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Disclosure Statement
• There are no conflicts of interest or restrictions (including off-label use disclosure) related to this presentation and/or related materials.
Adela Flores-BrennanCASBHC 2013 Annual Conference
May 3, 2013
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SB11-200: The Colorado Health Benefit Exchange Act of 2011
• Passed in May 2011• Establishes framework for the
state Exchange• Governed by a Board of
Directors• Legislative Implementation
Review Committee • Mission is to increase access,
affordability and choice for individuals and small employers purchasing health insurance
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What is the Colorado Health Benefit Exchange?
An open, competitive marketplace soon to be called Connect for Health Colorado
for individuals and small employers to:
Compare information regarding cost and qualityShop features of plans containing the same base benefitsDetermine eligibility for and Access federal financial assistance
(premium discounts)Support in the health insurance decision-making processCall, text or sit down with someone for helpEnroll in a plan
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2 shopping paths
Small employer marketplace for businesses and non-profits
– Tax credits up to offset employer premium cost
Individual/family marketplace – Tax credits and cost sharing subsidies
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Small Employers
• Marketplace will provide small group plan options to Colorado employers with 2-50 employees
• Employers with up to 100 employees can be served in 2016• Employers can set benefit budget• Employers can provide greater choice to workers• Employees can use benefit allowance to shop for health plans• Small business tax credits will be available (up to 50% of
premium)• Other value-added services will be provided, like payment
aggregation, management tools and ability to use brokers
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Individuals and Families
• Marketplace is for Coloradans who currently buy insurance on their own, who are uninsured, or don’t have access to affordable coverage through large employer
• Online shopping, with assistance by phone and in-person• Insurers compete for your business • Health plans will provide more comprehensive coverage• Customers can access new federal financial assistance to
lower premiums, co-pays and deductibles• Several ways to shop: browse health plans, estimate savings,
or apply online for federal financial assistance
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Individuals and Families Eligibility
• To be eligible for the marketplace you must:– Be a Colorado resident, and– Be a US citizen or National, or– Be a non-citizen who is lawfully present in the US
for the entire enrollment period– Not be incarcerated
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Individuals and Families
• Customers who want assistance paying for health coverage will:– Answer questions about household and income– Verify identity, citizenship and income– Review eligibility results– Shop for and compare health plan – Medicaid and CHP+ eligible household members
will be directed to contact HCPF or link to PEAK for follow up activities
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Individuals and Families
Financial help (tax credit) to reduce the cost of premiums– Individual earning up to $45,960/year– Couple earning up to $62,040/year– Family of 4 earning up to $94,200/year
• Tax credit applied up-front by IRSFinancial help to reduce cost sharing• Individuals earning up to $28,725/year • Family of 4 earning up to $58,875/year
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Tax Credits for Individuals and Families
Tax credit amount is on a sliding scale, based on income as a percent of poverty and limits premiums as a percent of income.
FPL Range Percent of Income
Up to 133% 2
133-150% 3-4
150-200% 4-6.3
200-250% 6.3-8.05
250-300% 8.05-9.5
300-400% 9.5
Example (Individual)• Bill is a 40 year old male making $30,000 per year.• He enters the marketplace through the website and
applies for assistance paying for his coverage.• He qualifies for $166 per month in premium discounts.
He is offered the choice to adjust the tax credit down if he expects to have an increase in income during the year so he doesn’t owe the IRS later.
• He shops for and compares health plans with the same base benefits.
• He finds a plan that costs $375 per month. The premium discount brings his total cost to $209 per month.
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Tax credit estimates – Individual
Premium discount – advanced premium tax credit. Based on a $375 monthly premium for a 40 year old adult. Premiums fluctuate based on the type of plan purchased.
Annual Income $ 15,000 $ 20,000 $ 30,000 $ 40,000
Monthly Tax Credit $ 350 $ 290 $ 166 $ 58
Monthly Premium $ 25 $ 85 $ 209 $ 317
% APTC of Total 93% 77% 44% 15%
Example (Family)
• The Smith family is a family of four with an income of $45,000.
• They submit an application for coverage and assistance paying for coverage.
• They qualify for a monthly premium discount of $790. This can be adjusted down if they want.
• The Smiths find a plan with a monthly premium of $1,010.
• When they apply their premium discount, the Smith’s monthly premium cost is $220.
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Tax Credit estimates – Family of Four
Premium discount – advanced premium tax credit. Based on a $1,010 monthly premium for a family of four. Premiums fluctuate based on the type of plan purchased.
Annual Income $ 30,000 $ 45,000 $ 60,000 $ 75,000
Monthly tax credit $ 960 $ 790 $ 600 $ 416
Monthly Premium $ 50 $ 220 $ 410 $ 594
Percent of income as covered by discount
95% 78% 59% 41%
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Comprehensive CoverageQualified health plans sold to individuals and small businesses inside and outside of the marketplace must provide, at a minimum, the following essential health benefits:
Ambulatory patient services Emergency Services Hospitalization Maternity/newborn care Mental health/substance abuse Prescription drugs Rehab/habilitative services and devices Laboratory services Preventive and wellness care/chronic disease management Pediatric services, including oral and vision care
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COHBE Customer Support System
• COHBE is creating a system of customer support that includes– Self help using online decision tools– Customer Service Center (including co-browsing and
chat)– Certified Health Coverage Guides– Licensed and Certified Brokers
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Connect for Health Assistance Network
• A network of local organizations that will provide impartial, community based assistance to customers seeking health coverage through the health insurance marketplace.
• Aligns with federal regulations on Navigators and guidance on in-person assisters.
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Assistance Network Structure• Health Coverage Guides
– Individuals who provide impartial information, education and assistance with the application for coverage and assistance.
• Assistance Sites– Targeted, trusted local resources geographically
distributed throughout the state.– Employ and supervise Health Coverage Guides. May serve
individual market, SHOP or both.
• Regional Hubs– Additional support to Assistance Network as conveners,
hubs for training and outreach.
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Health Coverage Guides• Public Education and Outreach• In Person Assistance
– Information on health coverage options and assistance paying for health coverage
– Assistance completing application or determining plan and benefit options for small employers
– Search and prioritize health plan options– Post-enrollment support for income and household
changes– Referrals to consumer assistance– Connect with Customer Service Center or Broker
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Assistance Sites• Commitment to COHBE mission• Infrastructure to support ADA accessible Health Coverage
Guide activities • Define geographic region for service• Recruit and supervise Health Coverage Guide staff
– In-person assistance– Public Education and Outreach/Inreach
• Respond to Email and Phone inquiries and appointment setting
• Adhere to privacy, security, conflict of interest policies• Monitoring and reporting• Support for small employers and their employees (SHOP
Sites)
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Regional Hub• Define geographic area for service• Convene Health Coverage guides
– Information sharing, best practices, etc.
• Ensure coordinated system of referral in region• Serve as hub for outreach
– Coordinate events– Public presentations
• Support training efforts– Staff a trainer– Identify training needs– Serve as mentor
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COHBE 2013 Key Activities• Launch Connect for Health Assistance Network• Work with DOI to certify health plans• Open Customer Service Phone Center• Launch broad marketing and outreach campaign• Apply for Level 2 Grant from federal government• Test technology systems and back-office functions• Train thousands of navigators, brokers, customer service
representatives, partners• Open October 1
Thank you!
QUESTIONS?
