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Plan Standardization in the Commonwealth Health Insurance Connector . Anya Rader Wallack, Ph.D. June 6, 2011. CommChoice Seal of Approval Requirements. Participate in all CommChoice offerings (individual, small group, young adult)

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plan standardization in the commonwealth health insurance connector

Plan Standardization in the Commonwealth Health Insurance Connector

Anya Rader Wallack, Ph.D.

June 6, 2011

commchoice seal of approval requirements
CommChoice Seal of Approval Requirements
  • Participate in all CommChoice offerings (individual, small group, young adult)
  • Offer all standardized benefit packages for all plan benefit levels (gold, silver, bronze)
  • Offer products with the broadest possible provider network available to the carrier (also allowed to offer select/limited network products)
  • Offer products that provide “good value” with comprehensive benefits
why the changes
Why the changes?
  • Actuarial equivalency confusing to consumers
  • Focus groups showed support for simpler (more intuitive) product comparisons
  • But carriers wanted more flexibility to differentiate
  • More recent focus groups supported some limited additional flexibility
  • Beginning July 1, plans can vary cost-sharing for some categories of services
evolution of offerings in commcare subsidized coverage
Evolution of offerings in CommCare (subsidized coverage)
  • Highly standardized plans
  • Some effort to reduce variation (smoking cessation)
  • Plans mostly Medicaid-based, restrictions tend to rely more on network and less on benefit design
issues
Issues
  • On what basis do you want plans to differentiate?
    • Benefit design
    • Network
  • Are employers and consumers best served by more benefit standardization or less? Is the answer different for different market segments?
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