page 1 june 7, 2011 health benefit exchange: overview delaware department of health and social...
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June 7, 2011June 7, 2011
Health Benefit Exchange: OverviewHealth Benefit Exchange: Overview
Delaware Department of Health and Social Services
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Agenda
Introductions
Purpose of the Public Forums
Overview of the Health Benefit Exchange
What is an Exchange
Core Responsibilities
Key Decisions for Delaware
Open Discussion
Wrap-Up and Next Steps
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Purpose of the Public Forums
Gather input from the public on key issues pertaining to the establishment of a Health Benefit Exchange in Delaware.
Provide information to the public on federal requirements and the state’s options for planning, designing and developing an Exchange for Delaware.
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Overview of the Health Benefit Exchange | What is it?
“Expedia” for health insurance:
Organized commercial insurance marketplace for individuals and small employers (up to 50 employees)
Enables consumers to review/compare plans, and enroll in coverage
One-stop shop for publicly subsidized health coverage:
Medicaid
Delaware Healthy Children Program (CHIP)
Subsidized commercial insurance
Source of information on carriers and plan performance
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Exchange | A Structured Marketplace
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Exchange | Core Responsibilities
Develop single, streamlined eligibility process for all public health coverage programs
Offer “qualified health plans” in five benefit groups, which will differ based on point-of-service cost sharing (e.g., co-pays, co-insurance, deductibles):
Platinum (90%)
Gold (80%)
Silver (70%)
Bronze (60%)
High Deductible Health Plan
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Exchange | Core Responsibilities
Offer health plans in the individual and small group markets:
Premium subsidies and lower out-of-pocket costs available to eligible individuals and families with income up to 400% of the Federal Poverty Level (e.g., up to $43,561 for an individual)
Premium subsidies available to small employers with lower-wage employees
Develop “calculator” to enable people to estimate total cost of coverage (e.g., premiums, co-pays, deductibles)
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Exchange | Single Coverage Premiums
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Exchange | Core Responsibilities
Establish call center and customer service unit to assist consumers
Develop multiple channels (i.e., web, phone, mail, walk-in) to enable people to shop for insurance, compare health plans, and enroll in coverage
Rate health plans and offer decision-support tools to assist consumers
Certify exemptions under the individual mandate and report information to federal agencies
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Exchange | Individual Shopping Experience
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Exchange | Small Employer Options
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Exchange | Key Decisions for Delaware
What are the goals of the Delaware Exchange?
Connect people to health insurance
Promote change in the health insurance market
How will the Exchange help individuals and small employers compare plans and purchase health insurance?
Pro-active outreach and education
Cost and quality rankings of health plans
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Exchange | Key Decisions for Delaware
How will the Exchange operate alongside the existing individual and small group markets?
Same plans offered inside and outside the Exchange
Rating and underwriting rules comparable
Should the state establish one Exchange or two?
Combined Exchange serving individual and small group markets – OR – separate Exchanges
How will the Exchange interact with Medicaid/CHIP?
Continuity of coverage across programs
Reduce churn between programs
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Exchange | Next Steps
Upcoming public forums focused on:
The effect on the commercial market (June 15th and 16th)
Consumer shopping experience (June 27th and 28th)
How the Exchange aligns with Medicaid/CHIP programs (June 29th and 30th)
Small employers (July 11th)
Prepare strategic plan and roadmap to develop an Exchange