nevada broker / agent health exchange on boarding session 2

Broker & Agent Onboarding - Session 2

July 31, 2013

Enrollment and Payments for Individuals & Small Business

Health Options Program (SHOP)

Agenda 1. Broker Portal

2. Individual Open Enrollment Periods 3. Individual Special Enrollment Periods 4. SHOP Employer Enrollment and Employee Open Enrollment 5. SHOP Employer/Employee Choice Models 6. SHOP Minimum Contribution and Participation Rates 7. Special Enrollment for SHOP 8. SHOP Renewals

Broker Portal • Brokers and agents will manage

Exchange clients on the Exchange website Broker/Agent portal to include: • Run proposals • Sales • Enrollment • Premium payment tracking • Service issues

Broker Portal Screenshot

Broker Login & License Validation

Individual Open Enrollment Periods

October 2013: Brokers & agents will be able

enroll individual clients in a health insurance plan using the broker & agent portal. December 15, 2013: Clients signed up for insurance by December 15, 2013 will have coverage on January 1, 2014. March 31, 2014: Enrollment closes for individuals until it reopens in the next open enrollment season (October 15 – December 7).

Individual Open Enrollment Eligibility

Eligibility for a Qualified Health Plan: • United States citizen, national, or lawfully

present • Cannot be incarcerated (unless awaiting

disposition of charges) • Must be a resident or intend to reside in

Nevada

Individual Special Enrollment Periods

Triggers: • Birth, Adoption or Placement for Adoption • Marriage / Domestic Partnership • Loss of Minimum Essential Coverage • Gains Citizenship, National, or Lawful Presence • Unintentional, Inadvertent, or Erroneous Enrollment/

Non-Enrollment as a Result of Nevada Health Link or HHS

• QHP Substantially Violates a Material Provision of the Contract

• Change in Eligibility for APTC/CSR • Employer Plan Unaffordable • Permanent Change in Residence to a New Service Area • American Indian/Alaskan Native • Other exceptional circumstances

Individual Special Enrollment Periods, cont.

Length of Period: enrollees are provided 60 calendar days after the date of a qualifying event to complete a plan selection. Effective Date of Coverage: • Birth/Adoption/Placement for Adoption – day of the

event. • Marriage/Domestic Partnership/Loss of MEC - first day

of the month following the qualifying event date. • All others:

• If the date the plan selected was completed between the 1st – 15th, the date of coverage is the first day of the following month.

• If the date the plan was selected was completed between the 16th – 31st, the date of coverage begins the month after the following month.

SHOP Employer Enrollment and Employee Open Enrollment

• Initial Open Enrollment begins October 1, 2013, with the first effective date of coverage beginning January 1, 2014

• A qualified employer may purchase coverage for its small group at any point during the year

• The employer’s plan year will consist of the 12-month period beginning with the qualified employer’s effective date of coverage

SHOP Employer Enrollment and Employee Open Enrollment, cont.

• Employers must select a purchasing model to offer to their employees at least 60 days prior to requested effective date of coverage

• Employees will be provided 30 days to select a QHP option from the employer’s selected purchasing model and complete the application process

• Employer’s enrollment and initial payment to the Exchange must occur at least 15 days prior to the effective date of coverage

SHOP Employer/Employee Choice Models

Four Purchasing Options: • Open Metal Tier • Open SHOP • One Carrier Package • Carrier Partnership Package Premium aggregation will be provided starting in 2014 for all purchasing options. Sample plans:

Example SHOP QHP Purchasing Model Options

SHOP Minimum Contribution and Participation Rates

Employer • All plans in the SHOP Exchange have a

standard minimum employer contribution rate of 50% of the lowest cost QHP available to the employer’s employees.

• Minimum employee participation rate of 75% of

eligible employees.

SHOP Eligibility Employee • Must receive an offer of coverage from a

qualified employer • Must be an eligible employee as defined by

the employer • New Group - Must be hired before the

group’s effective date of coverage • Existing Group - Must complete the group’s

waiting period if a new hire – or have a Special Enrollment event

SHOP Eligibility, cont. Spouse • Legally married to employee • Domestic Partner is at the option of the

employer Dependents • Children (born to, adopted, or legal

guardianship) ages 0-25 • Disabled (must be declared disabled by

SSA prior to enrollment and submit proof)

Special Enrollment for SHOP

Special Enrollment for SHOP, cont.

Employer • All plans in the SHOP Exchange have a

standard minimum employer contribution rate of 50% of the lowest cost QHP available to the employer’s employees.

• Minimum employee participation rate of 75% of

eligible employees.

SHOP Renewals • The Exchange will send renewal information

to the employer approximately 90 days prior to plan year end

• The Employer will have 30 days to submit changes to Purchasing Model & make changes to contributions

• The Employee will have 30 days to submit renewal changes

• If the employee does not submit changes, the employee’s plan will auto renew. If the plan the employee is enrolled with is no longer available, the employee must make a new plan selection.

Submitted Q & A

Nevada Health Link Silver State Health Insurance Exchange 2310 South Carson Street, Suite 2 Carson City, NV 89701 brokersandagents@exchange.nv.gov http://exchange.nv.gov/Resources/Brokers_Agents/

NevadaHealthLink.com