2015 fall broker training - blue cross of idaho2015 fall broker training. 2 •individual products...

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©2014 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

An Independent Licensee of the Blue Cross and Blue Shield Association

2015 Fall Broker Training

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• Individual products

• Dental products

• Group updates

• News and updates

Agenda

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Presenters

Terrie Havis – Director, Broker Relations

Lisa Wilson – Broker Relations Specialist Sr

Adam Caldwell – Broker Relations Specialist

Kathy McGuire – Director, Sales Operations

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Meet the Broker Relations Team

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Who are we?

• Terrie Havis – Director of

Broker Relations

• Crystal Hayes – Business

Analyst, Broker Relations

• Megan Hallingshead-Smith –

Competitive Intelligence

• Commission Specialists

• Julie Johnson

• Suzanne Finch

• Teresa Wendell

• Broker Relations Specialists

• Lisa Wilson – Commercial –

Treasure Valley, South and East

Idaho

• Adam Caldwell – Commercial –

Treasure Valley and North Idaho

• Lynette Gaskell – Medicare

Advantage, statewide

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Individual Product Update

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HSA Plans• The ACA requires that maximum out-of-pockets (MOOPs) for

health savings account (HSA) plans will be calculated on an

aggregate level starting in 2016.

• We will apply this method to deductibles as well

• The accumulators will match

• Deductibles and MOOPs are easier for employees (and

individuals) to calculate.

• Applies to all non-grandfathered individual plans, as well as small,

medium and large groups

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HSA AggregateUmbrella MOOP

Family 1 John $6,550

Family 2 John &Mary $13,100 The total must

accumulate before OOP

considered met

Family 3 John, Mary, Timmy & Joe $13,100 The total must

accumulate before OOP

considered met

Aggregate

Family 1 John $6,550

Family 2 John & Mary $6,550 each

Family 3 John & Mary

Timmy & Joe

$6,550/$6,550 Combination until

$13,100 is met among

family members

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New Product:

• CarePoint – our new coordinated care organization product

• Silver CarePoint 4000

• Supported by St. Luke’s Health Partners

• Same benefit design as other Connect products

Point sm

Care

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Terminating a Product

• We are not offering

Platinum Connect

Southwest, and

we’re creating a

transition plan for

current enrollees

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• Choice/Connect plans:

• Increase in-network MOOP amount:

• Choice (PPO plans):

• Out-of-network MOOP:

• Connect (CCO plans)

• No change to amount for out-of-network MOOP

New Maximum Out-of-Pocket

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• Choice/Connect

• Increased plan deductible for in and out-of-network

• Both in and out of network are now $6,850/$13,700

• Increased plan MOOP for in and out-of-network

• MOOP in-network: $6,850/$13,700

• MOOP out-of-network: $8,850/$17,000

• MOOP out-of-network for Bronze Connect remains the same

• $10,000/$20,000

Bronze Plan Changes

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Bronze HSA Saver

• New product name: Bronze Saver

• Name change applicable to individual QHPs only

• Increase MOOP

• In-network – from $6,350/$12,700 to $6,550/$13,100

• Out-of-network – from $8,350/$16,700 to $8,550/$17,100

• Cost-of-Living Adjustment (COLA) max is now $6,550

• Increased in and out-of-network deducible from $5,000 to $6,200

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Silver Plan Changes

• Office visit (physician and mental health) change for

each silver plan

• Removed visit limit (4 or 5) and deductible/coinsurance

• Will apply copayment only for unlimited office visits

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Silver Choice/Connect 4000

• Prescription drug deductible

• Decreased from $2,350 to $1,500

• Copayment for office visit

(physician/mental health)

• Increased from $10 to $20

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• Silver Choice 3000

• Copayment for office visit (physician/mental health)


• Silver Connect 3000

• Copayment for PCP and non-PCP/specialist office

visits (physician/mental health)

• PCP: Increased from $20 to $25

• Non-PCP/Specialist: Increased from $40 to $45

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• Brand name prescription drug deductible

• Increased from $1,000 to $1,500

• Copayments for brand name prescriptions

• Increased from $30/$50 to $50/$70

• No changes to copayments for specialty drugs

• Copayment for office visits (physician and mental

health)

• Decreased from $45 to $40

• Connect only: Copayment for specialty office visit

• Decreased from $65 to 60

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Silver Choice/Connect No

Deductible• New product names

• Silver Choice 500 and Silver Connect 500

• Plan deductible

• Increased from $0 to $500/$1,000

• Out-of-network deductible

• Decreased from $1,000/$2,000 to $500/$1,000

• Matches in-network deductible

• Benefit design for in-network office visits

• $20 copayment for office visits (physician/mental

health)

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Silver Saver – New Plan for 2016

Plan highlights

• HSA

• PPO network

• $3,000 deductible

• $4,000 MOOP

• 80% in-network

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CSR Variations for Silver Plans

• We will modify/decrease:

• Deductible

• MOOP

• Coinsurance

• Copayments for ER and advanced imaging

• Please watch for the sales lit that lists this plan information

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Gold Plans

• Office visit (physician and mental health) change for

Gold Choice/Connect

• Removed visit limit (4 or 5) and deductible/coinsurance

• Will apply copayment only for unlimited office visits

• Copayments for office visits (physician and mental

health)

• Increase from $10 to $20

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Catastrophic Plans

• Covered Choice/Connect

• Deductible – Increased from $6,350/$12,700 to

$6,850/$13,700

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Tribal Plans

• We do not have any

changes to Tribal

Choice/Connect.

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Individual Renewal Timeline

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Renewal Timeline

Blue Cross of

Idaho sends

notice of

discontinuance

Blue Cross of

Idaho sends

individual

renewal packets

Blue Cross

targeted phone

and e-mail

campaign

DHW notice

asking for

changes that

may impact tax

credit

Anonymous

browsing

begins on YHI

DHW sends 2016

tax credit

calculations

Open enrollment

for new members

or those who

want to change

plans

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Renewing Delinquent Clients

• If your client receives an APTC, renews his/her plan in January,

but is delinquent, we will apply premiums to the oldest

amount due.

• If your client is not paid-to-date, we will not effectuate his/her

January 2016 coverage.

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Example Scenario

Clark has a $100 monthly premium

October – Paid!Nov/Dec – Not

paid!

Clark enters his 90 day grace

period

Owes $200 for Nov/Dec

Clark pays January renewal

of $105

We apply this payment to past due premiums

Cancel 2016 plan for failure to make first

payment

Clark still owes $95 for 2015; does not have 2016 coverage

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Example Scenario

• Clark pays $100 monthly premium. He pays his October 2015

bill in full, but does not pay his November or December

premiums.

• Clark enters his 90 grace period for the 2015 plan in November &

owes $200 for November & December

• His new January renewal premium is $105, which he pays

• We apply this payment to his past due 2015 premiums

• We cancel his 2016 plan for failure to make a first payment.

• Clark still owes $95 for 2015, and does not have 2016

coverage

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Dental Changes

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Dental Blue Connect

for Small Groups• Dental Blue Connect is

now available to all group

sizes as a dual option with

another Blue Cross of

Idaho dental plan

• Plans are fully insured

• Groups may offer with or

without employer

contribution

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Individual & Small Group

• Individual

• No changes to Dental Choice/Choice Plus

• Small group

• No changes to Dental Choice/Choice Plus

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Small Group Product Changes

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Bronze Plan Update

• Bronze HSA Saver

• In and out-of-network deductible


• Choice/Connect/Point 4000

• MOOP


• Brand name prescription drug deductible


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Bronze Choice – PPO plan

• Copayments for office visits (physician and mental health)

• Decreased from $40 to $30

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Bronze Connect/Point – POS

plans• Copayments for office visits (physician and mental health)

• Decreased from $40/$60 to $30/$50

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Silver Plans


• MOOP



• MOOP


• Added $100 deductible for brand name prescription drugs

• Silver HSA Saver

• In and out-of-network deductible


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Gold Plans

• No changes

• Gold Choice/Connect/Point 2000



• MOOP


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Affordable Care Act Overview

for All Groups

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Where to Keep Up With ACA

Changes• We’ve created new ACA resource guides for large and small

employers

• Includes a timeline of compliance requirements for each size

group and action alerts on critical issues

• You can find these toolkits at reform.bcidaho.com

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reform.bcidaho.com

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What’s Ahead for Compliance?

• In 2016, your small and large groups can expect the

following regulations to go into effect:

• Grandmothered status ends – Renewal Nov. 2016

• Group size reclassification – Jan. 2016

• Employer shared responsibility – Jan. 2015

• IRS financial reporting – Jan. 2016

• HSA aggregate – Jan. 2016

• MOOP – Jan. 2016

• New SBC formats for renewal – Jan. 2017 effective dates

• Stay up-to-date at reform.bcidaho.com

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Grandmothered plans

• Small groups starting with November 2016

renewal must move to a QHP beginning with

their 2016 renewal

• Small groups with January through October

renewals move to a QHP at 2017 renewal

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Group Size Recalculation

Group sizes at 2016 renewal and all new

business are changing!

• Small group: 2-100

• Medium groups 50 – 100 move to small group

• Large group: 101 and above

• Grandfathered groups between 50 and 100 move into

the small group category, but can retain grandfathered

status

• Non-grandfathered groups can:

• Move to a QHP

• Become grandmothered, with renewal dates before Nov.

2016

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Group Size Recalculation:

Counting to 100 • State eligible employee counting method

• DOI calculation is different than tax reporting

calculation

• Groups between 1 – 100 eligible employees (an

average within the calendar year)

• An employee who works on a full time basis and has a

normal work week of 30 or more hours

• Groups with 101 full-time employees & above, but

enrolling less than 100 employees, are Community

Rated

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Federal Full-Time Equivalent (FTE) Counting Method

– Employer Shared Responsibility & Tax Reporting

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Federal FTE Counting Method -

Continued

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Employer Shared Responsibility

• Applicable large employers must offer minimum essential coverage

to employees

• Coverage must be

• Affordable

• Provide minimal essential coverage (MEC) 60% AV

• Penalties for noncompliance with MEC started in 2015

• Applicable large employer (ALE)

• 2015 greater than 100 employees

• 2016 greater than 50 employees

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Small group – Tax reporting

• Reporting to the IRS was voluntary in 2014, but mandatory in 2015 tax year

• Most Blue Cross of Idaho small groups are fully insured, so we report to the IRS on their behalf

• We encourage any individual employer in multi-employer groups to consult a tax advisor to prepare for the 2015 reporting

• The ACA includes Section

6055 that requires small

employers (fewer than 50

FTEs) to report the health

insurance provided to

employees

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What actions does a small employer

need to take?• No action for fully insured

small employers

• We are required to file 1094-B and 1095-B forms to the IRS on behalf of most small employers

• 1095-B: reports information about each employee

• 1094-B reports summary information on the employer and determines employee eligibility for premium tax credits

• We will provide a copy of this information to employees in 2016.

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Large group tax reporting

• The ACA includes two sections requiring large employers to report

the health insurance provided to employees:

• Section 6055: enforces the individual mandate

• Section 6056: enforces the employer mandate

• Both sections were voluntary in 2014

• No action is needed for the 2014 plan year, unless a group

voluntarily complied with the rule

• Mandated reporting starts for the 2015 calendar year

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Large group tax reporting• 1095-C reporting

• Blue Cross of Idaho will provide member-specific data by group from our

systems with which to populate the forms. MS Excel Format.

• Data elements include

• Part I – Employee/Employer

• Employee Name, SSN, Street Address, City, State, Zip

• Employer Name, EIN, Street Address, Contact phone number, City,

State, Zip

• Part III – Covered Individuals

• Dependent Name, SSN, DOB, Covered all 12 months (yes/no)? If

no, each month covered

• Excluded Data Elements:

• Part II – Employee Offer and Coverage

• Offer of Coverage (code), Offered all 12 months (yes/no)? If no, each month

offered

• Employee Share of Lowest Cost Monthly Premium for Self-Only Minimum

Value Coverage

• Applicable Section 4980H Safe Harbor (code)

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Large group tax reporting

• What additional information does Blue Cross of Idaho need from

the group?

• Collection support for missing group subscriber/dependent SSN’s

• Once the group has gathered the missing SSN information they can

contact their account manager for instructions on how to return the

information securely to Blue Cross of Idaho

• Contact the groups Blue Cross of Idaho account manager and advise

them that the group would like to request 1095-C data support

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Where can I go for more

information?• We do encourage you and/or your groups

to contact a tax consultant with specific

questions

• Blue Cross of Idaho will provide data on

the healthcare plan for the employer

• Instruction for forms 1094-C and 1095-C is

at irs.gov/pub/irs-dft/i109495c--dft.pdf

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Further information on tax

reporting• Questions and answers on Section 6055 reporting

• irs.gov/affordable-care-act/questions-and-answers-on-

information-reporting-by-health-coverage-providers-section-6055

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HSA Aggregate

• All 2015 renewals may keep their umbrella plan but will change to

aggregate upon renewal in 2016

• Beginning Jan. 2016, mid-sized groups with HSA plans can:

• Transition to grandmothered status

• Blue Cross will require them to move to the aggregate deductible and MOOP

• Enter the small group QHP market. These groups will move to aggregate

deductible and OOP

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New SBC formats for renewal

• New SBC format Dec 2016

• By Nov 1:

• Access SBC and contract available post-login on Member site

• Later in 2015, “Sample” group SBCs available for QHP on web

bcidaho.com/SBC

• This site will link to sample contracts

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Back to the Future!

• Congress is currently looking at some ACA

provisions

• Group size reclassification

• Cadillac tax

• We’ll update you quickly of any changes

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News and Updates

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Sales Operations Updates

• Online enrollment center

• Private exchange – Defined contribution

• Field alignment

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CostAdvisor

• Our new CostAdvisor is an online transparency platform that

provides your clients with cost estimates for healthcare services and

procedures

• All Blue Cross of Idaho individual members and fully insured groups

have CostAdvisor as a value-added feature at no cost

• Cost look up – Your client can search costs prior to accessing care

• Ways to Save – Your client can view new ways to save on services they

already use, like physical therapy.

• ASC’s must buy-up Ways to Save at $2 pmpy

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Where does it get its data?

• Blue Cross of Idaho provides the

CostAdvisor with a rolling

12-months of claims through our

data warehouse

• CostAdvisor uses this data to create

a database of information about

specific healthcare costs, providing

the most up-to-date estimated cost

results

• MA members get access to the

CostAdvisor at the end of the 2nd

quarter

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Mobile App

• The Blue Cross of Idaho mobile app is a

smartphone-friendly tool which gives your

clients immediate access to the most vital parts

of their health insurance benefits

• Provides personalized health insurance

information wherever, whenever

• Gives members a snapshot of their healthcare

finances

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How does it work?

We designed the app to help your clients have greater control

over their healthcare finances by giving them the freedom of

having key health coverage information the palms of their hands.

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Download it

It’s free!

It’s available for iPhones and Android devices

Search “Blue Cross of Idaho”

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Broker Relations Resources

Need more information or training for you or your staff:

New broker training the second Wednesday of most months. Register through

the Online Learning Center –

Open to admins and staff

New Broker Appointment not required

Training or information for you or your staff, contact

[email protected]

6666

Contact ListDistrict Sales Office 800-365-2345

For individual/group service and sales questions

Enrollment applications for existing groups [email protected]

All new group setup information [email protected]

Broker Commercial Hotline 866-675-1848For all non-sales issues including billing, claim or benefit questions

Member Customer Service 800-627-1188

MA Broker Relations Hotline 855-230-6858

To order supplies and for product & compliance questions

MA Broker Assist Line 800-289-8617

For eligibility, enrollment, & benefit questions

MA Member Services 888-494-2583

Commissions [email protected]

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Identity Protection Services

• The BCBSA now requires each Blues plan to offer

identity protection to all eligible members on or

before January 1, 2016

• ID protection plans must cover:

• Credit monitoring

• Fraud detection

• Credit/ID repair

• This service is not a health plan benefit expense, but

an additional value to Blue Cross of Idaho members

• More information is forthcoming.

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Co-Op Advertising Website• We’re streamlining our co-op advertising program to enhance the

co-op advertising program

• You select an ad, customize it and submit it to us for design

• The new website launches on October 1

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Co-Op Advertising Website

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Broker Satisfaction Survey

� Overall Satisfaction Ratings:

� Customer Service 77%

� Broker Relations: 81%

� District Office: 72%

� Website: 62%

� Overall Communications: 79%

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Broker Satisfaction Survey

� Areas for Improvement:

� Website navigation and functionality

� More detailed communication about group changes

� Knowledgeable staff available to answer the telephone

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Broker opinion panel

We want you to have the support and information needed to

continue to provide a high level of service to your clients

� That’s why we have our broker opinion panel

� bcidahobrokerpanel.com

� Things we’ve improved or changed due to your suggestions:

� Broker hotline

� Book of Business on the broker portal

� Extended customer service hours

� Remember to register and check your spam folder if you don’t receive an

email from us

� You have a chance to win an iPad for each survey you complete

� Congrats to Lori Shandro, Boise

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Thank you!

We’re proud to partner with you to help

Idahoans improve their lives with access to

quality healthcare.

2015 fall broker training - blue cross of idaho2015 fall broker training. 2 •individual products...

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