Thursday, December 19, 2013 Celeste Richards Erin Malone
Agenda Structure of ACA health Exchange and Mandated Elements of Plan Design Georgia Regions Alliant Health Plans Exchange Products and Provider Contracting
Health Insurance Exchange
Health Insurance Marketplace Exchange: Online Marketplace where consumers can shop for health insurance. Consumers are able to compare and purchase plans online. State based Marketplace State creates and runs its own Marketplace State Partnership Marketplace State partners with Federal government to run some Marketplace functions Federally Facilitated Marketplace State has a Marketplace established and operated by the Federal government known to consumers as The Health Insurance Marketplace Georgia falls into the Federal Marketplace
Types of Federal Exchanges Federal Exchange Two Types: Small Business Health Options Program (SHOP) Employees SHOP is a Marketplace for small businesses and their employees (fewer than 100 employees) States may limit participation to those with 50 or fewer employees for the first 2 years Employer will access the SHOP where its principle business office is located Employer must offer coverage to all full time employees Sole proprietors may buy through the Marketplace rather than the SHOP Technological Delays for SHOP 1) Cannot apply online for 12 months (may apply via agents or directly with insurance carrier) 2) Initially included multiple plan offerings for employees, but this has been delayed for 12 months Individual Exchange (FFE Exchange) Consumers can shop individually for plans to chose the option that best suits their needs and their budget. Note: There are also private exchanges and people can purchase insurance directly through an insurer and get the same plan design / benefits. However, a person must go through one of the two Federal exchanges listed above to obtain any subsidy available to them.
Federal Exchange/Marketplace 2014 Open enrollment period began October 1, 2013 and ends March 31, 2014 enrollment deadline for 1/1/2014 extended through 12/23/2013) Those persons not having coverage by 3/31/2014, will be subject to penalties on their 2015 taxes Penalties start small, but grow each year Penalties for year 1 Greater of $95 or 1% of gross income Penalties for year 2 Greater of $325 or 2% of gross income Penalties for year 3 Greater of $695 or 2.5% of gross income
Insurance Carrier Exchange Requirements Requirements: Be deemed a Quality Health Plan (QHP) Become certified by the state/federal exchange (based on size, marketing, & plans for improving members health) Provide essential health benefits package Follows established limits on member s out of pocket costs Offers at least one silver and one gold plan Charge same premium on and off the exchange Meet network requirements including Essential Community Providers (ECPs)
What are essential benefits? 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management 10. Pediatric services, including oral and vision care
Metallic Plan Names Plan Levels Metallic Plan Name % of Costs Covered by Plan Bronze 60% Silver 70% Gold 80% Platinum 90%
Additional Plan: Catastrophic Plan Who is eligible? Young adults under 30 years of age (called Young Invincibles ) Those who can not afford coverage and obtain a hardship waiver from the Marketplace What is catastrophic coverage? Plans with highdeductibles and lower premiums Includes coverage of 3 primary care visits and preventive services with no out of pocket costs Protects consumers from high out of pocket costs
Georgia Exchange Chose not to create own exchange, but default to the Federal Healthcare Exchange Divided into 16 regions for purposes of underwriting 5 insurance companies participate in Georgia, but their participation varies by region Alliant Blue Cross Blue Shield of GA Humana Kaiser Peach State
Georgia Regions for Health Exchange
Details on Insurance Company Offerings Insurance Companies Do not have to be in every region of the state* Within each region, an insurance company can choose to only be in some counties and not in others* Insurance Companies do not need to offer the same plan designs in each region Must cover all essential benefits but Can offer different co payments and deductibles Must cover preventative services at 100% *Note: By ACA law, the largest insurance company in each state must offer a product in every region and county.
Marketing in 32 Counties
Alliant Health Plans will be marketing in Region 4, which includes Haralson, Carroll and Heard Counties. Haralson Carroll Heard
2014 IFP & Small Group Plans Products available inside the Health Insurance Marketplace
Plan Specifics Plan Names: SoloCare Individual and Family Plans Simple Care Small Group Plans Product names are attributed to the product lines whether purchased privately or through Health Information Marketplace. All member ID cards reference Alliant Health Plans. There will be no identifying mark to distinguish if the member has a plan purchased through the HIM.
Alliant Provider Participation Providers who participate with Alliant Health Plans will be a part of the Exchange network. No additional contracting is necessary. Fee schedules will remain the same for all Alliant Health Plan products.
Health West Contact Information George Royal 770 838 8711 groyal@tanner.org Suzanne Altman 770 838 8712 saltman@tanner.org Health One & Alliant Health Plans Contact Information Celeste Richards 706 629 3744 ext 212 crichards@alliantplans.com Erin Malone 706 629 3744 ext 248 emalone@alliantplans.com