Marketplace Overview

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What is Connect for Health Colorado?

An open, competitive marketplace for individuals and small employers to:

• Compare health insurance costs and features side by side

• Shop plans containing the same base benefits• Determine eligibility for and access new federal

financial assistance, based on income• Call, chat or sit down with trained representatives

for help• Enroll in a health plan

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Connect for Health Colorado is NOT

• A replacement for the current market or brokers• Engaged with negotiating rates between carriers and

providers • Part of Medicaid• Offering Medicare or supplemental health plans• A new government health care system• A State agency or regulatory body• An organization that receives funding from Colorado

General Fund

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What is the Individual Marketplace?

• One of two shopping paths offered by Connect for Health Colorado (other is for small employers)

• A new resource for Coloradans seeking health coverage

• Providing individual and family health plans that take effect starting Jan. 1 2014

• Online shopping, with assistance by phone and in-person

• The only place where Coloradans can access new federal financial assistance to lower premiums, co-pays and deductibles

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Who can shop?

• Coloradans who currently buy insurance on their own• Coloradans who are uninsured• Coloradans who are self-employed• Coloradans who don’t have access to affordable

coverage through their employer• Coloradans with legal immigration status• Family members/dependents of employees who are

offered employee-only coverage by employer• Not for individuals eligible for Medicare or seeking

supplemental plans

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Ways to shop

• Starting October 1: go to www.ConnectforHealthCO.com

• Answer a few questions and browse health plan prices and features

• Answer a few questions and get an estimate of eligibility for new financial assistance

• Shop for commercial health plans without financial assistance

• Fill out the application for new financial assistance and insurance affordability programs (Medicaid and CHP+) and find out what you are eligible for

• Enroll in health coverage that takes effect starting Jan. 1 2014

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Individual Marketplace Open Enrollment

Oct. 1 Dec. 15 Jan. 1, 2014 March 31, 2014

Shopping starts October 1, 2013Coverage Begins January 1, 2014

Individual Open Enrollment Ends

Coverage begins

Deadline for

enrollment to have

coverage Jan. 1, 2014

Open Enrollment

Begins

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What can you shop for?

• 150 new health plans that include a comprehensive set of medical services and benefits, free preventive services

• 10 Carriers:o Access Health Colorado, Anthem Blue Cross and Blue

Shield, Cigna, Colorado Choice, Colorado HealthOP, Denver Health, Humana, Kaiser Permanente, Rocky Mountain Health Plans, UnitedHealthcare

• PPO, HMO, HSA, CYA (high deductible plans for young adults)

• Health plans with dental coverage and without• Separate dental plans• Find out eligibility for Medicaid and CHP+ and enroll• A link to vision plans

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Who can help you use the Marketplace?

• Online chat and decision-support tools

• Help over the phone by Customer Service Center Representatives through toll-free number

• Impartial help in-person by certified Health Coverage Guides located at over 50 community-based Assistance Sites statewide

• Advice in person and by phone by licensed and certified health insurance agents and brokers located statewide

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Key changes

• Starting in 2014, you can not be denied health coverage based on a pre-existing condition or your health history

• You will not be asked about your health history or medical needs when you apply for health insurance (other than pregnancy, tobacco use and disability status)

• Starting in 2014, about 160,000 Coloradans will be newly eligible for Medicaid because of a state law passed this year; adults earning up to about $15,000 a year, couples earning up to about $21,000 and families of four earning up to about $32,000 will be eligible for Medicaid and the Marketplace will help you access Medicaid and CHP+

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Other facts to know

• There will be set open enrollment periods for commercial health plans that will provide coverage for the calendar yearo Oct. 1 2013 to March 31 2014 o Oct. 15, 2014 to Dec. 7, 2014 for future

years

• Customers who sign up by the 15th of the month will have coverage begin on the first of the next month; if you sign up after the 15th, you will wait until the following month

• There will be ways to sign up for coverage outside of open enrollment periods (loss of job, marriage or divorce, move into the state, birth of child, change in income, etc)

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Comprehensive Coverage

Health plans will provide, at a minimum, the following categories of services, also known as 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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How much will I pay?

• Prices depend on age, the region of the state in which you live, how many people are on plan, and if you use tobacco products

• Colorado Division of Insurance (DOI) approved rates in August

• Prices will not be affected by your health needs or history

• Preliminary filings show a wide range of prices:

o Rates for a 21-year-old living in Denver range from $153 to $299 a month for bronze plans and from $201 to $377 for silver plans, before cost-reductions based on income.

o Rates for a 40-year-old living in Denver range from $186 to $364 for bronze plans and from $245 to $460 for silver plans

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How can I organize my options?

•Health plans will be organized by coverage levels based on how much of the services, on average, are paid for by the carrier and how much are paid for by the customer

o Bronze (60% paid by carrier/ 40% paid by customer)

o Silver (70/30)o Gold (80/20)o Platinum (90/10)

•You can look for health plans by• medical provider and facility• Carrier• Coverage level• Premium

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Cost reductions for Individuals & Families

New financial help to reduce the cost of premiums• Individual earning between $15,856 to $45,960/year• Couple earning between $21,404 to $62,040/year• Family of four earning $32,499 to $94,200/year

o Tax credit applied up-front by IRSo Tax credit is higher for older Coloradans, especially for those ages

55-64

New financial help to reduce out of pocket costs (co-pays and deductibles)

• Individuals earning $15,856 to $28,725/year • Family of 4 earning $32,499 to $58,875/year

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How does the new tax credit work?

• Customers will fill out the financial assistance application, providing information about future income, tax household, identity and other details to determine eligibility

• Customers will learn how much financial assistance they can receive after they are denied Medicaid/CHP+

• Customers will choose a health plan and decide how much of the tax credit to use right away to reduce the monthly premium vs. claiming the credit on taxes

• The amount of tax credit will be the same regardless of the health plan you choose

• Customers will need to report change in income to Marketplace to re-determine eligibility for financial assistance

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How do the cost-sharing reductions work?

• Same financial assistance application will be used

• It is possible for customers to receive both forms of financial assistance, based on income

• If eligible, based on income, customers can enroll in health plans that have lower co-pays and deductibles – like an upgrade

• Eligible Native Americans can enroll in health plans that have no co-pays and deductibles for in-network services

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Information for financial application

• Estimated household income for coming year (adjusted gross income reported on 1040 with some additional information, not including assets such as property)

• Identity info, such as Social Security numbers, for each person to be covered

• If you have other coverage through an employer, Medicare, Medicaid and/or pediatric dental through a separate policy

• Info about tax household, Colorado residency status, immigration status

• Other questions specific to public programs and specialized populations such as Native Americans

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Small Business Marketplace

• One of two shopping paths for customers of Connect for Health Colorado

• New option for providing group plans to employees

• Small businesses and non-profit organizations set the terms of the group plan and then employees come to the Small Business Marketplace to sign up for coverage

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How do Businesses Qualify?

• Have a Colorado location

• 2 – 50* combined full-time and full time equivalent employeeso Our Board chose to define our small group market

in 2014-2015 as 50 or fewer employeeso Will increase to 100 or fewer employees in 2016

• Offer coverage to all full-time employees

* Business Groups of One will shop in the Individual Marketplace

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How do Businesses Qualify?

• Counting Employees

• Based on a monthly totals for previous calendar year

• Add monthly full time employees to full time equivalent part-timers

– Determine part-time hours for each month (but not more than 120 per employee, then divide by 120

– An employer may select any 6 month period to determine average for previous calendar year

• Once an employer is Marketplace qualified they may remain regardless of changes in employee count

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Small Employer Health Care Tax Credit

Who qualifies?

• Employers with fewer than 25 employees for the tax-yearo Full-time employeeso Add part-time hours and divide by 2080 to obtain full-time

equivalent

• Average employee income of less than $50,000 o (not counting owners or family members)

• Employer must pay premiums under a “qualifying arrangement” with nondiscriminatory contributions of not less than 50% of employee cost

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Small Employer Health Care Tax Credit

Amount of Credit:

For tax years beginning 1/1/2014…

o Up to 50% (35% for nonprofits) of contributions made for non-owner employees and their dependents

o Nonprofits may take the credit against their payroll taxes

o Credit can be claimed for only two years beginning in 2014

o Amount of credit is determined on a sliding scale based on the number of employees and employee average income

Estimate the credit at: www.connectforhealthco.com

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Small Group Choices

• 92 Health Plans

• Anthem Blue Cross and Blue Shield• Colorado Choice• Colorado HealthOP• Kaiser Permanente• Rocky Mountain Health Plans• See Change Health

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Employer/Employee Choice Options

• One Carrier / One Plan

• One Carrier / All Plans

• One Metal Level / All Carriers

• Two Adjacent Metal Levels / All Carrierso Example: Bronze and Silver

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How Will Employers Access the Marketplace?

• Employer or Agent/Broker – open an account• Build a roster/census• Review proposal options• Decide on the right plan design at the right price• Complete a preliminary application –

contribution/waiting period • Trigger Employee Open Enrollment• Employee review their options menu and select plans or

waive• System reviews completed enrollment and waivers• Open enrollment closes – participation is reviewed• Final Invoice – Employer approval• Release Employer Application and enrollments to

carriers• Carrier provide certificates and ID cards• Small Business Marketplace provides employer billing

and ongoing administration

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Protecting Your Privacy

• The Marketplace will comply with state and federal laws to protect your informationo We won’t use or share your financial information after

determination of eligibility for financial assistance is madeo We won’t ask you for medical information (except for

tobacco use, pregnancy and disability)

• There will be strict security to protect access to files

• The website and backup systems will have strong protections against outside attacks

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Key Takeaways

• You have a broad array of health plan choices in one place

• Connect for Health Colorado is the only place to access cost savings that you can use right away to reduce your costs

• You can get help over the phone and in-person from a statewide network of trained professionals

• Sign up by Dec. 15 to have your coverage start Jan. 1

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Resources

• Website: www.ConnectforHealthCO.com

• Email questions: Info@ConnectforHealthCO.com

• Toll-free help by phone: 1-855-PLANS-4-YOU (855-752-6749) 8 am to 6 pm Monday to Friday, 8 am to 5 pm Saturdays

• County Snapshots: http://www.connectforhealthco.com/how-it-works/county-snapshots/