Connecticut Health Insurance Exchange

1. Connecticut Health Insurance Exchange A Vision for the Future CBP Kevin J. Counihan October 16, 2012

2. What Is An Insurance Exchange? • Organized marketplace for health plans to compete and offer services efficiently in the small group and individual markets • Not exclusive – markets will exist outside exchange • All enrollees in/outside exchange in single risk pool • Provides level playing field for health plans to comply with benefit requirements and consumer protections • Facilitates competition based on price, quality, and value

3. What Is An Insurance Exchange? • Options: • State-Based Exchange (CT) • Federal Partnership Program • Federal “Default” Exchange • Medicaid Expansion – 133% of FPL • Subsidized Coverage – 134%-400% of FPL receive tax credits to offset premium costs • Eligibility for subsidies and public coverage based on IRS Modified Adjusted Gross Income (MAGI)

4. Customer Service Functions • Create an “easy and simple” web portal for consumers, small businesses, brokers to shop and compare for health insurance • Provide call center for eligibility, subsidy, selection, and enrollment assistance • Brokers and “Navigators” for individual customer information and enrollment support • Assist determining eligibility for tax credits and subsidies

5. How It Works • The Exchange enrollment process is defined by 6 major steps 1 Enter Applicant Information 2 Carrier 6 Medicaid Process Application Verify With Data “Hub” 5 3 Complete Enrollment Display Plan Options 4 Select Plan

6. Existing State Exchanges • Massachusetts Connector • Merged Individual and Small Group markets • Quasi-governmental organization • 220,000 enrollees • Utah Exchange • Defined Contribution small group model • Part of Governor’s Office of Economic Development • 5,000 enrollees • Roughly 13 state-based exchanges in progress

7. CT Exchange - Opportunity • 10% of state residents uninsured • 344,000 individuals • 585,000 Medicaid enrollees • Project Medicaid increase of 115K enrollees • Expect 150-160K in state exchange • Majority newly eligible for subsidies • Roughly 10-20% will be small business enrollees

8. Employer Penalties • Penalties Apply to “Large” Employers • >50 Full-time “Equivalent” Employees • Based on Hours Worked – 30 per week • Excludes Seasonal Ees - <120 days per year • Large Employer Liabilities • At least 1 Ee receives Advance Premium Tax Credit (APTC) • No Coverage Offered • FTEs – 30 * $2,000 • Coverage Offered • 1 Ee Receives APTC • Ee’s Contribution to Single Coverage > 9.5% of household income • Coverage Offered below “Bronze” level (60% actuarial value) • Penalty = $3,000 per Ee – limited to Maximum of FTEs – 30 * $2,000

9. Key Functional Areas • IT Systems • Integrated Eligibility – “No Wrong Door” • Gap analysis complete • Business requirements • IT and Integration Architecture • Systems Integrator Procurement • Program Integration • Rules and support for DSS program management • Roles and responsibilities for CID, OPM, DRS

10. Vision For The Future • Create User-Friendly Shop and Enrollment Experience • Reduce Level of Uninsured • Provide for Health Insurance Options • Promote Innovation and Competition • Facilitate Discussion to Create More Affordable Health Insurance Coverage