Insure Montana Insure Montana Small Business Health Insurance ProgramSmall Business Health Insurance Program

The Small Business Health Care Affordability Act, was The Small Business Health Care Affordability Act, was requested by State Auditor John Morrison and Governor requested by State Auditor John Morrison and Governor

Brian Schweitzer and was signed into law in May of 2005. Brian Schweitzer and was signed into law in May of 2005.

The program is designed to give tax credits to small The program is designed to give tax credits to small businesses already offering health coverage and to provide businesses already offering health coverage and to provide monthly assistance and membership in a purchasing pool to monthly assistance and membership in a purchasing pool to

businesses that have not offered health insurance in the past. businesses that have not offered health insurance in the past.

About Montana’s Population:•Montana’s uninsured rate ranks among the worst in the nation.

•One in five Montanans or about 170,000 residents have no health insurance.

•53% of Montana’s uninsured population works for a small business.

•80% of small firms not offering insurance would do so if they could afford the premiums.

Popularity of Insure MontanaPopularity of Insure Montana

740 previously uninsured businesses are enrolled in the 740 previously uninsured businesses are enrolled in the purchasing pool; covering 5,100 livespurchasing pool; covering 5,100 lives655 small businesses are receiving a tax credit through 655 small businesses are receiving a tax credit through Insure Montana, covering 3,800 livesInsure Montana, covering 3,800 livesOver 500 small businesses are on a waiting list to Over 500 small businesses are on a waiting list to participate in the program, either through the purchasing participate in the program, either through the purchasing pool or a tax credit. pool or a tax credit.

Lee Newspapers Poll, reported on 12/20/06 showed:Lee Newspapers Poll, reported on 12/20/06 showed: – A program that provide subsidies and income tax-breaks to help A program that provide subsidies and income tax-breaks to help

small businesses provide health insurance for employees small businesses provide health insurance for employees (Insure Montana) was supported by 87 percent of those (Insure Montana) was supported by 87 percent of those surveyed, while only 6 percent opposed an expansion. Seven surveyed, while only 6 percent opposed an expansion. Seven percent were undecided. percent were undecided.

Insure Montana Purchasing Pool Insure Montana Purchasing Pool and Tax Creditsand Tax Credits

Eligibility Requirements: Eligibility Requirements: – Businesses with 2-9 full time employees where no employee Businesses with 2-9 full time employees where no employee

earns more than $75,000 (excluding the owner) meet the initial earns more than $75,000 (excluding the owner) meet the initial criteria.criteria.

– In order to be eligible for the Purchasing Pool, a business must In order to be eligible for the Purchasing Pool, a business must NOT have offered group health insurance in the past 24 months. NOT have offered group health insurance in the past 24 months.

– Purchasing Pool participants receive monthly employer incentive Purchasing Pool participants receive monthly employer incentive payments and employee assistance paymentspayments and employee assistance payments

– In order to be eligible for a Tax Credit, a business must currently In order to be eligible for a Tax Credit, a business must currently pay some or all of the cost of group health insurance for their pay some or all of the cost of group health insurance for their employees. The program also provides additional Tax Credits employees. The program also provides additional Tax Credits when employers pay insurance premiums for the employee’s when employers pay insurance premiums for the employee’s spouse or their dependents. spouse or their dependents.

Insure Montana ImplementationInsure Montana Implementation Purchasing PoolPurchasing PoolCoverage began January 1, 2006 Coverage began January 1, 2006 740 previously uninsured businesses 740 previously uninsured businesses enrolledenrolled5,130 lives covered5,130 lives coveredAverage monthly assistance amount: Average monthly assistance amount: $158 (per employee) $158 (per employee) Average monthly incentive amount: Average monthly incentive amount: $203 (per employer) $203 (per employer) Funding available for approximately Funding available for approximately 760 businesses 760 businesses

Tax CreditsTax CreditsCredit effective January 1, 2006Credit effective January 1, 2006725 businesses received a credit for 725 businesses received a credit for 20062006655 businesses enrolled for 2007655 businesses enrolled for 20073,800 lives covered3,800 lives coveredAverage yearly tax credit: $5,300Average yearly tax credit: $5,300

Insure Montana Funding Funded by $1 per pack cigarette tax passed by voters. Funded by $1 per pack cigarette tax passed by voters.

Insure Montana was allocated $13 million dollars for the first two years. (FY 2006, Insure Montana was allocated $13 million dollars for the first two years. (FY 2006, 2007)2007)

For the upcoming biennium $20 million dollars has been allocated (FY 2008, 2009) For the upcoming biennium $20 million dollars has been allocated (FY 2008, 2009)

Insure Montana’s Governing BoardInsure Montana’s Governing Board

Insure Montana Mission Statement: Insure Montana Mission Statement: – Increase the well-being of all Montanans by enabling access to Increase the well-being of all Montanans by enabling access to

comprehensive healthcare for the members of the small comprehensive healthcare for the members of the small business workforce and their families. business workforce and their families.

Insure Montana has a Governing Board consisting of 7 Insure Montana has a Governing Board consisting of 7 membersmembers– 3 members are appointed by the Commissioner 3 members are appointed by the Commissioner – 4 members are appointed by the Governor 4 members are appointed by the Governor

Premium Incentive and Assistance Premium Incentive and Assistance PaymentsPayments

Employer Incentive Payment: Employer receives a Employer Incentive Payment: Employer receives a monthly incentive payment for a portion of their monthly incentive payment for a portion of their contribution contribution

Employee Assistance Payment: Individual employee Employee Assistance Payment: Individual employee receive a monthly assistance payment based upon receive a monthly assistance payment based upon household incomehousehold income– Employee’s can receive anywhere from 20%- 90% assistance Employee’s can receive anywhere from 20%- 90% assistance

on their share of the premium on their share of the premium – Additional assistance is provided if an employee is covering Additional assistance is provided if an employee is covering

dependentsdependents

Benefits of Pool CoverageBenefits of Pool Coverage Coverage available through Blue Cross Blue Shield of Coverage available through Blue Cross Blue Shield of MontanaMontanaTwo comprehensive plans offeredTwo comprehensive plans offered– Standard Healthlink Plan: Standard Healthlink Plan:

$1000/$2000 Deductible $1000/$2000 Deductible Coinsurance 70/30Coinsurance 70/302 office visits paid at 100% 2 office visits paid at 100% Preventative Benefits paid at 70%Preventative Benefits paid at 70%Dental coverage included- 2 cleanings per year Dental coverage included- 2 cleanings per year RX $100 deductible RX $100 deductible

– Premier Healthlink Plan: Premier Healthlink Plan: $500/1000 deductible $500/1000 deductible Coinsurance at 80/20Coinsurance at 80/202 office visits paid at 100% 2 office visits paid at 100% Preventative Benefits paid at 80%Preventative Benefits paid at 80%Dental coverage included- 2 cleanings per year Dental coverage included- 2 cleanings per year RX 0 deductible RX 0 deductible

How the Employer Incentive How the Employer Incentive Payment WorksPayment Works

Employers are required to contribute 50% of the Employers are required to contribute 50% of the employee-only premiumemployee-only premium

Insure Montana (IM) reimburses the employer 50% of Insure Montana (IM) reimburses the employer 50% of their contribution amount through a monthly incentive their contribution amount through a monthly incentive payment, based on the Standard Healthlink plan (subject payment, based on the Standard Healthlink plan (subject to rate tier 6, and age 54)to rate tier 6, and age 54)

If an employer contributes more than 50%,the incentive If an employer contributes more than 50%,the incentive payment will not increasepayment will not increase

How the Employee Assistance How the Employee Assistance Payments WorkPayments Work

Employees are responsible for other half of their Employees are responsible for other half of their premium, plus dependents if they are covering thempremium, plus dependents if they are covering them

Premium assistance payment is determined by annual Premium assistance payment is determined by annual household income amounts; based on a sliding fee scale household income amounts; based on a sliding fee scale

Employees receive 20-90% assistance monthly Employees receive 20-90% assistance monthly

If an employee is covering dependents the amount of If an employee is covering dependents the amount of assistance will be greater assistance will be greater

Insure Montana ExamplesInsure Montana Examples

Employee #1: Single Coverage, 35-39 Employee #1: Single Coverage, 35-39

Total Monthly Premium: $214.74Total Monthly Premium: $214.74– Employer contribution: $107.37Employer contribution: $107.37

– Employer incentive payment: $53.69Employer incentive payment: $53.69

– Employee contribution: $107.37Employee contribution: $107.37

– Employee assistance: $64.42 (60%) Employee assistance: $64.42 (60%)

– Employee total: $42.95Employee total: $42.95

Employee #2: Family+ Child, 35-39Employee #2: Family+ Child, 35-39 Total Monthly Premium: $742.07Total Monthly Premium: $742.07

– Employer contribution: $152.78Employer contribution: $152.78

– Employer incentive: $76.39Employer incentive: $76.39

– Employee contribution: $589.29Employee contribution: $589.29

– Employee assistance: $471.43 (80% assistance) Employee assistance: $471.43 (80% assistance)

– Employee total: $117.86Employee total: $117.86

Looking ForwardLooking Forward

– Insure Montana anticipates enrolling an additional 25 Insure Montana anticipates enrolling an additional 25 businesses in the purchasing poolbusinesses in the purchasing pool

– Governor Schweitzer proposed an additional $1 Governor Schweitzer proposed an additional $1 million for the program which passed the 2007 million for the program which passed the 2007 Montana LegislatureMontana Legislature

– Insure Montana will be submitting a Request for Insure Montana will be submitting a Request for Proposal (RFP) for additional carriers this summer to Proposal (RFP) for additional carriers this summer to participate in 2008. Legislation allows for up to 3 participate in 2008. Legislation allows for up to 3 carriers and 6 plans to be offeredcarriers and 6 plans to be offered

Insure Montana Contact Insure Montana Contact InformationInformation

www.insuremontana.orgwww.insuremontana.org

Lisa Crowley, Program Director (406)444-2406Lisa Crowley, Program Director (406)444-2406