A BETTER WAY to take care of business. Small Group Expansion Overview June 3, 2015

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1 Small Group Expansion Overview June 3, kp.org/choosebetter June 3, Kaiser Foundation 2015 Kaiser Health Foundation Plan, Inc. All Health Rights Plan, Reserved. Inc. All Rights Reserved.

2 Our small group expansion goals Comply with Affordable Care Act (ACA) to incorporate groups with employees into the small group line of business Ensure a positive broker, employer, and member experience 2 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

3 Today s discussion Small group expansion overview Small group expansion timeline Your clients options What s changing for brokers What changing for your clients What s next 3 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

4 Small group expansion overview 4 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

5 Small group expansion overview What does it mean? The ACA requires all states to include employers with no more than 100 full-time-equivalent employees in the small group market for health coverage by January 1, This means groups with full-timeequivalent employees will now be considered small groups. 5 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

6 What s not certain Whether the ACA-required change in the definition of small group from 1-50 to might be delayed due to executive order or legislative action at the federal level Whether states will be allowed to retain their definition of small group eligibility based on fulltime employees, or if they must change to the federal definition based on full-time-equivalent employees 6 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

7 What s not certain Whether Keep Your Plan will be applied to groups in Maryland, allowing these groups to renew their large group plans beyond January 1, 2016 Whether groups with grandfathered large group plans, or a mix of grandfathered and nongrandfathered large group plans, will be required to transfer to small business in June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

8 Small group expansion timeline 8 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

9 Timeline for new business New business will be enrolled in small business effective January 1, June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

10 Timeline for existing business Existing groups in Maryland will have to move to small business plans at renewal in 2016 if there are no federal or state transition delays and current benefit plans are not grandfathered. Both Virginia and the District of Columbia have adopted the Keep Your Plan transition policy, announced by CMS, through October 2016 renewals. 10 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

11 Your clients options 11 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

12 2016 new business options New groups can get coverage directly from Kaiser Permanente, through the Small Business Health Options Program (SHOP), or other private exchanges. 12 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

13 2016 renewal options Groups with grandfathered plans: Transition may be voluntary. Groups with nongrandfathered plans: Transition may be required but could be delayed by early renewal, Keep Your Plan, or implementation delay at the federal level. Groups with grandfathered and nongrandfathered plans (hybrids): Transition may or may not be required, but could be delayed by early renewal, Keep Your Plan, or implementation delay at the federal level. 13 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

14 What s changing for brokers 14 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

15 What s changing for brokers Streamlined sales and renewal processes with standardized plans and rates Faster turnaround using Kaiser Permanente online self-service quoting tool for new business Demographic data for dependents is needed to generate a quote 15 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

16 What s changing for your clients 16 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

17 What s changing for your clients Products in District of Columbia* ACA-compliant, non-customizable plan portfolio consisting of 18 plans across the metal levels 2 copay HMO plans 6 deductible HMO plans 7 deductible HMO + HSA plans 3 2-Tier Point of Service (POS) plans All plans meet minimum value and essential health benefit requirements. All plans are offered through the SHOP (DC Health Link). District of Columbia employers are no longer able to purchase off-shop small group plans. Six plans in the platinum and gold tiers are offered with either our Signature Network or Select Network. Full breadth of metal tiers: 2 Platinum, 6 Gold, 5 Silver, 5 Bronze *2016 plans are subject to change and pending regulatory approval 17 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

18 What s changing for your clients Products in Maryland* ACA-compliant, non-customizable plan portfolio consisting of 19 plans across the metal levels 2 copay HMO plans 6 deductible HMO plans 4 deductible HMO + HSA plans 3 deductible HMO + HSA + HRA plans 3 2-Tier Point of Service (POS) plans 1 3-Tier Point of Service (POS) plan All plans meet minimum value and essential health benefit requirements Most plans are offered both on-exchange and off exchange 1 DHMO, 2 of the 3 2-tier POS, and the 3-Tier POS plans are offered off-exchange only New (!) 3-Tier deductible POS plan (Gold Metal Tier) to enable maximum flexibility for those groups that have Out-of-network coverage requirements. All plans except for the 3-Tier POS plan are offered with either our Signature Network or Select Network. Full breadth of metal tiers: 3 Platinum, 7 Gold, 5 Silver, 4 Bronze *2016 plans are subject to change and pending regulatory approval 18 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

19 What s changing for your clients Products in Virginia* ACA-compliant, non-customizable plan portfolio consisting of 19 plans across the metal levels 2 copay HMO plans 6 deductible HMO plans 4 deductible HMO + HSA plans 3 deductible HMO + HSA + HRA plans 3 2-Tier Point of Service (POS) plans 1 3-Tier Point of Service (POS) plan All plans meet minimum value and essential health benefit requirements Most plans are offered both on-exchange and off-exchange All POS plans (2-Tier and 3-Tier) are offered off-exchange only New (!) 3-Tier deductible POS plan (Gold Metal Tier) to enable maximum flexibility for those groups that have Out-of-network coverage requirements. All plans except for the 3-Tier POS plan are offered with either our Signature Network or Select Network (off exchange). Full breadth of metal tiers: 3 Platinum, 8 Gold, 5 Silver, 3 Bronze *2016 plans are subject to change and pending regulatory approval 19 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

20 What s changing for your clients Rating methodology Member level rating Rates are calculated individually for each employee, using certain factors Composite premium member level rating methodology (available in Maryland and Virginia only) An aggregate (or average) premium is allocated per employee, based on a 4-tier rating structure Only available with a single plan-offering 20 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

21 What s changing for your clients Rates A group transitioning into small group may see rate increases or decreases depending on: benefit plan(s) selected member demographics geographic location Individual member s rate increase or decrease may differ from group s increase or decrease due to member level rating. 21 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

22 What s changing for your clients Policies and procedures Maryland, Virginia and District of Columbia laws regulating small businesses differ from those that apply to large groups. For more information: Small Business Field Sales Guide Small Business Guides (available for Maryland, Virginia and the District of Columbia) account.kp.org 22 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

23 What s next 23 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

24 What s coming in 2015? group renewal strategies We ll work with you to develop the best transition plan for each of your group renewals. Planning meetings Pre-renewal meetings: beginning in June 2015 Renewal meetings: beginning in Fall 2015 Regular updates to keep you informed 24 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

25 Have questions? Contact me Visit us on the Web: account.kp.org 25 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.

26 Thank you! 26 June 3, Kaiser Foundation Health Plan, Inc. All Rights Reserved.