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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

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Plan standardization in the commonwealth health insurance connector l.jpg

Plan Standardization in the Commonwealth Health Insurance Connector

Anya Rader Wallack, Ph.D.

June 6, 2011


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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


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Evolution of offerings in CommChoice (unsubsidized coverage)


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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


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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


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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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Current product offerings in RI (non-group, BCBSRI)


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Current product offerings in RI (small group, BCBSRI)


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Current product offerings in RI (small group, United Health Care)


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