Health Benefit Exchange Update

1. Health Benefit Exchange Update Kelly Smith – Director, SHOP Exchange Sherry Tomasky - Director, Stakeholder Engagement Northeast NAHU Presentation June 13, 2013

2. Key Accomplishments to Date • Contracted with customer service organization • Invited Health Plans to participate in the Exchange • Invited organizations to apply to be In-Person Assistors/Navigators, created a complete broker training curriculum • Received conditional certification from HHS in December2012 Awarded nearly $370 million in federal funds for Exchange establishment activities Established and convened five Regional Advisory Committees Conducted background research on key policy decisions Contracted with a System Integrator to build IT system

3. Functions of the Exchange • Certify Qualified Health Plans (QHPs) • Make available qualified health and dental plans to eligible individuals and employers • Assign a quality rating and actuarial value to each QHP offered though the Exchange • Require QHPs to offer Essential Health Benefits • Ensure adequacy of plan networks Eligibility and Enrollment • Toll-free telephone hotline • Web portal for eligibility determination and enrollment • Ability to calculate the actual cost of coverage after individual tax credits and cost sharing reductions • Certify individuals as exempt from individual responsibility

4. SHOP End-to-End Flow and Online Experience Broker or Agent Pre-Certification Training/ Application Certification Build Companies and Rosters Plan Selection Enrollment / Other Processing Enter Company Information Pass Exam Attend DFS NY HBE Training Employer Send Enrollment to QHP Enter Company Roster Information Identity Proofing Create NY-HBE Account Print and Mail Notices Receive NY HBE Certification Online Pre-select Plans Select Coverage Plan(s) Resolve Problems in Customer Support Employer Build Company Information Agree to Terms of Participation Phone Broker or Agent Process Appeal Mail In-Person Assistor /(Broker or Navigator) Employees receive an invitation from NY HIX to log on and create an account – flow not depicted here Customer Support

5. Health Plan Invitation Goals Offer comprehensive affordable, coverage in all areas of the state Balance innovation with reasonable choice Make it easy for consumers to compare options Ensure health plans have adequate networks Monitor health plan quality, utilization of services, and consumer satisfaction Preserve consumer protections, as defined in federal and state law and regulation Ensure consistency with the outside market

6. Insurer Requirements Invitation open to all licensed and certified insurers in the state in good standing and meeting state solvency requirements Insurer may choose to participate in the Individual Exchange, the SHOP Exchange, or both Must offer 1 Standard Plan at ever metal level, in each county of the service area Must cover Essential Health Benefits package Cost Sharing for Standard Plans http://www.healthbenefitexchange.ny.gov./invitation

7. Federal Law Requires Coverage of Ten Essential Health Benefits • Ambulatory patient services • Emergency room services • Hospitalization • Maternity and newborn care • Mental health and substance abuse disorders • Prescription drugs • Rehabilitation and habilitation services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision 7

8. Qualified Health Plans

9. Insurer Requirements May offer up to 3 Non-Standard Plans Cannot offer fewer benefits than Standard Plans May offer additional benefits Can use different networks and different cost sharing, but must be AV equivalent Can make AV equivalent benefit substitutions for Preventative/Wellness/Chronic Disease Management or for Rehabilitation/Habilitation

10. QHP Certification Process and Timeline Invitation released January 31, 2013 Proposals were due April 15, 2013 (every major insurer has shown interest) Initial Provider Network Submissions were due April 30, 2013 and a second submission is due in July Submission of Rates and Forms were due to the Dept. of Financial Services on April 30, and the QHP Binder Filings were due May 15th Anticipated notification of Certification is July 15, 2013.

11. Broker Training and Certification • Exchange training will be CE credit eligible • SHOP Training – 8 credits • Individual Exchange Training – 8 credits • Timeline: • SHOP training classes begin early August and continue through 2014. • Individual Exchange training for brokers will be available in late August/September. • Certification testing immediately follows completion of training. • Training format : Classroom, online, webinar. • Brokers will be notified of rollout via Exchange website, email, through state associations, and on future Exchange webinars starting in July 2013.

12. Individual EE End-to-End Flow and Online Experience Individual, or Authorized Representative Application / Account Management Verification Eligibility Determination Plan Selection Enrollment / Other Processing Create NY-HX Account Apply MAGI Rules Send Enrollment to QHP Online Send Enrollment to Medicaid / CHIP Create Application / Demographics Apply Program Specific / Special Rules Apply forCoverage Verify at Federal Hub Phone Print and Mail Notices Apply forAssistance Verify Through NYS Interfaces Display Eligibility Results Select Coverage Plan(s) Build Household / Income Mail Resolve Problems in Customer Support Apply for Exemption In-Person Assistor /(Broker or Navigator) Process Appeal Customer Support

13. Source: Kaiser Family Foundation Subsidy Calculator Illustration of Tax Credits for Individuals www.HealthBenefitExchange.ny.gov

14. Consumer Assistance and Enrollment • Online • Through the Exchange portal for new applications and administrative renewals • Web chat for assistance • In Person • In Person Assistors and Navigators • Agents and Brokers • Informal Assistors • Assistance available in many languages • Phone • Leverage current public program call center • Assistance available in most languages • Mail • Upon request

15. In-Person Assistors

16. IPA/Navigator RFA Released February 13, 2013 Goals • Ensure that all types of organizations permitted in federal rules are eligible to compete • Provide grants to a diverse group of organizations that will provide high-quality enrollment assistance, in a manner that is linguistically and culturally appropriate to the populations being served • “One-Stop” consumer assistance for Exchange, Medicaid and Child Health Plus coverage • Ensure availability of assistors in all counties of the State • Have IPA/Navigators ready to provide assistance at open enrollment, October 1, 2013

17. IPA/Navigator Program WE ARE HERE

18. Timeline

19. www.HealthBenefitExchange.ny.gov

20. Contacts: Kelly Smith Director, SHOP Exchange KKS03@health.state.ny.us Sherry Tomasky Director, Stakeholder Engagement SLT05@health.state.ny.us