Presentation on theme: "Association Insurance Cooperative Kenneth S. Lee, LFACHE Program Director."— Presentation transcript:
Association Insurance Cooperative Kenneth S. Lee, LFACHE Program Director
What Is AIC? AIC is not an insurance agency AIC is a cooperative that brings together Association Members and Carriers AICs goal is to stabilize or reduce health insurance costs for employers and their employees through group purchasing AICs immediate role is to find solutions for each demographic of your group: executive-level part-time salaried hourly
DECEMBER WEBINAR CONSIDERATIONS 1. TRANSFER THE RISK DEFINED CONTRIBUTION 2. RETAIN THE RISK SELF-FUNDING 3. RETAIN THE RISK HIGH DEDUCTIBLE HEALTH PLANS WITH HEALTH SAVINGS ACCOUNTS AND OR GAP PLAN. Three Courses of Action Survey
PRIVATE HEALTH INSURANCE EXCHANGES Private Exchanges multiplying – most focused: single Carrier (WellPoint) – Market Specific (Mercer – Medicare Retirees) – In-house employer groups (Sears) AIC Exchange is a multi-carrier based shopping cart Collaboration with Word and Brown – State Insurance Exchanges in California and Nevada Qualified Health Plans Minimal Essential Health Benefits Cost Sharing 60/70/80/90% of premiums; employee share not to exceed 9.5% of W-2 wages Guarantee lowest premiums – but does not include underwriting Prices going up in 2013 and sticker shock in 2014 and beyond – Community Rating, EHB, Guaranteed Issue Strongly consider self-insured plans
Essential Health Benefit Benchmark Default Benchmark Plan = small group health plan with the largest enrollment will be selected by default. The benchmark plan will define the standard set of benefits that must be covered by plans in that state. Insurers in every state will be required to offer plans with benefits substantially equal to those found in a states benchmark plan. EHB benchmark defines only what benefits must be covered, not what the cost-sharing levels will be. Carriers will develop the cost-sharing features for the products they offer based on the actuarial values for the different metal level plans (bronze, silver, gold, and platinum) spelled out in the ACA.
ESSENTIAL HEALTH BENEFITS Indiana – Ohio – Illinois - Michigan IndianaOhioIllinoisMichigan EHB Benchmark Plan Status Default Recommended Plan NameAnthem (BCBS)- Blue Access, PPO Community Insurance Company (Anthem BCBS)- Blue Access, PPO BCBS of IL- BlueAdvantage Entrepreneur, PPO Priority Health, HMO Plan TypeSmall group plan Commercial HMO Pediatric DentalFEDVIP*FEDVIPCHIP*CHIP Pediatric VisionFEDVIP Mental HealthIncluded Benchmark Plan Includes Habilitative Services Yes No For habilitative services, states may define the services to be included in that category or, if they choose not to make that determination, insurers must provide parity with rehabilitative services or define which habilitative services to cover and report to HHS. Almost every state will need to supplement its benchmark plan for pediatric dental and/or pediatric vision services; the proposed rule allows states to select these services from the Federal Employees Dental and Vision Insurance Program (FEDVIP)* or the states Childrens Health Insurance Program (CHIP)*.
EMPLOYER PREMIUM COST – HYPOTHETICAL SCENARIO Employer cost share of 70% (actuarial value = AV) = Silver Plan Employee cost share 30% Employee cost share cannot exceed 9.5% of W-2 wages. Assume lowest wage of FT employee is $20,000.00 Employee premium cost share cannot exceed $1,900 for the year or $158.33 per month The maximum monthly premium cost = $158.33 /.30 = $527.76 without underwriting (0 – 40% load) $527.76 assumes that the employee is healthy. Assume a 20% increase in premium cost due to underwriting, because of imperfect health, =.80% of $527.76. $422.00 would be the maximum premium. What will $422.00 buy? What should it buy? ($2,000.00 – 4,000.00 deductible); max out-of-pocket spending of $6,250.00 PRIVATE EXCHANGE LINK
Have a Question? (765) 352-1776 email:firstname.lastname@example.org Kenneth S. Lee Program Director