical csts. If yu have an individual r small emplyer plicy, yur premium is based n the claims f everyne with yur type f plicy. If yu have cverage under a large emplyer health plan, yur premium is based in part n the claims f everyne in the grup. What is the public s rle in the rate review prcess? While the prpsed rates are nnpublic data prir t the apprval and effective date, yu can cmment n the rate review prcess by ing: healthinsurance.ratecmments@state.mn.us r tweeting us Wh can I cntact if I have questins abut the rate review prcess? Yu can call the Department f Cmmerce at r (Greater Minnesta) Cnnect with Minnesta Department f Cmmerce at: 24 mn.gv/cmmerce/insurance