MAKING INSURANCE AFFORDABLE AND ACCESSIBLE FOR RHODE ISLANDERS. August 2013 HealthSource RI Outreach Tour

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1 MAKING INSURANCE AFFORDABLE AND ACCESSIBLE FOR RHODE ISLANDERS August 2013 HealthSource RI Outreach Tour

2 Overview u What is HealthSource RI? u Why HealthSource RI? u Using HealthSource RI u Benefits for Individuals and Families u Benefits for Small Employers u Enrollment Timeline u Q & A 2

3 What is HealthSource RI?

4 What Is HealthSource RI? HealthSource RI is a new way that Rhode Islanders and small employers can find and compare health insurance plans, and purchase the coverage that best fits their needs. All plans cover essential health benefits. (doctors visits, prescriptions, hospital stays) OCTOBER 2013 Enrollment begins Compare plans JANUARY 2014 Coverage takes effect 4

5 Why HealthSource RI? One-stop shop Greater choice High quality, affordable options It s all in one place, at your convenience. With 25+ plan options, Rhode Islanders can see, compare and enroll in the plan that best fits their needs, from insurance carriers Blue Cross & Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, and UnitedHealthcare. With increased competition and financial assistance through tax credits and Medicaid, more Rhode Islanders can access quality, affordable insurance and providers and hospitals. Creating needed change The cost of insurance will be more predictable and better suited to your needs. 5

6 HealthSource RI drives health reform changes Ongoing negotiations with carriers to ensure that Rhode Islanders have the best choices of affordable plans 25+ plans available through HealthSource RI, increasing quality and choice for Rhode Islanders Rhode Island will be one of the only states to offer Full Employee Choice Increasing number of carriers in individual and small group markets (3 insurers participating in 2014 and 4 insurers participating in 2015) 6

7 Affordability HealthSource RI is committed to increasing access to more affordable healthcare options in a variety of ways. For Rhode Island Small Employers who qualify: u Tax credits of up to 50% of employers premium contribution For Rhode Island Individuals and Families who Qualify: u u u Tax credits to help pay for insurance (139% of FPL to 400% of FPL) No-cost insurance plans through Medicaid (138% of FPL and below) Discounts on co-pays and other out-of-pocket expenses for lowerincome Rhode Islanders For all Rhode Islanders: u u More competition and greater transparency Making changes in our healthcare system to bring down costs 7

8 INDIVIDUALS 8

9 Individuals and Families Using HealthSource RI 5 easy steps to purchasing insurance through HealthSource RI: Access HealthSource RI Online Phone In person Fill out information on your income and family composition The State instantly determines if you are eligible for tax credits or Medicaid Compare health plan options side-by-side 5 Choose the plan that s right for you 9

10 Helping Individuals Afford Insurance EXAMPLE: A 45-year-old married couple with two children Annual Income * Example of EsAmated Monthly Premium (Before tax credit) Premium Limit % of Income Tax Credit Received (per month) Amount Paid per Month $35,000 $ % $ $ $47,000 $ % $ $ $55,000 $ % $ $ $94,000 $ % $ $ Modified Adjusted Gross Income Source: Kaiser Family Founda@on 10

11 How Does it Work? Federal Government Tax Credits if eligible are applied immediately no need to wait to file Individual HealthSource RI BCBSRI NHPRI 11

12 How Individuals and Families Can Benefit Choice of plans and levels of coverage to best fit your needs and budget You may qualify for tax credits that help reduce the cost of insurance, or for no-cost or low-cost insurance Apples to apples comparisons across carriers All plans cover essential health benefits (doctors visits, prescriptions, hospital stays) Insurers are competing for your business (improves quality, lowers costs) 12

13 SMALL EMPLOYERS 13

14 Small Employers* Using HealthSource RI 5 easy steps to purchasing insurance through HealthSource RI: Access HealthSource RI Your Broker Online Phone In Person Provide information about your business or organization Tell us about your employees How many? Ages Dependents HealthSource RI instantly presents available plan options and monthly rates for insurance 5 Two Options: 1. Let your employees each choose their own plan 2. Choose a single plan for all of your employees *Par@cipa@on is open to employers with fewer than 50 employees (small group). 14

15 Small Employers Using HealthSource RI Employers have two choices when purchasing insurance through HealthSource RI: 1 2 Use the Full Employee Choice Option You select a plan and a contribution level that best fits your budget Your employees select the plan that best meets their needs You write one check Your employees have access to 7-day-a-week support You focus on your business, not on health insurance Or a Single Plan for all of your employees 15

16 Full Employee Choice at Work Maria owns a small manufacturing company in Pawtucket. She selects a Blue Cross & Blue Shield of Rhode Island plan that costs $1,000/month per family and $500/month per individual. She decides to contribute $650 a month toward the family premium and $325 toward the individual premium. Her employees check out HealthSource RI Selena is 27 years old. She finds a UnitedHealthcare plan with a lower premium and higher out-of-pocket costs. United Plan = $400/mo Employer Contribution = $325 Employee = $75 Jimmy thinks the plan Maria selected is just fine for him and his family. He goes with that. BCBSRI Plan = $1,000/mo Employer Contribution = $650 Employee = $350 Eddie is over 50. He opts for a plan from Neighborhood Health Plan of Rhode Island for his family with a higher monthly premium and he pays the difference.. NHPRI Plan = $1,200/mo Employer Contribution = $650 Employee = $550 Whatever her employees choose Maria writes one check to HealthSource RI. The Contact Center is available to help them all. 16

17 Small Business Health Care Tax Credit If your business or organization offers coverage through HealthSource RI and meets the following criteria Number of Employees: Fewer than 25 Full Time Equivalents (FTE s). (FTE s are generally defined as working 30 hours/week. Consult your CPA or Payroll Company for help determining your FTE s.) Employee Income: An average of $50,000 a year or less Your Insurance Contribution: At least 50% of your FTE s premium costs you may qualify for a tax credit worth up to 50% of your premium contribution in 2014 Number of FTEs Annual Wages Annual Employer ContribuAons To healthcare premiums Tax Credit Amount 10 $250,000 ($25,000 per employee) $70,000 $35,000 (50% of contribulons) 17

18 How Does it Work? Employer Premium HealthSource RI Insurance Companies Employee Payroll Deduction Employee Payroll Deduction Employee Payroll Deduction Tax Credits Eligible employers receive their tax credits to help them pay for insurance at the end of their tax year, when they file. 18

19 How Small Employers Can Benefit Tax credits for your business Find a plan that fits your budget, with more predictable costs We negotiate with the carriers to provide you with better options and full employee choice Fully staffed Contact Center to help your employees choose a plan, reducing your administrative burden You can maintain your existing relationship with your broker 19

20 TIMELINE 20

21 HealthSource RI Enrollment Timeline Small Employers u Beginning on October 1, 2013 through December 2014, small employers can enroll at their usual anniversary date. u Coverage is available after January 1, Individuals u Individual enrollment runs October 1, 2013 through March 31, u Coverage begins January 1, u u After the first enrollment period, individual enrollment will run annually October through December. Families with children may be eligible for RIte Care now. 21

22 QUESTIONS? Call us at or visit healthsourceri.com 22