individual healthcare marketplace 2016contentz.mkt2527.com/lp/11207/224755/py2016product...• in...

This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does not constitute legal, tax, compliance or other advice or guidance.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,

an Independent Licensee of the Blue Cross and Blue Shield Association

Individual Healthcare Marketplace 2016

10192015

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.

In order for a producer to sell Health Insurance Marketplace plans (and receive compensation) in Texas, a producer must register as an agent/broker with the Federally Facilitated Marketplace. This process is managed by the Centers for Medicare and Medicaid Services (CMS). 1. Producers who are CMS-certified in the Individual Marketplace can sell and

receive compensation for both Marketplace retail plans and non-Marketplace retail plans.

2. Producers who are NOT CMS-certified in the Individual Marketplace can only sell and receive compensation for non-Marketplace retail plans.

The training that follows includes important product and benefit information to ensure your success when helping clients with 2016 products.

Training Requirement to Sell Individual

2


Training Topics

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Products

Product Overview • Naming Structure • Plan Design Components

Major Medical Products • Marketplace Plans Comparison Charts • Non-Marketplace Plans Comparison Charts • Catastrophic Plans

Out-of-pocket Costs • Deductibles • Out-of-Pocket Limits • Copayments

Network Information • Network Coverage • Out of Network Benefits

Pharmacy Benefits

• Benefit Structure • How to Read Drug List • Prior Authorization • Step Therapy • Preferred Pharmacy Network

Rates & Pricing

Dental/ Ancillary Products • Pediatric Vision Benefits • Dental Benefits • Wellness Benefits

Rules Affecting Rates 1. Age Bands 2. Family Demographics 3. Benefit Design 4. Tobacco Use 5. Geographic Rating Areas

Retail Shopping Cart (RSC) • Marketplace Shopping • Non-Marketplace Shopping • Retail Shopping Cart Videos


Product Overview

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. 5

Product Overview

Naming Structure BCBSTX is offering several new major medical products in the under 65 retail market. These products were developed to give consumers many options. The naming structure will help you find the product best suited for your clients. For the product named, “Blue Choice Silver PPO 004,” the naming structure breakdown is as follows:

Branding All names start

with “Blue”

Network Name Indicates the name

of the network

Metallic Level Indicates the metal level of the product: Bronze, Silver, Gold or Platinum. Catastrophic products

are also available Network Type

HMO, PPO

Modifier Differentiates

between plans on the same network in the

same metal level

Blue Choice Silver PPO 004


Product Overview

Plan Design Components 1. Essential Health Benefits 2. Deductibles 3. Out-of-Pocket Costs 4. Per Occurrence Deductible 5. Out-of-Network Benefits 6. Copayments 7. Prescription Drug Tiers

Name Ded OPX Coins OV / SPC ER RX Sample

Plan $2000 $4,000 30% $40/$60 $600 $0 / $10 / $50 / $100 / 30%


Major Medical Products


Major Medical Products for BCBSTX

On Exchange Plans

Metallic Plan # Ded OPX CoinsOV/SPC copay

ER Per Occurrence

Deductible**

IP Per Occurrence

Deductible**

OP Per Occurrence

Deductible**Rx

Gold Blue Advantage Gold HMO 101 $500 $5,250 70%* $20 / $40 $500 $300 $200 $0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

Gold Blue Advantage Gold Plus 101 $2,750 $3,500 80%* $10 / $20 $400 $200 $200 $0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

Silver Blue Advantage Silver HMO 102 $2,000 $6,850 70%* $40/$60 $600 $500 $300 $0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

Silver Blue Advantage Silver HMO 103 $3,500 $3,500 100%* 100%* 100%* 100%* 100%*100%* 100%*

SilverBlue Advantage Silver Plus 102-

Three $0 PCP visits$3,250 $6,850 80%*

80%* after free

visits$600 $400 $300

$0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

*After Deductible **Per Occurence Deductible then Annual Deductible and Coinsurance



On Exchange Plans


ER Per Occurrence

Deductible**

IP Per Occurrence

Deductible**

OP Per Occurrence

Deductible**Rx

BronzeBlue Advantage Plus 103 -

One $0 PCP Visit $6,800 $6,850 80%*

80%* after

free visit

$950$750 $400

$12/80%*/70%*/60%*/50%* $17/75%*/60%*/50%*/50%*

Bronze Blue Advantage Plus Bronze 104 $4,500 $6,450 70%* 70%* 70%* 70%* 70%*80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%*

Bronze Blue Advantage Bronze HMO 006 $6,000 $6,000 100%* 100%* 100%* 100%* 100%*100%* 100%*

BronzeBlue Advantage Bronze HMO 105 -

Two $40 PCP Visits$6,750 $6,850 70%*

70%* after $40

visits70%* 70%* 70%*

80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%*




Off Exchange Plans


ER Per Occurrence

Deductible**

IP Per Occurrence

Deductible**

OP Per Occurrence

Deductible**Rx

Gold OFF Exchange only:

Blue Advantage Gold HMO 111$0 $6,850 100%* $40 / $70 $750 copay

$1,500 copay per day

$500 copay$0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

Gold Blue Advantage Gold HMO 101 $500 $5,250 70%* $20 / $40 $500 $300 $200 $0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

Gold Blue Advantage Gold Plus 101 $2,750 $3,500 80%* $10 / $20 $400 $200 $200 $0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

Silver Blue Advantage Silver HMO 102 $2,000 $6,850 70%* $40/$60 $600 $500 $300 $0/$10/$50/$100/70%* $5/$15/$60/$110/70%*

Silver Blue Advantage Silver HMO 103 $3,500 $3,500 100%* 100%* 100%* 100%* 100%*100%* 100%*

SilverBlue Advantage Silver Plus 102-

Three $0 PCP visits$3,250 $6,850 80%*

80%* after free

visits$600 $400 $300

$0/$10/$50/$100/70%* $5/$15/$60/$110/70%*




Off Exchange Plans


ER Per Occurrence

Deductible**

IP Per Occurrence

Deductible**

OP Per Occurrence

Deductible**Rx

BronzeBlue Advantage Plus 103 -

One $0 PCP Visit $6,800 $6,850 80%*

80%* after

free visit

$950$750 $400

$12/80%*/70%*/60%*/50%* $17/75%*/60%*/50%*/50%*

Bronze Blue Advantage Plus Bronze 104 $4,500 $6,450 70%* 70%* 70%* 70%* 70%*80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%*

Bronze Blue Advantage Bronze HMO 006 $6,000 $6,000 100%* 100%* 100%* 100%* 100%*100%* 100%*

BronzeBlue Advantage Bronze HMO 105 -

Two $40 PCP Visits$6,750 $6,850 70%*

70%* after $40

visits70%* 70%* 70%*

80%*/80%*/70%*/60%*/50%* 75%*/75%*/60%*/50%*/50%*



Catastrophic Plans

Eligibility requirements remain the same:

• Under 30 years of age OR receive “hardship exemption” from Marketplace

• Catastrophic plans meet QHP requirements

• Only covers 3 PCP visits at copay per year (then deductible coinsurance)

• Monthly premium is lower, but out-of-pocket may be higher

• Available On- and Off-Exchange

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Out-of-Pocket Costs


Out-of-Pocket Costs

Deductibles (In-Network)

Out-of-Pocket Maximums (In-Network)

All Medical expenses excluding Copayments and Per-Occurrence Deductibles

● Deductibles ● Per-Occurrence Deductibles ● Copayments (including Rx) ● Coinsurance

What counts toward Deductibles and Out-of-Pocket Maximums?

What is excluded from Deductibles and Out-of-Pocket Maximums?

> Premiums > Claims for uncovered services > Preauthorization penalties


Deductible and Out-of-Pocket Limits

• In 2016, the ACA mandated maximum out-of-pocket limits are: Individual: $6,850 Family: $13,700

• Family deductible and OPX will be 2-3x individual • When a family OPX has been met, all members are

considered to have met the OPX regardless of whether an individual has met their deductible

• When an individual hits their own deductible, their coinsurance benefits kick in even if a member has family coverage

• Pediatric dental deductible and OPX are separate from medical, no cross accumulation


Network Information


Member Out-of-Pocket Expenses • Remember, copays and per occurrence deductibles do not

feed into the deductible.

• All other claims feed into the deductible.

• Out-of-Pocket (OPX) includes: • Annual Plan Deductibles • Per Occurrence Deductibles • Medical Plan Copays • Coinsurance amounts • RX Covered pharmacy costs; particularly helpful for chronic conditions

including asthma, diabetes, etc

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In the ACA world, the OPX is more critical to the average customer than the deductible is.


Network Information for BCBSTX

Network Coverage

Network Offering

Service Area Marketplace or Non Marketplace

Metallic Levels

Blue Advantage HMO (Introducing New HMO Plus products which includes out of network benefits)

Statewide Both Gold, Silver, Bronze


2016 BCBSTX Plan Changes

• BCBSTX will not be offering the Blue Choice PPO for retail members enrolled in an ACA-compliant plan (those individual members who buy their own insurance and are not enrolled in a grandfathered plan).

• Members currently in the ACA-compliant PPO plans will have their plan discontinued and will be transitioned to another plan.

• In addition to our Blue Advantage HMO product, we will be adding an HMO Plus product with benefits for out-of-network care, called Blue Advantage Plus.

• There are some providers who were in our individual PPO plan that will no longer be an in-network option for our individual HMO members.

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The HMO Plus product is different from the HMO and you should be clear when selling it.


Out-of-Network Benefit Changes

Significant changes for 2016 • Out-of-Network deductibles and coinsurance amounts are higher • Members utilizing Out-of-Network Services will incur higher cost

sharing • Out-of-Network Services will not be capped at an out-of-pocket

maximum • Members utilizing Out-of-Network Services will incur expenses

up to the amount actually charged • Applies to PPO plans • HMO plans do not have Out-of-Network benefits except for

emergencies

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HMO Plus Product

What is it? • HMO In-Network with Out-of-Network benefits available

• Member’s chooses PCP • Referrals required to see specialists

• Member may receive care from non-network providers but will incur greater out-of-pocket costs

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HMO Plus Product

Blue Advantage HMO Plus

• On and Off Exchange

• In-network utilization maximizing lower cost-sharing for members

• PCP referrals for service receive in-network benefits

• Leverages existing Blue Advantage HMO network

• Plan name only includes Blue Advantage Plus

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PPO vs. HMO vs. HMO Plus

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Pharmacy Benefits


Prescription Drug Benefit Structure

• Drug Card or Coinsurance after medical deductible

• One drug list (also known as formulary) – Generics Plus, with drug exclusions

• Generics Plus Drug List: A “generics plus” drug list is essentially a leaner version of the standard drug list (less choices in the preferred brand category)

• We are utilizing a five-tier prescription benefit structure, with two of those tiers for generics (preferred and non-preferred)

• The five-tier structure drives utilization towards generic prescriptions

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Prescription Tiers Cost Example 1 Generic: Preferred $0 Hydrochlorathiazide

2 Generic: Non-Preferred $10 Valsartan-Hydrochlorathiazide

3 Brand: Formulary $35 Crestor

4 Brand: Non-Formulary $75 Advair

5 Specialty $150 Humira


How to Read the Drug List

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• Generic pravastatin – Tier 1 (generics in small bold)

• Brand PRAVACHOL – Tier 4 (brands CAPITALS) +Step Therapy

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Prior Authorization (PA)

• Designed to promote patient safety and use of the drug as intended by the manufacturer and the FDA

• Requires members to meet certain criteria before particular drugs are covered

• Physicians are required to obtain certification of medical necessity prior to drug dispensing

• Existing prior authorizations for current members will be transitioned • If member has previous approval will look for approval and enter

override • Members who were with other carriers need to go through the PA

process • No coverage if request is denied

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Step Therapy

• Encourages use of safe, clinically appropriate and most cost-effective drugs

• Program requires that a member use a generic/formulary product before other agents will be covered • Example: pravastatin tried and failed before Crestor

• If member cannot take first line agent or has tried and failed, their doctor can request authorization

• Members who have received previous authorization will not need to go through the program except for PPI, Pain and glucose test strip programs

• No coverage if request is denied

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Quantity/Dispensing Limits

• Limits placed to promote appropriate use and prevent stockpiling, e.g., Ambien: 30 tablets per 30 days

• Limits are based on: • FDA approved dosing • Drug manufacturer dosing recommendations • National published guidelines • Package size • Evidence from peer-reviewed literature

• Limits are approved by a committee of physicians and pharmacists from a variety of specialties

• A dispensing limits drug list is posted on our website and member can submit a letter of medical necessity if they need a larger quantity

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Specialty Pharmacy Program

• Specialty medications are used to treat conditions such as multiple sclerosis, rheumatoid arthritis, cancer and cystic fibrosis

• Medications are limited to a 30-day supply

• Self-administered products are standardly covered under the pharmacy benefit while physician administered products are covered under the medical benefit

• 50% out of network penalty if members do not use Prime Specialty Pharmacy

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Member Pay the Difference Program (MPTD)

• Requires members who fill a brand name prescription for which there is an exact generic equivalent to pay the brand copay or coinsurance plus the difference in cost between the brand and generic drug

• Only impacts drugs with an EXACT generic equivalent

• MPTD applies to deductible if plan has deductible shared with medical benefit (bronze plans)

• Penalty applies to the OPX: once OPX met no penalty is charged

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One Drug List/Formulary for All Plans

• All exchange plans will be moving to the Generics Plus Drug List/Formulary

• Generics Plus Formulary: A “generics plus” formulary is essentially a leaner version of the standard formulary and includes both non-specialty and specialty drugs for all major therapeutic categories. • Less choices in the preferred brand category

• Members who were on the Standard Drug List/Formulary may be impacted by certain drugs changing from a preferred brand status to a non-preferred brand status

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Top Impacted Drugs (moving to Non-Preferred)

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Top Impacted Drugs Vyvanse Advair Diskus Lyrica Ciprodex

Pataday Voltaren Lialda Vigamox

Benicar Colcrys Xarelto Benicar HCT

Prednisone Solution

Androgel Pump Lotemax Linzess

Dulera Suboxone Vesicare Lumigan


Preferred Pharmacy Network/ESN

• Benefits will now contain a preferred retail pharmacy network (except IL HMO and 100% cost sharing plans)

• A preferred retail pharmacy network allows members to pay the lowest copayments/coinsurance at a network of pharmacies designated as preferred

• Members would pay a higher copay/coinsurance at non preferred pharmacies (any pharmacy in the network not designated as preferred)

• 90 day supply at retail will only be available at the preferred network pharmacies

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Preferred Pharmacy Network/ESN

Texas • CVS • Walmart • HEB • Brookshire’s • Access Health

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Medical versus Pharmacy Coverage

• Self administered medications (including self injectables) covered under the pharmacy benefit

• Physician administered medications (including infused medications) covered under the medical benefit

• Specialty drugs are either pharmacy benefit or a medical benefit

• If a specialty medication is not on the drug list – then refer to the medical benefit for possible coverage

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90-Day Delivery Options

• Limited Extended Supply Network (ESN) • Members can obtain a retail 90-day supply at a limited network of

pharmacies • Align limited ESN with preferred pharmacies only • Available at three times the retail copay

• Mail Order Program • Members can obtain up to a 90-day supply of maintenance medications

through the mail • PrimeMail is the mail order pharmacy • Available at three times the retail copay

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Other Benefit Exclusions

• The following items are excluded from the pharmacy benefit: • Compound drugs • Weight loss • Impotency • Infertility • OTC equivalents • Repackaged medications • Any drug not listed in the Drug List (also known as formulary)

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Other Benefit Considerations

• Insulin/syringes: copay applies for both even if filled on the same day

• Oral oncology – $0 copay for oral cancer medications

• 30 day supply limit at retail/ 90 days at mail

• 50% out of network penalty – retail (No OON for HMO)

• Vaccines covered at retail pharmacies

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Dental/Ancillary Products


Pediatric Vision

Pediatric Vision Benefits Available to children up to age 19; up through age 18

Embedded in each medical product, premium is included in medical rate

Davis Vision will administer vision products and adjudicate all claims

Vision offerings are based off of FED VIP benchmark plans identified by HHS. They include:

● Offerings include Eye Exams (one annually) and Frames (one pair in a category of frames) or Contact Lenses

● No member cost sharing for vision services, except for HSA plans with cost sharing for frames and contact lenses


Ancillary Products: Dental

• Family and child-only dental products are available.

• Marketplace dental products and non-Marketplace dental products available.

• Dental product deductibles and out-of-pocket maximums are separate from major medical product deductibles and out-of-pocket maximums. There is no cross accumulation.

• Pediatric dental benefits available to children up to age 21

Dental Products Overview



Routine Dental Services • Diagnostic evaluation • Diagnostic radiograph • Preventative

Basic Dental Care • Miscellaneous preventive services • Basic restorative • Non-surgical extractions • Non-surgical perio • Adjunctive services • Endodontics • Oral surgery • Surgical perio

Major Dental Care • Major restorative • Prosthodontics • Miscellaneous restorative and

Prosthodontic services

Orthodontia

Added Provisions with Pediatric Dental • Unlimited annual and lifetime maximums

applied both in and out of network • No waiting periods for in network benefits • Medically necessary orthodontia • Out-of-pocket maximum applied for in

network only

.

Pediatric Dental Rules The following benefits are covered for both Family and Pediatric products and are subject to coinsurance and deductibles.



Marketplace Dental Plans • We will offer family and child only dental products. • Plans are available on the FFM through BCBSIL or other issuers

Non-Marketplace Dental Plans • After a buyer selects a medical plan, he/she will have the option to purchase a stand-alone dental

plan. • If a buyer chooses not to purchase a stand-alone dental plan then reasonable assurance must be

captured that he/she already has an ACA compliant pediatric dental plan. • A child only dental plan (pediatric benefits) will be added with the medical product if we do not

receive “reasonable assurance” from the buyer that they already have an ACA compliant dental plan.

• Once we receive the confirmation that they have an ACA compliant pediatric dental plan, the child only product will be removed.

• Dental products can be purchased without purchasing medical Marketplace plans or non-Marketplace plans.

Pediatric Dental Rules



2016 Dental Product will continue to with member-based rating

Maximum of 3 dependents (age 0-21) will be rated on a family plan, additional children are added at no charge

Dental Pricing


Wellness Benefits

Wellness Offerings (Non HMOI plans)

Well onTarget Member Wellness Portal: • Health Assessment • Blue points program • Health trackers • Self-directed wellness courses

Fitness Program: • Discounted gym membership to a nationwide network of

fitness centers 24/7 Nurseline: • Around the clock, toll-free access to registered nurses for

health information, as well as an audio library Utilization Management: • Pre-authorization, notification, prospective review concurrent

review, discharge planning, and post-service review CCEI • A skilled team of CCEI clinicians reaches out to the

identified members before, during, and after a hospital admission and offer education and support as needed

HMOI plans: Well onTarget, Fitness Program, and Behavioral Health

Condition Management: • Health professionals work with members and physicians to

help better manage the following targeted conditions: asthma, diabetes, coronary artery disease and low back pain

Longitudinal Care Management: • Proactive, longer-term management of members with

complex but relatively stable conditions to prevent health deterioration and adverse events (such as hospitalizations).

Special Beginnings: • Gives expectant moms support and education from early

pregnancy to six weeks after delivery.

Case Management: • Services include alerts (emergency room/transportation),

potential and actual high dollar claimants, Integrated Grand Rounds, chronic kidney disease/end stage renal disease, hip/knee replacement and multiple comorbidities (three or more).

Behavioral Health: • Licensed behavioral health professionals help members

access services and offer support for conditions like anxiety, depression, eating disorders, substance abuse and other mental health disorders.


Rules Affecting Rates



Rating Characteristics 1. Age Bands

• Ages 0-20 have a single age band • Ages 21-63 have their own, individual year age bands • Ages 64+ have a single age band • 3:1 age rating ratio for adults age 21 and older

• Premium for a 64 year-old can be rated no more than 3 times the premium of a 21 year-old

2. Family Demographics • The maximum number of dependents (age 0-20) that will be rated on a family

plan is capped at 3 • Dependents age 21+ do not count toward the cap • Spouses under age 21 do not count toward the cap

3. Benefit Design

• Metallic Level & Actuarial Value • Cost Sharing • Network



Rating Characteristics 4. Tobacco Use

• Two tiers: tobacco use vs. non-tobacco use • “6 month look back” for tobacco use • Issuers are permitted to rate for tobacco use within a

ratio of 1.5:1 • Our tobacco use rates are 10-33% higher than our

non-tobacco use rates

5. Geographic Rating Areas • Geographic rating will be by county, not zip code • Based on the address of the primary insured, even if

any member on a policy has a different address than the primary insured

• To see state-specific Geographic Rating Areas, visit www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/state-gra.html

http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/state-gra.html




Retail Shopping Cart (RSC)


Retail Shopping Cart

Marketplace Shopping: Two Pathways Producers intending to work with consumers in Texas, which is a Federal Partnership Marketplace state, will be able to assist consumers to apply for and purchase Marketplace plans in two ways:

(a) an issuer-based pathway, through which a producer uses an issuer’s website, such as the BCBSTX Retail Shopping Cart, to assist the consumer, or

(b) a Marketplace pathway, through which a producer assists the consumer by directly accessing the Federally Facilitated Marketplace (FFM)

Both pathways transmit producer identifying information to us so that you will be compensated for sales of BCBSTX Marketplace plans.

Both pathways allow a producer to assist a qualified individual with initial enrollment and changes during the coverage year, including changes that impact eligibility.



Before You Begin: What Your Clients Need for Marketplace plan shopping 1. Social Security Numbers or document numbers for legal

immigrants (proof of U.S. citizenship or legally present)

2. Current Blue Cross Blue Shield plan information (if applicable)

3. Valid email address is highly encouraged (required if using debit/credit card)

4. Primary Care Physician (PCP) information (if choosing an HMO product)

5. Payment Information (debit, credit, check or money order)



• Window shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans.

• Create a shopping account with us. • We’ll take you to the Marketplace where

you’ll get your results and complete your enrollment.

• We’ll send you a bill.

• Shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans.

• Create a shopping account with us. • Complete enrollment and payment at

BCBSTX.com.

Express Link works with the Retail Shopping Cart and supports enrolling consumers in both Marketplace and non-Marketplace plans.

Process when shopping Non-Marketplace products during

Special Enrollment Period

Process when shopping Marketplace products during Special Enrollment

Period



• Window shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans.

• Create a shopping account with us. • We’ll take you to the Marketplace. • Apply for your credit and get your results. • Come back to our site and submit your

payment.

• Shopping begins on BCBSTX.com Retail Shopping Cart website where they can view and compare plans.

• Create a shopping account with us. • Complete enrollment and payment at

BCBSTX.com.

Express Link works with the Retail Shopping Cart and supports enrolling consumers in both Marketplace and non-Marketplace plans.

Process when shopping Non-Marketplace products during Open

Enrollment Period

Process when shopping Marketplace products during Open Enrollment

Period

Retail Shopping Cart: Shopping During Special Enrollment This Flow Chart Illustrates a Producer-Led or Producer-Generated process from Express Link through Enrollment

Connect Member to

RSC

Census Page User enters Census Data

Tax Credit Estimate

Plan Results User shops and

compares

Confirm & Enroll

Complete Enrollment and

Payment through RSC

Official Determination

from Healthcare.gov

Direct Enrollment Process

Off Exchange

On Exchange

Expr

ess

Link

Re

tail

Shop

ping

Car

t En

rollm

ent

Retail Shopping Cart: Shopping During Open Enrollment This Flow Chart Illustrates a Producer-Led or Producer-Generated process from Express Link through Enrollment

Connect Member to

RSC

Census Page User enters Census Data

Tax Credit Estimate

Plan Results User shops and

compares

Confirm & Enroll

Complete Enrollment and

Payment through RSC

Official Determination

from Healthcare.gov

Direct Enrollment

Process

Off Exchange

On Exchange

Expr

ess

Link

Re

tail

Shop

ping

Car

t En

rollm

ent



BCBSTX Pathway for Open Enrollment Period • Consumers complete the Marketplace eligibility application process.

• When complete, they are moved back to the BCBSTX shopping website to complete payment, please see wireframes on next slides.


Direct Enrollment

• Users are connected to Healthcare.gov from Retail Shopping Cart. Users obtain their eligibility via HC.gov then return to Retail Shopping Cart to shop and enroll for an On Exchange Plan.

60


My Account

• Returning from Healthcare.gov users will be promoted to sign into their RSC account. Users will then be able to view their applicant’s as well as their eligibility results from Healthcare.gov.

61


Plan Results

• After clicking on view plans users will be navigated to the plan results page. On plan results users can view the new plan premium with their official APTC applied to the premium.

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Confirm and Enroll

• After users select an OnX plan on plan results they will be navigated to the OnX Confirm and Enroll. On this page users can select an OnX dental plan and view their selected plan details, then click enroll to begin the enrollment process.

63


Attestation

• The attestation page is the first page of direct enrollment. The tax payer must read and attest to the statement prior to moving forward in the enrollment process.

64


Terms

• The second page of the direct enrollment process is the terms page. On this page users read all of our terms & agreement, acknowledgements, etc. After accepting all the terns the user can move to the next page.

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Other Information

• The other information page gathers information from users regarding any other BCBS plans, replacement coverage and special communication needs.

66


Payment

• The payment page gathers the users payment information, payment & billing preference as well as billing information. The payment page is broken down into 5 pages and is available in Spanish.

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Review and Sign

• On the Review and Sign page users can verify their plan, applicant, payment details and PCP/MG selection are correct. If all the items look correct, they user can sign and submit their application.

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Finish

• The finished page is the last page of web enrollment. It informs the user of what is to come, i.e. welcome kit, as well as other useful links about being a Member of Blue Cross Blue Shield and items for their records.

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Payment Redirect Page


Finished Page



View Retail Shopping Cart videos For more details on the Retail Shopping Cart, go to the BCBSTX Blue Access for ProducersSM website. Log in to your account. 1. Click on the Individual icon. 2. Select the Training and Administration link. 3. Scroll to the Individual Products Training link and find the Retail Shopping

Cart (RSC) Recorded Demo videos, which are accessed via Dropbox.

individual healthcare marketplace 2016contentz.mkt2527.com/lp/11207/224755/py2016product...• in...

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