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Minimum Creditable Coverage Policy Committee Meeting January 22, 2007

Minimum Creditable Coverage Policy Committee Meeting January 22, 2007. Minimum Creditable Coverage. Establish the floor below which insurance products will not meet requirements of individual mandate Offer products that: Protect beneficiaries from catastrophic costs

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Minimum Creditable Coverage Policy Committee Meeting January 22, 2007

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  1. Minimum Creditable Coverage Policy Committee Meeting January 22, 2007

  2. Minimum Creditable Coverage • Establish the floor below which insurance products will not meet requirements of individual mandate • Offer products that: • Protect beneficiaries from catastrophic costs • Promote access to routine preventive care

  3. Minimum Creditable Coverage • Balance premium affordability with potential out-of-pocket costs • Encourage preventive care • Cover core medical services

  4. MCC Exclusions • Fee schedule based coverage • Limits per sickness/illness/annual/lifetime

  5. MA Non-Group Market (pre-merger) • 45,200 lives covered as of 12/31/05 • > 40% age 50 or older • < 20% under age 30 • Limited options • HMO or PPO, with or without Rx coverage • Over 85% enrolled in HMO products • Over 18,000 buy products w/out Rx coverage • 4,500 purchase high deductible PPO • $5,000/$10,000 deductibles (ind./fam.)

  6. National Non-Group Market • AHIP non-group survey conducted in 2004 • Broader and younger age distribution than MA market • > 35% under age 35 • < 30% age 50 or older • 85% enrolled in PPOs • Average deductibles ~ $2,000 • 20% co-insurance in network • 40% co-insurance out-of-network • Out-of-pocket maximums between $3,500 and $4,000

  7. MA Small Group Market (pre-merger) • 759,000 lives covered as of 12/31/05 • Over 85% enrolled in HMO products • Approximately 10% purchase policies with a deductible • Average deductible is less than $1,000 • In-network co-insurance is virtually non-existent • Average office visit co-payment -- $15-$20 • Inpatient admission co-payment is $250 • Increase in number of policies with $500 co-payment

  8. National Small Group Market

  9. National Small Group Market

  10. PC RECOMMENDATIONS • Acturial Value: 55% to 60% • O.O.P. Maximum: $5,000 / $10,000 • Maximum Deductible: $2,000 / $4,000 • Prescription Coverage: -Covered Medical Service -Generics covered pre-deductible • Routine/Preventive Office Visits: 2/4 vs 4/8

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