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Seneca Regional Chamber of Commerce & Visitor Services Health care reform and health insurance exchanges. Deborah R. Boop Sr. Account Executive September 25, 2012. 455430 27517. The big picture for individuals.
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Deborah R. Boop
Sr. Account Executive
September 25, 2012
2017 and beyond:
Greater of $695 or 2.5% of taxable income
Greater of $325 or 2% of taxable income
Greater of $95 or 1% of taxable income
For exchange plans only
Income ranges for 133% to 400% FPL
$14,856 to $44,680
Family of four:
$30,656 to $92,200
Based on 2012 guidelines for the 48 contiguous states and D.C.
50 or more full-time employees
Employer provides coverage, but it is not “affordable”
Lesser of $2,000 x total FTEs – or –
$3,000 x number of employees receiving tax credit
March 23 Health care law enacted
HHS started issuing planning grants to states
Oct. 1 (approx)
Deadline for states to submit exchange plans
Exchange coverage begins
HHS issued first set of proposed rules
Target date for exchanges to be financially self-sufficient
State option to expand exchange eligibility to larger groups
HHS determines whether state exchange will be ready by October
Open enrollment begins
Outside exchange – Fully insured large group and self-insured
Outside exchange – Fully insured small groupand Individual
Include essential health benefits
Provide 60% actuarial value minimum
Adhere to deductible and out-of-pocket maximum limits
Comply with “metal levels” – benefit tiers with specified actuarial values (60% 70% 80% 90%)
Be certified by the exchange through which the plan is offered (certification requirements to be determined)
* The health care reform law does not require carriers to offer plans with at least a 60% actuarial value, nor does it require employers to provide health coverage. However, it imposes penalties on 50+ employers that do not provide minimum coverage.
No health status rating
Also known as modified community rating
3:1 age rating bands
Broker / Consultant
Powered by Bloom Health
Medical, Specialty, Pharmacy and Other Products / Services
In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc.
In Connecticut: Anthem Health Plans, Inc.
In Indiana: Anthem Insurance Companies, Inc.
In Kentucky: Anthem Health Plans of Kentucky, Inc.
In Maine: Anthem Health Plans of Maine, Inc.
In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits.
In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada.
In New Hampshire: Anthem Health Plans of New Hampshire, Inc.
In Ohio: Community Insurance Company.
In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123.
In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies.
Independent licensees of the Blue Cross and Blue Shield Association. ®