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HEALTH REPUBLIC INSURANCE OF NEW JERSEY

HEALTH REPUBLIC INSURANCE OF NEW JERSEY. Providing a New Choice in Health Care Roy Frank, MBA, PAHM Member Engagement & Outreach Manager. Introductory Video. Get Ready for the Affordable Care Act http://kff.org/health-reform/video/youtoons-obamacare-video/. Health in Bergen County.

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HEALTH REPUBLIC INSURANCE OF NEW JERSEY

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  1. HEALTH REPUBLIC INSURANCE OF NEW JERSEY Providing a New Choice in Health Care Roy Frank, MBA, PAHM Member Engagement & Outreach Manager

  2. Introductory Video • Get Ready for the Affordable Care Act • http://kff.org/health-reform/video/youtoons-obamacare-video/

  3. Health in Bergen County • ● Total uninsured: 80,167 (estimate) • 보험에 가입하지 않은 사람: 약 8만 167명 • ● Qualify for Marketplace: 34,056 (estimate) • 마켓플레이스 자격 해당자: 3만 4천 56명 • ● Off Marketplace: 15,420 (estimate) • 마켓플레이스 제외 대상자: 1만 5천 420명 • Data source: Centers for Medicare and Medicaid Services • All figures are estimates

  4. New Jersey’s Korean Population뉴저지 한인 인구 • ● Korean Population in NJ saw a growth rate of 43.4% from • 2000 –2010뉴저지 한인 인구 증가율 43.4% • ● Korean Population in NJ 93,679 (12.9% of Asian 뉴저지 한인 인구Population in the State) • ● Korean Population in Bergen County 56,773 (60%) • 버겐카운티 한인 인구 • ● Uninsured Koreans in Bergen County 6,495 (11.4%) • 버겐카운티 무보험자 • Data source: Centers for Medicare and Medicaid Services and Labor Market & Demographic Research • All figures are estimates as of 2010

  5. Target 대상 • Individuals & families with earnings between138% - 400% of the Federal Poverty Level (FPL) • 개인 & 가족 연방 저소득 수준이 138% ~ 400% 까지 증가 • Individuals & families earning >400% of FPL • Small businesses (< 50 FTEs) • 자영업자

  6. Who We Are; 뉴저지 핼스리퍼블릭 보험 • Health Republic Insurance of New Jersey (HRINJ) • One of 23 non-profit CO-OP’s, member-governed health insurance companies in America. 비영리단체, 정부보험회사 • Part of the Affordable Care Act: • goal of bringing down health care costs and making health insurance accessible to millions of people 건강 비용 감소와 보험 가입 증가 • HRINJ received start up and “reserve” loans from the U.S. Department of Health and Human Services to get started 미보건국으로 부터 지원금 비축 • An idea of Freelancers Union, New York, New York 뉴욕 프리렌서 조합 • A Progressive Champion: 혁신적인 최고의 건강플랜 제공, 커뮤니티 건강우선 • Our mission is to provide innovative health plan choices and put the interests of our members first. We aim to ensure that high-quality benefits are provided in an affordable way that works for all members. We are the persistent advocate and change-agent working for the health and wellness of the communities we serve.

  7. Our Priorities 우선 순위 • Provide a new choice for consumers • 소비자를 위한 새로운 선택을 제공 • Give enrollees a voice in their health plan and health care (51% of Board of Directors will be comprised of health plan members) • 가입 멤버에게 플랜에 관한 의견 발언 기회 제공, 수렴 및 채택 • Use our surplus revenues wisely as a CO-OP to benefit enrollees 비영리 단체로서 사업수익을 가입한 멤버의 혜택을 위해 사용

  8. Our Advantage 플랜 장점 • focus on members of the CO-OP and their health care needs 비영리단체로서 맴버의 건강 관리 및 요구에 촛점 • use the QualCare network 퀄케어 네트워크 • non-tiered hospitals • health plans that will promote: • preventive care and wellness 예방 관리와 건강 증진 • early treatment for health problems 건강 문제를 조기에 치료 • special programs for chronic conditions and managing a serious illness 만성질환을 위한 특별 프로그램과 심각한 질병에 대한 관리

  9. Federal Poverty Level 연방 저소득 수준

  10. Eligibility for Tax Credits & Cost Sharing세금 공제 & 비용 공유 가능

  11. Four Questions4가지 질문 • Here are four questions consumers should ask when enrolling in an insurance plan: • 소비자가 보험 플랜에 가입 전 반드시 알아야 할 4가지 질문: • What are my choices for health insurance? • 건강보험을 위한 나의 선택은 무엇인가요? • 2. How do I get it? 어떻게 선택한 플랜을 가입할 수 있나요? • 3. How much will it cost me? 선택한 플랜의 비용은 얼마인가요? • 4. How will I use it? 어떻게 선택한 플랜을 사용할 수 있나요?

  12. Costs Covered on Average평균 커버 비용 • Bronze: Plans cover 60% of costs 브론즈:비용의 60% 커버 • Silver: Plans cover 70% of costs 실버:비용의 70% 커버 • Gold: Plans cover 80% of costs 골드:비용의 80% 커버 • Platinum: Plans cover 90% of costs 플래티넘:비용의 90% 커버

  13. Essential Health Benefits • Providing essential health benefits:건강에 관한 필수 혜택 • Ambulatory patient services (outpatient care you get without being admitted to a hospital) 외래환자 서비스 • Emergency services 응급실 서비스 • Hospitalization (such as surgery) 입원 • Maternity and newborn care (care before and after your baby is born) 출산과 신생아 케어 • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) 정신건강 • Prescription drugs 처방된 약 • Rehabilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) 재활의학 서비스와 기구 • Laboratory services 실험실 서비스 • Preventive and wellness services and chronic disease management 예방과 건강 서비스, 만성 질환 관리 • Pediatric services 소아과 서비스

  14. Streamlined Eligibility & Enrollment Process 보험 가입 자격 & 가입 프로세스 • Supported by Federally managed data services. • Determine eligibility for Medicaid & Chip. • Advanced tax credit & cost sharing reduction calculated. • Online plan comparison tool available to inform selection • Enrollment in Medicaid or CHIP • Advanced payment of tax credit applied to premium payment • Online • Phone • Mail • In Person- *Certified Application Counselors From CMS presentation - A Seamless Path to Affordable Coverage in 2014

  15. Small Business Health Option Plan (SHOP)자영업자 건강 옵션 플랜 • Rolling monthly enrollments for employers after • January 1 2014 고용주를 위해 매월 가입 가능 • Once enrolled, rates guaranteed for 12 months 한번 가입시, 12개월간 가격 보장 • Employer must pay 50% of premiums 고용주가 보험료의 50% 지불해야 함 • Average FTE salary must be less than $50k • Must have less than 50 FTE’s • Tax credits for employers with less than 25 FTE’s • Tax credits are currently 35%; 2014 50%

  16. What happens if I don’t get Insurance만일 보험에 가입하지 않으면 어떻게 되나요? • 2014 • 1% of your yearly household income. The maximum penalty is the national average yearly premium for a bronze plan.매년 총가족 수입의 1% 벌금. 최대 브론즈 플랜 프리미엄 비용 정도의 벌금 • $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.매년 성인 한명 당 $95 벌금 최대 한가족당 $285 정도의 벌금 • 2015 ---- 2% of income or $325 per person. 총수입의 2% or 한명 당 $325 벌금 • 2016 & later----- 2.5% of income or $695 per person. After that it is adjusted for inflation.총수입의 2.5% or 한명당 $695 벌금 • If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you’re uninsured for less than 3 months, you don’t have a make a payment.

  17. FAQ’s • How do I enroll? Online, by mail, or by telephone. 온라인,우편,전화 가입 • *Telephone: 1-888-990-5706 • *Online: www.healthcare.gov or www.newjersey.healthrepublic.us • What if I don’t’ want insurance? The fee for not being insured will be $95 for the first year and increase up to $600 by year 2016 • How much will this cost me? It depends on your income and size of your family. 총수입과 가족수에 따라 비용 결정 • How do I get a subsidy? Your tax credit will depend on your previous year tax return지난해 세금보고에 따라 세금 공제 결정 • Is my doctor part of Health Republic Insurance Network? • HRINJ is working with QualCare a NJ based network of health providers. To find out a list of all of our providers please visit www.qualcareinc.com본인 주치의가 핼스리퍼블릭 보험을 받는지 확인은 퀄케어 보험을 통해서 확인가능.

  18. Resources • www.newjersey.healthrepublic.us • www.healthrepublic.us • www.healthcare.gov/law/features/choices/co-op/index.html • www.healthcare.gov/law/features/choices/exchanges/index.html • http://kff.org/health-reform/ • http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/ • http://kff.org/interactive/subsidy-calculator/ (Kaiser Calculator) • http://101.communitycatalyst.org/ (Health Insurance 101) • www.enrollamerica.org • www.familiesusa.org • www.getcoveredamerica.org • http://iom.edu/~/media/Files/Perspectives-Files/2013/Discussion-Papers/BPH HelpingConsumersUnderstand.pdf

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