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A Federally Facilitated Marketplace

Arizona :. A Federally Facilitated Marketplace. Erin H. Klug , Arizona Department of Insurance. Arizona Marketplace Landscape Since 10/1/2013. 27,943 – Marketplace Plans selected ( HHS Enrollment Report October 1, 2013 – December 28, 2013)

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A Federally Facilitated Marketplace

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  1. Arizona: A Federally Facilitated Marketplace Erin H. Klug, Arizona Department of Insurance

  2. Arizona Marketplace Landscape Since 10/1/2013 • 27,943– Marketplace Plans selected (HHS Enrollment Report October 1, 2013 – December 28, 2013) • 98,203 – Adults added to AHCCCS (1,369 in 100-133% FPL category; AHCCCS Enrollment Update as of 1/10/14) • $144 to $665 – Premium range (Marketplace medical plans, age 30, all counties, all metal levels; https://www.healthcare.gov/shop-health-plan-information/)

  3. FFMcertified insurance companies in AZ:

  4. Who does what in Arizona? CCIIO/CMS State Insurance Department Outreach/education: Direct advertising, consumer publications, funding others Approve and remove entities to operate on the exchange: QHP issuers, agents, web-brokers, Navigators, CACs Management of the exchange website: Collect, correct and display insurer plandata Consumer Assistance Marketplace appeals, special enrollment, APTC & CSR Premium Stabilization: Risk adjustment, reinsurance and risk corridors programs Links to Medicaid/AHCCCS for eligibility determination Regulate contracts of insurance issued by health insurers on- and off-exchange: Review insurance contracts, rates, and advertising for compliance with state requirements and ACA Consumer Assistance Monitoring & Enforcement Financial oversight of insurers

  5. How do we coordinate? • CCIIO certification of QHP issuers requires DOI input on: • Insurer licensure • Insurance policies and rates filed/approved • HMO service areas • Enforcement activity • DOI may require data regarding insurer and agent exchange activity to perform: • Complaint investigations • Market analysis • Fiscal monitoring

  6. How we assist consumers? • FFM assists consumers with: • Plan enrollment and eligibility • Special Enrollment • APTC eligibility • Marketplace appeals • ADOI assists consumers with: • Problems with insurance plans • Claim denials/delays, appeals • Access to care • Agent misconduct • Unlicensed activity/insurance scams

  7. What’s next? • Plan networks • Mismatches • Decertification process • Producers (agents) on the exchange • Fraud

  8. Consumer Affairs DivisionArizona Department of Insurance2910 N. 44th Street, Ste. 210Phoenix, AZ 85018www.azinsurance.gov602.364.2499Erin H. Klug - eklug@azinsurance.gov

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