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Access Health Connecticut...• Plans (as of final filing to CID)by Metal Level 10 licensed...
Transcript of Access Health Connecticut...• Plans (as of final filing to CID)by Metal Level 10 licensed...
Access Health ConnecticutAHCT Broker WebinarDecember 12, 2019
Agenda
• Recap: Individual Market Changes for 2020 Certification Requirements
• Moving Forward: 2021 Plan Year Information Collection: Potential Exhibits
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Recap: Individual Market Changes for 2020
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2020 QHP Offerings –Summary
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Topic “On-Exchange” Individual Market “On-Exchange” Small Group MarketCarrier
ParticipationAnthem Health Plans Inc. (Anthem)
ConnectiCare Benefits Inc. (CBI)Anthem Health Plans Inc. (Anthem)
ConnectiCare Benefits Inc. (CBI)CID 2019 Rate
Filing DecisionsAnthem: -7.3 to +16.7%
CBI: -3.1 to +8.7%Anthem: +7.4 to +27.6%
CBI: -10.0 to +9.7%Plans to be
Offered via AHCTAnthem: 9
CBI: 8Anthem: 9
CBI: 5New Plans (#) Yes (4) No
Plan Crosswalk13 of the 2019 plans are renewing;
2 Silver plans per carrier not renewing (enrollees mapped to carrier’s remaining Silver plan)
All 14 of the 2019 plans are renewing
Common Cost Share Changes
(# of Plans)
MOOP (11); Emergency Room (7); Outpatient Facility (7); Rx Tier 1 (6); Deductible (6); Rx Tier 3 (6)
• Additional flexibility on copay maximums
MOOP (11); Urgent Care (8); Specialist (7); Deductible (6); Rx Tier 1 (5)
• Additional flexibility on copay maximums
Noteworthy Items
• CBI adding Adult Dental Preventive Benefit (Non-EHB) to non-standard Catastrophic, Bronze & Gold plans
• CBI new Gold non-standard plan includes $0 PCP copay at Sanitas Center (design similar to terminated Silver plan)
• ConnectiCare Inc (CCI) “Off-Exchange” Silver plan is lower in premium than any “On-Exchange” Silver plan (ranges by county
from -8.8% to -11.9%)• Anthem “On-Exchange” Gold non-standard plan is lower in
premium than any “On-Exchange” Silver plan (ranges by county from -0.1% to -11.8%)
• Plans (as of final filing to CID) by Metal Level
10 licensed insurance companies “On/Off”
Metal LevelOff- Exchange
ONLYOn-Exchange Total
Bronze 23 5 28Silver 62 5 67Gold 49 3 52
Platinum 16 1 17Grand Total 150 14 164
2020 QHPs: Plans Offered thru AHCT
*Catastrophic plans:• generally available only to those who are under 30 years old at the time of enrollment;• do not qualify for Premium Tax Credits 5
Individual Market
“On-Exchange” Permitted Number of Plans per Carrier “On-Exchange” Submitted Plans
Metal Level Standardized (Required)
Non-Standard(Optional)
Anthem Health Plans
ConnectiCare Benefits, Inc. Total
Catastrophic* N/A 1 1 1 2
Bronze 2 3 4 4 8
Silver 1 0 1 1 2
Gold 1 3 3 2 5
Platinum N/A 2 0 0 0
Total 4 Up to 9 9 8 17
2020 QHPs: What Changed from 2019?• Plan Benefits & Cost
Sharing– Cost sharing changes
for some covered services in mostrenewing plans
– Anthem Tiered-Network Plans Renewed (Gold & Bronze Non-Standard Plans)
– CBI Adult Preventive Dental Benefit (Catastrophic, Bronze & Gold Non-Standard Plans)
Individual Market Submitted Plans
Metal Level (Nbr) Anthem Health Plans ConnectiCare Benefits, Inc.
Catastrophic (2) 1 plan renewed 1 plan renewed
Bronze (8) 3 plans renewed;1 new plan
3 plans renewed;1 new plan
Silver (2) 1 plan renewed;2 plans terminated
1 plan renewed; 2 plans terminated
Gold (5) 2 plans renewed, 1 new plan
1 plan renewed;1 new plan
Net Change vs 2019: • 2 more Bronze plans• 4 fewer Silver plans• 2 more Gold plans
Current enrollees are notified by their insurance company about specific plan changes, including any resulting from assignment to an alternative from a terminated plan.
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2020 QHPs: Individual Market Silver Plans*
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2019 Anthem Blue Cross Blue Shield ConnectiCare Benefits, Inc. (CBI)Per Carrier:
2 standard Silver plans required with option to submit 1 non-standard
Silver plan
Silver PPO Pathway X
Tiered
Silver PPO Standard
Coinsurance Pathway X
Silver PPO Standard
Pathway X
Choice Silver Alternative
POS
Choice Silver Standard
Coinsurance POS
Choice Silver Standard
POS
2020 Anthem Blue Cross Blue Shield* ConnectiCare Benefits, Inc. (CBI)*Per Carrier:
1 standard Silver plan required (non-standard plans not permitted)
Silver PPO Standard Pathway X Choice Silver Standard POS
*Silver ‘On-Exchange’ plans filed with Connecticut Insurance Department (CID) for 2020 plan year
Comparison: On & Off-Exchange Plans
Bronze• In every county, at least two
Bronze plans offered via AHCT are lower in premium than any of the other 12 Bronze plans filed for Plan Year 2020 in the Individual Market
Silver• In all counties, one Silver “Off-
Exchange” plan filed by CCI is lower in premium than any of the other 9 Silver plans filed for Plan Year 2020
• Premium difference vs lowest “On-Exchange” Silver plan ranges by county from -8.8% to -11.9%
Gold• In every county, one Gold plan
offered via AHCT is lower in premium than any of the other 6 Gold plans filed for Plan Year 2020
• In all counties, this Gold plan is lower in premium than the lowest premium “On-Exchange” Silver plan (premium difference ranges from -0.1% to -11.8%)
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Individual Market Plans Filed for 2020
Wakely Consulting: Rate Review and Rate Impact Analysis Report*
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*Excerpts of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf
**Full report begins on page 71
Wakely Consulting: Rate Review and Rate Impact Analysis Report*
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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf
**Full report begins on page 71
Enrollees eligible for auto-renewal who
were enrolled in one of the 4 Silver plans
available in 2019 that will not be offered
for 2020 will be cross-walked to their carrier’s remaining
Silver plan
Wakely Consulting: Rate Review and Rate Impact Analysis Report*
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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf
**Full report begins on page 71
Enrollees eligible for auto-renewal can
shop for a different plan that may be
better suited to their needs for the 2020
plan year
Each carrier will be offering a new Gold
plan and a new Bronze plan for 2020
Each carrier will continue to offer a Catastrophic plan
Wakely Consulting: Rate Review and Rate Impact Analysis Report*
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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf
**Full report begins on page 71
Sample household scenario illustrates the net change in
premium for an enrollee in the lowest cost Silver plan in each county for 2019 when auto-
enrolled to their carrier’s remaining Silver plan for 2020
In every county except Litchfield, the enrollee will
remain in the lowest premium Silver plan after auto-
enrollment
Enrollee can also shop for an alternate plan
Wakely Consulting: Rate Review and Rate Impact Analysis Report*
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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf
**Full report begins on page 71
Sample household scenario illustrates the net change in
premium for an enrollee in the lowest cost Bronze plan in each
county for 2019 when auto-enrolled to the same Bronze
plan for 2020
In every county, the enrollee will remain in the lowest
premium Bronze plan after auto-enrollment
Enrollee can also shop for an alternate plan
Moving Forward: 2021 Plan Year
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Plan Management Certification Life Cycle
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Regulations & Guidance
Develop AHCT Certification
Requirements
QHP Solicitation
PMP System Annual
Upgrades
QHP Application
QHP Application Submission
& Data Review
PMP Data Testing/
Uploads/ Issuer Preview
QHP/SADP Certification/
Data Publication
Open Enrollment November -
April
December -April
February -April
February -August
April -May
July -September
July -October
October
November - December
Each plan year, the cycle begins with the release of regulations and guidance, including the Actuarial Value Calculator (AVC) tool used to develop standardized plans, and ends once
Open Enrollment commences
Certification requirements for carriers, including development of standardized plans
takes place during this time period
Note: timeframes subject to change
AHCT Agency Website: Health Plan Benefits & Qualifications Advisory Committee
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https://agency.accesshealthct.com/
AHCT Agency Website: Health Plan Information
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https://agency.accesshealthct.com/
Appendix
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AHCT Individual Market Gold Plan
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PLAN FEATURE 2019 Standard Gold 2020 Standard Gold
Deductible: Individual (medical) $1,300 $1,300
Deductible: Individual (prescription) $50 $50
Out-of-Pocket Maximum: Individual $5,000 $5,250
Provider Office Visits
Provider Office Visits (Primary Care, Mental & Behavioral Health, Substance Abuse) $20 copayment per visit $20 copayment per visit
Specialist Office Visits $40 copayment per visit $40 copayment per visit
Prescription Drugs – Retail (up to 30-day supply/script)
Tier 1 $5 copayment per script $5 copayment per script
Tier 2 $25 copayment per script $35 copayment per script
Tier 3 $50 copayment per script $60 copayment per script
Tier 4 20% coinsurance up to a maximum of $100 per script after INET Rx deductible
20% coinsurance up to a maximum of $100 per script after INET Rx deductible
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020
AHCT Individual Market Gold Plan
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PLAN FEATURE 2019 Standard Gold 2020 Standard GoldOther Services
Outpatient Services (in a hospital or ambulatory facility)
$500 copayment per visit after INET plan deductible
$500 copayment per visit after INET plan deductible (OP Hosp) or
$300 copayment per visit after INET plan deductible (Freestanding Facility)
Hospital Services
Inpatient Hospital $500 copayment per day to a maximum of $1,000 per admission after INET plan
deductible
$500 copayment per day to a maximum of $1,000 per admission after INET plan
deductibleEmergency and Urgent Care
Emergency Room $200 copayment per visit after INET medical deductible
$400 copayment per visit after INET medical deductible
Urgent Care Center or Facility $50 copayment per visit $50 copayment per visit
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020
AHCT Individual Market Silver Plans
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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver 70% AV Level (>250% FPL) 73% AV Level (>200% to ≤250% FPL)
Deductible: Individual (medical) $4,300 $4,300 $3,900 $3,950
Deductible: Individual (prescription) $250 $250 $250 $250
Out-of-Pocket Maximum: Individual $7,900 $8,150 $6,300 $6,500
Provider Office VisitsProvider Office Visits (Primary
Care, Mental & Behavioral Health, Substance Abuse)
$40 copayment per visit $40 copayment per visit $40 copayment per visit $40 copayment per visit
Specialist Office Visits $50 copayment per visit $60 copayment per visit $50 copayment per visit $60 copayment per visit
Prescription Drugs – Retail (up to 30-day supply/script)
Tier 1 $5 copayment per script $10 copayment per script $5 copayment per script $10 copayment per script
Tier 2 $35 copayment per script after INET Rx deductible
$45 copayment per script after INET Rx deductible
$35 copayment per script after INET Rx deductible
$45 copayment per script after INET Rx deductible
Tier 3 $60 copayment per script after INET Rx deductible
$70 copayment per scriptafter INET Rx deductible
$60 copayment per script after INET Rx deductible
$70 copayment per script after INET Rx deductible
Tier 420% coinsurance up to a
maximum of $200 per script after INET Rx deductible
20% coinsurance up to a maximum of $200 per script
after INET Rx deductible
20% coinsurance up to a maximum of $100 per script
after INET Rx deductible
20% coinsurance up to a maximum of $100 per script
after INET Rx deductibleAV = Actuarial ValueFPL = Federal Poverty Level
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020
AHCT Individual Market Silver Plans
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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver
70% AV Level (>250% FPL) 73% AV Level (>200% to ≤250% FPL)Other Services
Outpatient Services (in a hospital or ambulatory facility)
$500 copayment per visit after INET plan deductible
$500 copayment per visit after INET plan deductible (OP
Hosp) or $300 copayment per visit after INET plan deductible
(Freestanding Facility)
$500 copayment per visit after INET plan deductible
$500 copayment per visit after INET plan deductible (OP
Hosp) or $300 copayment per visit after INET plan deductible
(Freestanding Facility)Hospital Services
Inpatient Hospital $500 copayment per day to a
maximum of $2,000 per admission after INET plan
deductible
$500 copayment per day to a maximum of $2,000 per
admission after INET plan deductible
$500 copayment per day to a maximum of $2,000 per
admission after INET plan deductible
$500 copayment per day to a maximum of $2,000 per
admission after INET plan deductible
Emergency and Urgent Care
Emergency Room $200 copayment per visit after INET medical deductible
$450 copayment per visit after INET medical deductible
$200 copayment per visit after INET medical deductible
$450 copayment per visit after INET medical deductible
Urgent Care Center or Facility $75 copayment per visit $75 copayment per visit $75 copayment per visit $75 copayment per visit
AV = Actuarial ValueFPL = Federal Poverty Level
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020
AHCT Individual Market Silver Plans
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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver 87% AV Level (>150% to ≤200% FPL) 94% AV Level (>138% to ≤150% FPL)
Deductible: Individual (medical) $600 $650 $0 $0
Deductible: Individual (prescription) $50 $50 $0 $0
Out-of-Pocket Maximum: Individual $2,300 $2,500 $900 $900
Provider Office VisitsProvider Office Visits (Primary
Care, Mental & Behavioral Health, Substance Abuse)
$20 copayment per visit $20 copayment per visit $10 copayment per visit $10 copayment per visit
Specialist Office Visits $35 copayment per visit $45 copayment per visit $30 copayment per visit $30 copayment per visit
Prescription Drugs – Retail (up to 30-day supply/script)
Tier 1 $5 copayment per script $10 copayment per script $5 copayment per script $5 copayment per script
Tier 2 $20 copayment per script $25 copayment per script $10 copayment per script $10 copayment per script
Tier 3 $35 copayment per script after INET Rx deductible
$40 copayment per script after INET Rx deductible $30 copayment per script $30 copayment per script
Tier 420% coinsurance up to a
maximum of $60 per script after INET Rx deductible
20% coinsurance up to a maximum of $60 per script after INET Rx deductible
20% coinsurance up to a maximum of $60 per script
20% coinsurance up to a maximum of $60 per script
AV = Actuarial ValueFPL = Federal Poverty Level
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020
AHCT Individual Market Silver Plans
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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver 87% AV Level (>150% to ≤200% FPL) 94% AV Level (>138% to ≤150% FPL)
Other Services
Outpatient Services (in a hospital or ambulatory facility)
$100 copayment per visit after INET plan deductible
$100 copayment per visit after INET plan deductible (OP Hosp) or $60 copayment per visit after
INET plan deductible (Freestanding Facility)
$75 copayment per visit$75 copayment per visit (OP Hosp) or $45 copayment per visit (Freestanding Facility)
Hospital Services
Inpatient Hospital $100 copayment per day to a maximum of $400 per admission
after INET plan deductible
$100 copayment per day to a maximum of $400 per admission
after INET plan deductible
$75 copayment per day to a maximum of $300 per
admission
$75 copayment per day toa maximum of $300 per
admissionEmergency and Urgent Care
Emergency Room $75 copayment per visit after INET medical deductible
$150 copayment per visit after INET medical deductible $50 copayment per visit $50 copayment per visit
Urgent Care Center or Facility $35 copayment per visit $35 copayment per visit $25 copayment per visit $25 copayment per visit
AV = Actuarial ValueFPL = Federal Poverty Level
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020
AHCT Individual Market Bronze Plans
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PLAN FEATURE 2019 Standard Bronze 2020 Standard Bronze 2019 Standard Bronze HSA 2020 Standard Bronze HSA
Deductible: Individual (medical) $6,000 $6,200 $5,685 $5,685
Deductible: Individual (prescription) Included in Medical Included in Medical Included in Medical Included in Medical
Out-of-Pocket Maximum: Individual $7,900 $8,150 $6,550 $6,550
Provider Office VisitsProvider Office Visits (Primary
Care, Mental & Behavioral Health, Substance Abuse)
$40 copayment per visit $40 copayment per visit 10% coinsurance per visitafter INET plan deductible
10% coinsurance per visitafter INET plan deductible
Specialist Office Visits $50 copayment per visit after INET plan deductible
$60 copayment per visit after INET plan deductible
10% coinsurance per visitafter INET plan deductible
10% coinsurance per visitafter INET plan deductible
Prescription Drugs – Retail (up to 30-day supply/script)
Tier 1 $5 copayment per script $10 copayment per script 10% coinsurance per scriptafter INET plan deductible
10% coinsurance per scriptafter INET plan deductible
Tier 2 50% coinsurance per scriptafter INET plan deductible
50% coinsurance per scriptafter INET plan deductible
15% coinsurance per scriptafter INET plan deductible
15% coinsurance per scriptafter INET plan deductible
Tier 3 50% coinsurance per scriptafter INET plan deductible
50% coinsurance per scriptafter INET plan deductible
25% coinsurance per scriptafter INET plan deductible
25% coinsurance per scriptafter INET plan deductible
Tier 450% coinsurance up to a
maximum of $500 per script after INET plan deductible
50% coinsurance up to a maximum of $500 per script after INET plan deductible
30% coinsurance up to a maximum of $500 per script after INET plan deductible
30% coinsurance up to a maximum of $500 per script after INET plan deductible
HSA = Health Savings Account
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020
AHCT Individual Market Bronze Plans
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PLAN FEATURE 2019 Standard Bronze 2020 Standard Bronze HSAOther Services
Outpatient Services (in a hospital or ambulatory facility)
$500 copayment per visit after INET plan deductible
$500 copayment per visit after INET plan deductible (OP Hosp)
or $300 copayment per visit after INET plan deductible
(Freestanding Facility)
10% coinsurance per visitafter INET plan deductible
10% coinsurance per visitafter INET plan deductible
Hospital Services
Inpatient Hospital $500 copayment per day to a
maximum of $1,000 per admission after INET plan
deductible
$500 copayment per day to a maximum of $1,000 per
admission after INET plan deductible
10% coinsurance per admissionafter INET plan deductible
10% coinsurance per admissionafter INET plan deductible
Emergency and Urgent Care
Emergency Room $200 copayment per visit after INET plan deductible
$450 copayment per visit after INET plan deductible
10% coinsurance per visitafter INET plan deductible
10% coinsurance per visitafter INET plan deductible
Urgent Care Center or Facility $75 copayment per visit $75 copayment per visit 10% coinsurance per visitafter INET plan deductible
10% coinsurance per visitafter INET plan deductible
HSA = Health Savings Account
High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020