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Health Insurance Marketplace March 12, 2014

Health Insurance Marketplace March 12, 2014. 1. Agenda. Overview Open Enrollment Subsidy Type: Advanced Premium Tax Credit Subsidy Type: Cost Sharing Reductions Membership Reports Blue Network E Marketplace Performance Membership by Service Area Membership by Previous Coverage.

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Health Insurance Marketplace March 12, 2014

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  1. Health Insurance Marketplace March 12, 2014 1

  2. Agenda • Overview • Open Enrollment • Subsidy Type: Advanced Premium Tax Credit • Subsidy Type: Cost Sharing Reductions • Membership Reports • Blue Network E • Marketplace Performance • Membership by Service Area • Membership by Previous Coverage • Membership by Age/Gender/Network • Membership by Product • Financial Assistance • CMS Changes • Education Campaigns • Know Then Go • Phone Support • Shop Smart Health Insurance Marketplace > Agenda 2

  3. Overview Health Insurance Marketplace 1

  4. Open Enrollment Health Insurance Marketplace • Open Enrollment Period 2014 • Oct. 1, 2013 – March 31, 2014 • Open Enrollment Period 2015 • Nov. 15, 2014 – Jan. 15, 2015 (proposed dates) • Effective dates based on application completion date: • On or before the 15th, effective 1st of the following month • After the 15th, effective 1st of the second following month Health Insurance Marketplace > Overview 4

  5. Subsidy Types: Advanced Premium Tax Credit (APTC) Health Insurance Marketplace • Advanced Premium Tax Credit Offsets cost of health insurance premiums • Eligible if all of the following apply:– Purchasing QHP* on the Marketplace– Household income is between 100%-400% FPL**– No access to affordable, minimum essential coverage through an employer or government program *Qualified Health Plan **Federal Poverty Level Health Insurance Marketplace > Overview 5

  6. Subsidy Types: Advanced Premium Tax Credit Health Insurance Marketplace • Example: Second Lowest Silver • Sample Scenario: An individual who earns 200% FPL* selects the second lowest cost silver plan, which has an annual premium of $4,000 • Individual Contribution: At 200% FPL, an individual cannot pay more than 6.3% (or $1,448) on health insurance • Government Subsidy: The government will be required to contribute the balance, or $2,552 (this determines the subsidy amount it will pay across all tiers) *Federal Poverty Level Health Insurance Marketplace > Overview 6

  7. Subsidy Types: Cost Sharing Reductions (CSR) Health Insurance Marketplace • Cost Sharing Reductions • Low-income individuals (income range of 100% to 250% of the FPL*) who buy Silver plans get federal benefit assistance through cost-sharing reductions. • Often results in Platinum-level benefits at Silver plan prices. *Federal Poverty Level Health Insurance Marketplace > Overview 7

  8. Subsidy Types: Cost Sharing Reductions Health Insurance Marketplace Impact on Base Plan Benefits Health Insurance Marketplace > Overview 8

  9. Membership Reports Health Insurance Marketplace 1

  10. Marketplace Performance Health Insurance Marketplace • Based on a February Marketplace Enrollment Report1, the Department of Health and Human Service (HHS) estimated 59,705Tennesseans selected a Marketplace plan as of Feb. 1, 2014. • HHS enrollment figures include those who had paid premiums as well as those who had not. • 1 US Dept. of Health and Human Services, February Enrollment Report, 2/12/2014 Health Insurance Marketplace > Membership Reports 10

  11. Membership by Service Area Health Insurance Marketplace • Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014 Health Insurance Marketplace > Membership Reports 11

  12. Membership by Previous Coverage Health Insurance Marketplace • Cover Tennessee includes CoverTN, AccessTN and Cover Kids • Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014 Health Insurance Marketplace > Membership Reports 12

  13. Membership by Age/Gender/Network Health Insurance Marketplace • Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014 Health Insurance Marketplace > Membership Reports 13

  14. Membership by Product Health Insurance Marketplace • Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014 CSR = Cost Sharing Reduction Health Insurance Marketplace > Membership Reports 14

  15. Financial Assistance Health Insurance Marketplace • Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014 Health Insurance Marketplace > Membership Reports 15

  16. CMS Challenges Health Insurance Marketplace 1

  17. CMS Challenges Health Insurance Marketplace Oct. 1 – Early/mid-November Healthcare.gov glitches and a shaky roll-out resulted in high call volumes, consumer confusion and persistent rule changes to accommodate limited functionality Nov. 14 President announces transitional proposal allowing individuals enrolled in non-grandfathered plans to keep existing plans for another year Late November/Early DecemberCMS announced process not in place to send 820 payment transactions for Advanced Premium Tax Credit and advance Cost Share Reduction payments Health Insurance Marketplace > CMS Changes 17

  18. CMS Challenges Health Insurance Marketplace Dec.17CMS/HHS* issued IFR entitled Maximizing 1/1/14 Coverage Opportunities that changed Open Enrollment eligibility rules for obtaining a 1/1 effective date and extended payment deadlines for first month’s premium during Open Enrollment Jan. 8CMS issued guidance outlining changes to enrollment data issuers are authorized to make directly (e.g. add a dependent to a Marketplace policy) Feb. 6CMS issued Bulletins on Enrollment and Termination Policies and Processes for FFM** Issuers *Department of Health and Human Service **Federally Facilitated Marketplace Health Insurance Marketplace > CMS Changes 18

  19. Education Campaigns Health Insurance Marketplace 1

  20. Education Campaigns Health Insurance Marketplace • Know Then Go • Highlights the importance of understanding provider networks and the associated potential costs savings • Phone Support • Help a client: • 1-888-257-0996 • For providers: • 1-800-924-7141 • For members: • 1-800-565-9140 Health Insurance Marketplace > Education Campaigns 20

  21. Education Campaigns Health Insurance Marketplace • Shop Smart • Online education available (bcbst.com/knownow)– Find list of FFM*-certified brokers appointed by BlueCross– Locate community meetings– Get information about instant quotes and subsidy calculations– View animated videos *Federally Facilitated Marketplace Health Insurance Marketplace > Education Campaigns 21

  22. BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association

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