2016 & Beyond Rhonda Fossitt Senior Deputy Director July 17, 2015.
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Transcript of 2016 & Beyond Rhonda Fossitt Senior Deputy Director July 17, 2015.
2016 & Beyond
Rhonda FossittSenior Deputy DirectorJuly 17, 2015
ACA: 2016 Highlights – Year 3
• Number of Issuers & Plans by Market
• Employee Choice on the SHOP
Small GroupOn/Off Market
7 Issuers337 Plans
Small GroupOff Market15 Issuers434 Plans
IndividualOn/Off Market
15 Issuers227 Plans
IndividualOff Market6 Issuers29 Plans
2016 Number of Issuers &Plans by Market
IndividualOn/Off Market
15 Issuers227 Plans
2016 Individual – On/Off Market
IndividualOn/Off Market
1 Issuer 11 Plans
Change Since 2015
IndividualOff Market6 Issuers29 Plans
2016 Individual – Off Market
IndividualOff Market 1 Issuer
125 Plans
Change Since 2015
2016 Small Group – On/Off Market
Small GroupOn/Off Market
7 Issuers337 Plans
Change Since 2015
Small GroupOn/Off Market 4 Issuers 53 Plans
2016 Small Group – Off Market
Small GroupOff Market15 Issuers434 Plans
Change Since 2015
Small GroupOff Market
No Change In Issuers 292 Plans
2016 Employee Choice for the SHOP
• Originally scheduled for 2015• Michigan opted to delay• Employee Choice
- Employers may allow employees: to choose any health plan at metal level
selected by employer
ACA: 2016 Timeline RemindersActivity Dates
Company-wide Participation in Plan PreviewContact DIFS if Errors Found (NEW!)
7/17/2015to 8/5/2015
Date to Review & Contact DIFS on Plan Preview (NEW!) 8/5/2015
CMS Notifies DIFS/Issuers of Necessary Correctionsto QHP Data
8/13/2015to 8/14/2015
Final Deadline for Issuers to Resubmit Data to DIFS 8/20/2015
Begin Marketing or Pre-EnrollmentOn or Off Marketplace
*Date QHP Agreements are Finalized with CMS
(Approx. 10/9/2015)
*Applies even if you are not required to sign QHP Agreement
ACA: 2016 Significant Issues – Year 3
• Expansion of Small Group• Large Group Transitional Policy
Expansion of Small Group MarketUnder ACA
• Effective January 1, 2016• Definition of “small employer” will change
- Employers with 100 of few FTE employees- Previously 50 or fewer
Expansion of Small GroupMarket Under ACA
According to American Academy of Actuaries:• Number of employees covered under small group
market may increase by 30%• Groups sized 51-100 will have more restrictive rating
rules• Groups sized 51-100 will have more benefit and
cost-sharing requirements• Could result in more self-insurance
Keep Current Definition ofSmall Group
• Legislation introduced in Congress to keep current definition of small group
• With King v Burwell behind us, legislation may move forward
• Legislation supported by many groups• If law is enacted, timing will be important
Large Group Transitional Policy
Michigan has adapted the Large Group Transitional Policy• Allows small employers (51-100)• Renewing prior to 10/1/2016• To delay adapting the small group definition• Transitional policies may not remain in effect
beyond 10/1/2017
ACA: DIFS Selected a BenchmarkPlan for 2017
As per HHS guidance, DIFS compared 10 plans in-force 3/31/2014:• 3 Largest Small Group Plans• 3 Largest State Employee Plans• 3 Largest Federal Employee Plans• Largest HMO Plan
ACA: DIFS Selected a BenchmarkPlan for 2017
DIFS:• Prepared comparison chart of 10 plans, along
with Benchmark Plan for Dental and Vision• Posted for public comment – May 15 to June 5• Reviewed public comment
Priority Health HMO Selected as Michigan Benchmark Plan
Selection Based on:• Mitigating rate increases for Michigan consumers• Ensuring all EHB requirements are met• Substantially similar to the current EHB benchmark
plan
The 2017 Essential Health Benefits Benchmark Plan Executive Report is posted on the DIFS website. This report outlines the process and selection of the plan.
Michigan Benchmark Plan – Final Steps
CMS will:• Post for public comment in late summer• Post the approved version in the Fall of 2015