Different Perspectives

Healthcare Exchanges

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Today’s Speakers

Rick Elliot - President and CEO United Healthcare of Georgia

What to Expect in 2014Lurline Craig-Burke, Partner GHSC Atlanta

Business Leader – Mercer

The State of the StatesMakela McDermott – Total Rewards Director – Euramax International

Our Radical Change to a Private Exchange

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Level Setting:What Are We Talking About??

What is an Exchange? NEAR TERM●Mechanism for individuals and groups to gain

access to health care financing options through a program administered by the state and/or Federal government (PUBLIC EXCHANGES)

• American Health Benefits Exchanges (AHBE) for individuals &

• Small Health Options Plans (SHOP) for small groups (under 50 or 100 defined by state)

• Can be combined

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Things an Exchange Must Do

Implement procedures for certification, recertification, and decertification of health plans

Operate a toll-free hotlineMaintain Internet website with standardized

informationAssign a rating to each planUtilize standardized format for presenting optionsInform individuals of eligibility for Medicaid, CHIP or

other applicable state or local public programsCertify exemptions from individual mandate

2011 National Association of Health Underwriters

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Things an Exchange Must Do

Make available a calculator to determine the actual cost of coverage after tax credits/subsidies

Grant a certification attesting that the individual is not subject to the coverage mandate because:

●there is no affordable option, or

●the individual is exempt from the mandateTransfer to the Treasury a list of exempt individuals

and employees eligible for tax credits/subsidiesProvide to each employer the name of employees

eligible for tax creditEstablish a Navigator program

2011 National Association of Health Underwriters

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Exchange Basics

The Exchange must be operated by a governmental agency or nonprofit entity created by the state.

The Exchange must make “qualified” plans available to individuals or employers.

The Exchange must provide for:

●Initial open enrollment period

●Annual open enrollment period

●Special enrollment periods

2011 National Association of Health Underwriters

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Exchange Basics Must offer Qualified Health Benefits and offer at

least one Silver and Gold option●Meeting Network Adequacy requirements

●Provide Essential Health Benefits

●Meet Actuarial Value benefits requirement • Bronze (60%)• Silver (70%)• Gold (80%) • Platinum (90%)

Originally SHOP was to allow employees to choose from multiple plan options, but…..won’t happen in 2014

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Private Exchanges

Carriers may not be required to participate in Public Exchanges

Potential to participate in both; expect to see an uptick in Private Offerings

Subsidies not available in Private Exchange●Carrier sponsored, Vendor Sponsored, Association

Sponsored

●Differentiation based on services and coverage provided, administrative services, billing consolidation, ancillary benefit offerings, wellness, and more

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What Else???

Don’t Panic - It’s just insurance!Pay or Play Decision guides your decision

processExpect Changes – and look beyond the cost

●Defined Contribution and Productivity will be the new watch words

●Self-funding is coming

And, from one of the driver’s of Reform

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Senator Max Baucus D – Montana, Senate Finance Committee Chairman "We need data. "You never give me any data. You give me concepts,

frankly.“ “My main concern is that when I ask them for information about the

navigators … that I don’t get anything back,” Baucus told reporters.