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Commonwealth Choice – Facilitator Model Patrick Holland Chief Financial Officer

Commonwealth Choice – Facilitator Model Patrick Holland Chief Financial Officer. Commonwealth Choice. Alternate distribution channel for the purchase of unsubsidized healthcare Competing with intermediaries & Carriers Exclusive distribution channel for Young Adults [age 19-26 inclusive]

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Commonwealth Choice – Facilitator Model Patrick Holland Chief Financial Officer

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  1. Commonwealth Choice – Facilitator ModelPatrick HollandChief Financial Officer

  2. Commonwealth Choice • Alternate distribution channel for the purchase of unsubsidized healthcare • Competing with intermediaries & Carriers • Exclusive distribution channel for Young Adults [age 19-26 inclusive] • Standardized benefit designs within coverage tiers • Range of affordable coverage options • Select and offer high value health plans

  3. Commonwealth Choice • Seal of Approval (SoA) • Approval of BOD indicating that a health benefit plan meets certain standards regarding quality and value • Carriers with 5,000 or more members required to respond to Health Connector SoA • SoA process intended to encourage innovation from Carriers

  4. Leverage Existing Market Indiv.& Families Voluntary Plans Small Business Young Adults

  5. Evolving Business Model • During recent SoA process, moving from non-standard to standardized benefit designs • Continue to simplify the shopping experience through website enhancements • Greater use of consumer-facing decision support tools • Small group options

  6. Goals of New Model • Promote transparency and standardization • Minimize disruption to existing members • Align choice of benefit designs with consumer demand • Use of focus group results • Market survey data

  7. Key Aspects of SoA • Carriers must respond to all proposed benefit designs • Continue to encourage “Select” or “Tiered” networks • If awarded SoA, selected carriers are required to participate in all tiers and products

  8. Key Aspects of SoA • Benefit Designs • Based on research of Commonwealth Choice members and non-members, SoA reflects; • Demand for choice of benefit designs and carriers • Balanced with need to make shopping experience easier • Price transparency also rated high by consumers • Influential on carrier price-point • Structure and refinement of most recent SoA reflects nearly two years of experience with exchange model

  9. SoA Results • Awarded SoA to all existing Carriers and approved a new market entrant • Carriers agreed to modify benefit plans to comport to Health Connector plan designs • Reduced number of benefit designs from 27 to 9 • New model allows consumer choice, but streamlines benefit design options • Clearer and easier shopping experience for consumer • Consistent with market research

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