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Different Perspectives PowerPoint Presentation
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Different Perspectives

Different Perspectives

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Different Perspectives

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  1. Healthcare Exchanges Different Perspectives

  2. Today’s Speakers • Rick Elliot - President and CEO United Healthcare of Georgia What to Expect in 2014 • Lurline Craig-Burke, Partner GHSC Atlanta Business Leader – Mercer The State of the States • Makela McDermott – Total Rewards Director – Euramax International Our Radical Change to a Private Exchange

  3. Level Setting:What Are We Talking About?? • What is an Exchange? NEAR TERM • Mechanism for individuals and groups to gain access to health care financing options through a program administered by the state and/or Federal government (PUBLIC EXCHANGES) • American Health Benefits Exchanges (AHBE) for individuals & • Small Health Options Plans (SHOP) for small groups (under 50 or 100 defined by state) • Can be combined

  4. Things an Exchange Must Do • Implement procedures for certification, recertification, and decertification of health plans • Operate a toll-free hotline • Maintain Internet website with standardized information • Assign a rating to each plan • Utilize standardized format for presenting options • Inform individuals of eligibility for Medicaid, CHIP or other applicable state or local public programs • Certify exemptions from individual mandate 2011 National Association of Health Underwriters

  5. Things an Exchange Must Do • Make available a calculator to determine the actual cost of coverage after tax credits/subsidies • Grant a certification attesting that the individual is not subject to the coverage mandate because: • there is no affordable option, or • the individual is exempt from the mandate • Transfer to the Treasury a list of exempt individuals and employees eligible for tax credits/subsidies • Provide to each employer the name of employees eligible for tax credit • Establish a Navigator program 2011 National Association of Health Underwriters

  6. Exchange Basics • The Exchange must be operated by a governmental agency or nonprofit entity created by the state. • The Exchange must make “qualified” plans available to individuals or employers. • The Exchange must provide for: • Initial open enrollment period • Annual open enrollment period • Special enrollment periods 2011 National Association of Health Underwriters

  7. Exchange Basics • Must offer Qualified Health Benefits and offer at least one Silver and Gold option • Meeting Network Adequacy requirements • Provide Essential Health Benefits • Meet Actuarial Value benefits requirement • Bronze (60%) • Silver (70%) • Gold (80%) • Platinum (90%) • Originally SHOP was to allow employees to choose from multiple plan options, but…..won’t happen in 2014

  8. Private Exchanges • Carriers may not be required to participate in Public Exchanges • Potential to participate in both; expect to see an uptick in Private Offerings • Subsidies not available in Private Exchange • Carrier sponsored, Vendor Sponsored, Association Sponsored • Differentiation based on services and coverage provided, administrative services, billing consolidation, ancillary benefit offerings, wellness, and more

  9. What Else??? • Don’t Panic - It’s just insurance! • Pay or Play Decision guides your decision process • Expect Changes – and look beyond the cost • Defined Contribution and Productivity will be the new watch words • Self-funding is coming And, from one of the driver’s of Reform

  10. Senator Max Baucus • D – Montana, Senate Finance Committee Chairman • "We need data. "You never give me any data. You give me concepts, frankly.“ • “My main concern is that when I ask them for information about the navigators … that I don’t get anything back,” Baucus told reporters.