Plan & Partner Management Update
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1 Plan & Partner Management Update Exchange Board of Trustees Meeting August 2013 A service of Maryland Health Benefit Exchange
2 Plan Management Update
3 Individual Marketplace Carriers Parent Company CareFirst Evergreen Kaiser Permanente UnitedHealthcare Medical Licensed Entity CareFirst Blue Choice CareFirst of Maryland Inc. Group Hospitalization and Medical Services Inc. Evergreen Health Cooperative Kaiser Foundation Health Plan All Savers Insurance Co Parent Company CareFirst Delta Dental DentaQuest Dominion Dental United Concordia Stand-Alone Dental Licensed Entity CareFirst of Maryland Inc. Group Hospitalization and Medical Services Inc. Alpha Dental Programs Delta Dental of PA DentaQuest Mid-Atlantic Dominion Dental Services United Concordia Life and Health 3
4 Parent Company Aetna CareFirst Coventry Evergreen SHOP Marketplace Carriers Medical Licensed Entity Aetna Health Co Aetna Life Insurance Co CareFirst Blue Choice CareFirst of Maryland Inc. Group Hospitalization and Medical Services Inc. Coventry Health and Life Coventry Health Care of DE Evergreen Health Cooperative Parent Company Best Life CareFirst Coventry Delta Dental DentaQuest Stand-Alone Dental Licensed Entity Best Life and Health CareFirst of Maryland Inc. Group Hospitalization and Medical Services Inc. Coventry Health and Life Alpha Dental Programs Delta Dental of PA DentaQuest Mid-Atlantic Kaiser Permanente Kaiser Foundation Health Plan Dominion Dental Dominion Dental Services UnitedHealthcare MAMSI Life and Health Optimum Choice UnitedHealthcare Insurance Co UnitedHealthcare of the Mid- Altlantic Guardian Life Metropolitan Life Guardian Life Insurance Co Metropolitan Life Insurance Co United Concordia United Concordia Life and Health United Concordia Dental Plans 4 Note: Information updated as of Carrier participation for the SHOP is subject to change. Plan filings have not yet been approved by the MIA.
5 Plan Certification Update on Plans All medical and stand-alone dental plans to be offered on the individual exchange were approved by the Maryland Insurance Administration on July 26 th 51 Medical Plans 3 Platinum; 16 Gold; 19 Silver; 10 Bronze; 3 Catastrophic 24 Stand-Alone Dental Plans 6 High Family; 6 Low Family; 6 High Pediatric; 6 Low Pediatric Of the 51 medical plans, 30 plans include embedded pediatric dental benefits 5
6 Producer Operations Update
7 Producer Operations The Producer Operations team is developing procedures for Producer Authorization that will accommodate the large volume of producers who may apply. 1. Submit the MHBE Application 2. Complete MHBE Training 3. Receive MHBE Authorization
8 Producer Operations Producer Authorization MHBE hosted a series of Producer Information Sessions to help producers prepare for authorization 1359 attendees for the four sessions conducted in July & August The Producer Authorization Application launched on July 25 th Web based application on applications received (as of August 8 th ) 8
9 Producer Operations Producer Authorization Training In-person Producer Authorization Training has been announced and will take place at locations around the State in August and September August 19 Chesapeake College August 22 University of Baltimore August 27 Greenbelt Marriott August 28 University of Maryland September 4 Greenbelt Marriott September 10 University of Maryland September 11 Greenbelt Marriot 9
10 TPA Services 10
11 TPA Services TPA Application Launch The TPA Certification Application Package has been posted on the MHBE website. TPA Application Form TPA Uniform Business Agreement Additional support documentation has also been posted on the MHBE website including Technical Integration Documents TPA Reference Manual TPA organizations that want to launch with SHOP for January 1, 2014 must return a completed Application Package and Business Agreement to MHBE by August 31, Applications received after the deadline will still be considered for certification but are not guaranteed a January 1 st effective date. 11
12 TPA Services TPA Certification Program - Launch Schedule August TPAs Submit Application Package s to MHBE Due 8/31 for 1/14 Go Live September MHBE Notifies TPAs of Application Status Certification Process Begins October December TPA System & Business Operations Validation Integration Testing Training January SHOP TPAs Go Live 12
13 Thank you! For questions on the information contained in this presentation, please contact: Tequila Terry Director, Plan & Partner Management Maryland Health Benefit Exchange
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