Washington Health Benefit Exchange

Transcription

1 Washington Health Benefit Exchange Plan Certification Update Exchange Special Board Meeting September 8, 2016 Molly Voris, Policy Director Christine Gibert, Associate Policy Director Molly Nollette, Deputy Insurance Commissioner, OIC

2 Overview of 2017 QHP and QDP Submissions (as of 9/8/2016) 46 individual QHPs approved for Renewals 12 New QHPs 5 family dental plans approved to be offered as QDPs 11 SHOP plans submitted from Kaiser in Clark and Cowlitz Counties Catastrophic plans offered by Group Health and Kaiser 2

3 2017 Plan Themes 6 plans cover primary care visits before deductible has been met 53% of 2017 plans are EPO plans, compared to 34% in 2016* Average deductible changes 2016 to 2017: Gold plans: 8.0% decrease Silver plans: 14.4% increase Bronze plans: 5.4% increase Average premium changes 2016 to 2017: Gold plans: 9.9% increase Silver plans: 0.3% decrease Bronze plans: 3.2% increase *Percentage of plans with EPO network types includes Regence/BridgeSpan plans for 2016 and

4 2017 Submitted and Approved QHPs (as of 9/8/2016) Individual Health Plans Submitted in May: 9 issuers and 98 plans OIC approved: 7 issuers and 46 plans (Regence and BridgeSpan have 52 plans pending OIC approval) SHOP Plans Submitted in May: 1 issuer and 11 plans OIC approved: 1 issuer and 11 plans 4

5 2017 QHP Issuers Individual Market HPF SHOP Market Approved by OIC as of 9/8/16 Approved by OIC as of 9/8/16 Community Health Plan of Washington Kaiser Permanente NW Coordinated Care Group Health Cooperative Kaiser Permanente NW LifeWise Health Plan of Washington Molina Healthcare of Washington Premera Blue Cross Not Approved by OIC as of 9/8/16 BridgeSpan Health Company Regence Blue Shield 5

6 2017 map does not include 52 Regence and BridgeSpan plans pending OIC approval 6

7 Carrier Approved 2017 Plan Rates 2015 Approved Rate 2016 Approved Rate 2017 Proposed Rate 2017 Approved Rate Community Health Plan of WA* $343 $363* $404* $403* Coordinated Care Corp. $235 $223 $232 $216 Group Health Cooperative $281 $240 $268 $274 Kaiser Foundation Health Plan of the NW* $307* $276* $306* $308* LifeWise Health Plan of WA $291 $297 $325 $292 Molina Healthcare of WA $277 $234 $256 $240 Premera Blue Cross $313 $314 $400 $396 Rates reflect the preliminary rate requested of the lowest-priced Silver plan for a 40 year old non-smoking King County resident in the individual Exchange. *Indicates carrier that is not offering plans in King County; plan rates reflect lowest silver premium in other rating area. 7

8 New QHP Quality Certification Criteria for 2017 Quality Improvement Strategies Each carrier s QIS has been approved for QIS target the following areas: Tobacco cessation 1 carrier Diabetes monitoring and care improvement 4 carriers Colorectal cancer screening 3 carriers Utilization of preventative services 1 carrier Cancer screening, immunizations, and chronic disease management 1 carrier Quality Rating System HBE on track to implement in open enrollment for

9 Dental Landscape for 2017 Family dental plans Delta Dental, Dental Health Services, and Dentegra Submitted in May: 3 carriers and 8 plans OIC approved: 3 carriers and 5 plans Pediatric-only dental plans Kaiser, LifeWise, Premera, Delta Dental, Dental Health Services Submitted in May: 5 carriers and 7 plans OIC approved: 5 carriers and 7 plans 9

10 Certify most plans today Renewal Timeline Schedule a special Board meeting if necessary to certify an additional carrier s plans next week Issuers send letter on non-renewed QHPs by Oct. 3 Exchange sends QHP renewal letter on Oct. 28 Informs consumer about renewed/mapped plan for 2017 Tax credit amount (based upon second lowest cost silver plan) for 2017 Enrollee s premium contribution for renewed/mapped plan in 2017 Issuers send letter on renewed QHPs by Nov. 1 Open Enrollment begins Nov. 1 10

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12 Appendix 12

13 Terminology The Board certifies plans Products are a suite of plans Consumers know issuers and plans 13

14 OIC QHP and QDP* Approval Criteria Issuer 1. Be licensed and good standing * 2. Comply with market rules (e.g., offer at gold and silver level) 3. Comply with non-discrimination rules* Product 4. Meet network adequacy requirements* 5. Use the national standard enrollment form 6. Use hospital patient safety contracts 7. If offered, integrate Direct Primary Care Medical Home into QHP Plan 8. Comply with essential health benefits*, limits on cost sharing*, metal levels 9. Comply with service area standards for a QHP (e.g., county, zip code) and submit rates for a plan year* 14

15 WAHBE QHP and QDP* Certification Criteria Issuer 1. Pay assessed user fees* 2. Comply with risk adjustment program (monitored by OIC) 3. Achieve accreditation with a national organization Product 4. Meet marketing requirements* 5. Provide a health care provider directory* 6. Implement a quality improvement strategy (applies beginning in open enrollment for 2017 plan year) 7. Submit health plan data* 8. Participate in quality measures (applies beginning in open enrollment for 2017 plan year) Plan 9. Submit and post justifications for premium increases 10. Submit health plan benefits, cost-sharing, and premium rates data to display on web pages for consumer shopping* 15