New York s Commercial Health Insurance Exchange HealthPass New York

Transcription

1 New York s Commercial Health Insurance Exchange HealthPass New York

2 What is an Exchange? Health insurance marketplace using principles of managed competition (Alain Enthoven) Transparent and standardized benefit packages Offers choice of plans (comparison shopping) Develops menu of choices based on quality, access, and premium costs Enhances consumer experience

3 What s s in the Legislation? State-based health insurance exchanges - American Health Benefit Exchange (AHBE) (for individuals) and Small Business Health Options Program (SHOP) Exchange - Govt. agencies and non-profits eligible - Regional sub-exchanges optional Must be established by 2014 & self-sustaining by 2015 Will offer only qualified health plans Creates single risk pools (one each for individual and small group markets)

4 Exchange Functions Health plan certification, recertification, decertification Operate a toll-free member services hotline Create and operate Internet portal to compare plan and benefit options Rate each qualified health plan based on quality Determine subsidy eligibility for AHBE and administer small business health care tax credits Establish Navigator member education programs

5 Benefits of an Exchange Choice, Choice, Choice! (at the member-level) - Among plans, carriers, & provider networks Initially open only to 2-50 small groups. Groups with up to 100 will be eligible to enter January 1, : Sole source of small business health care tax credits Simplification of choices standardized choices - Bronze (60%), Silver (70%), Gold (80%), Platinum (90%) - Catastrophic plan: if member is under 30 years old

6 What Else to Expect? (That s s not in the reform bill) COBRA/NY State Continuation Coverage administration Advocacy services Ancillary offerings: dental, vision, AD&D, life, LTD, Rx discount cards, and other benefits Enhanced purchasing assistance

7 Exchange Comparison Success depends on regulatory environment Must be set-up to reflect and respond to unique, local insurance and health care market conditions - MA first focused on individuals - CBIA (CT): open to groups of employees - NY: Serves 2-50 small group Able to write down to groups of 1 Possible model off which to build Carrier participation - Currently, participation is voluntary - Seal of approval as a qualified health plan - Exchange must work with carriers to ensure and monitor partnership - Leverage of uninsured population to engage carrier participation

8 Carrier Participation Currently, participation is voluntary Participation in exchanges will continue to be voluntary A market inside and outside exchange Seal of approval as a qualified health plan Exchange must work with carriers to ensure and monitor partnership Leverage of uninsured population to engage carrier participation

9 Member-Centricity Health plan oversight on rates and quality Information on quality ratings, enrollee satisfaction levels to assist with purchasing decisions Internet portal Navigators - Public education - Facilitate enrollment - Info of availability of subsidies and tax credits

10 Role of Brokers & Licensed 3 rd Party Intermediaries States will decide procedures under which brokers may: - Enroll individuals and groups through the Exchange - Assist individuals in applying for premium subsidies and cost-sharing reductions HealthPass experience: Brokers are vital to success of exchange model!

11 HealthPass New York Health Insurance Exchange Started in 1999 Joint partnership between: New York Business Group on Health The City of New York Health insurance industry Our Non Profit Mission: Grant small businesses greater access to healthcare Help stem the tide of the working uninsured

12 What is HealthPass? Fortune 500 benefits for small businesses Employee-Choice model in Community Rated Environment Menu of carriers and benefits 4 Categories of Medical Plans - In Network Only - Cost Sharing - In & Out of Network - HSA Ancillary Options Dental Security Package (LTD/Life/AD&D) Advocacy Services COBRA & NY State Continuation Administration

13 How HealthPass Works Employers Choose: Tier Structure, Rx, Defined Contribution amount Ancillary offerings Employees Choose: From multiple carrier networks EmblemHealth Oxford Health Plan (United HealthCare) Group Health Inc. (GHI) HIP Health Plans of New York From 25+ medical plan designs From available ancillary lines (through Guardian)

14 Employer Benefits No need to pick one plan for different employees Curbs wasted healthcare spending Helps to attract and retain key employees Empowers employees to participate in making informed healthcare decisions Defined contribution sets a benefits budget Simplified administration Robust client support Home billing of COBRA and COBRA administration No need to shop for insurance every year

15 Employee Benefits A voice in a personal decision healthcare Choice of HMO, EPO, POS, PPO or HSA coverage Voluntary options - Dental and EverGuard Annual choice to meet individual healthcare and budget requirements Pre-Tax contributions minimize out of pocket costs Account Management, Health Advocate and Medical Cost Advocate provide personalized support

16 Participation Requirements To be eligible a company must: Be a small business (2-50 employees); have a downstate NY location 5 Boroughs of NYC Long Island Westchester, Rockland, Orange, Putnam, Dutchess, Ulster or Sullivan counties Have 75% of employees covered under any insurance plan Note: Sole Proprietor Coverage is also available

17 Enrollment Requirements All businesses must submit the following forms: HealthPass Notice of Election (group application) Required tax documents (i.e. NYS-45) HealthPass Enrollment/Change Form (ee application) Business Check Other requirements may include: Student verification forms HSA account setup forms Domestic Partner registrations/verifications

18 Meeting Our Mission Greater access to healthcare for small businesses Multiple medical carriers/networks 250,000+ providers Over 25 medical plan options 2 dental plans 2 bundled security products Advocacy Services Stemming the tide of the working uninsured 50% of participating employers had no prior insurance 35% of employees had no prior insurance

19 Organizational Staffing NY Office - Sales, Marketing, Member Services Executive Director Sales and Marketing Directors Broker Sales (1) GA Sales (1) Business Development (1) Public Policy (1) Marketing Manager (1) Account Executives (4) and Account Liaisons (2) Member Services Director Member Services/Operations (1) Renewal/Benefits Manager (1) and Executive (1) Member Services Manager (1) Member Services Representatives (4) Internal Staff Financial Manager HR/Office Manager Receptionist

20 Third Party Administrator Workable Solutions Inc Staff of ~50 ee s ~15 staff members dedicated to HealthPass 4 Case Managers Data entry representatives Financial oversight Billing and Commissions Financial reconciliation Customer Service IT department (maintains HP system) Ancillary product management

21 Start Up Financial Considerations Started in 1999 with $1 million in seed money from NYC ~3 million more over next 4 years between direct and indirect funding Self sustaining by early 2005

22 Enrollment As of March ,100 employers covered 18,500 employees covered 34,500 members covered Tremendous growth during 2009 Additional 12,000 net members covered Addition of Oxford Health Plan (UnitedHealthCare) in 2010

23 Post-Health Reform in NY HealthPass positioned to be SHOP Exchange for NY Maintain 4 attributes of exchange Offer choice of plans Provide information Simplify Administration Allow for portability of coverage Scalable platform Able to deliver subsidies

24 Post-Health Reform in NY HealthPass 2.0 Central figure in bending the cost curve NY pure community rating (other than geography) No individual incentives to live healthy lifestyles Limited ROI for carriers to promote disease management, wellness programs Health Insurance as a commodity Exchange maintain connection with enrollees who transition from carrier to carrier annually

25 Planning Considerations Small business health care tax credit - Available only through exchange NYS Exchanges may be established before 2014 Consider average annual wages and number of employees For groups of over 50 employees, consider: - Leveraging free choice vouchers - Penalties for not providing adequate or affordable coverage

26 Information Sources Business Council of NYS ; Local Chambers & other BCNYS coalition/business development members HealthPass ;

27 Questions

28 New York s Commercial Health Insurance Exchange HealthPass New York