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The NEW Retail Market An Overview The Health Insurance Marketplace and the NEW CO-OP Option Consumers' Choice Health Insurance Company.

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Presentation on theme: "The NEW Retail Market An Overview The Health Insurance Marketplace and the NEW CO-OP Option Consumers' Choice Health Insurance Company."— Presentation transcript:

1 The NEW Retail Market An Overview The Health Insurance Marketplace and the NEW CO-OP Option Consumers' Choice Health Insurance Company

2 Presented By: New Retail Market Consumers' Choice Health Insurance Company Anita Maxwell Director of Community Relations Consumers' Choice Health Insurance Company

3 What’s It All About? New Retail Market Consumers' Choice Health Insurance Company

4 Health Insurance Marketplace New Retail Market Consumers' Choice Health Insurance Company

5 Coverage to fit individual needs Financial assistance based on income through new premium tax credit (immediate, not filed) Unbiased help and customer assistance and a toll-free phone number Qualified health plans that meet new standards Options are grouped for easy comparison Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Health Insurance Marketplace New Retail Market Consumers' Choice Health Insurance Company

6 Single application determines eligibility for: Qualified Health Plan through the Marketplace New tax credits or subsidies to lower premiums Medicaid Children’s Health Insurance Program (CHIP) Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Health Insurance Marketplace New Retail Market Consumers' Choice Health Insurance Company

7 Financial Assistance, 2013 FPL, subject to change New Retail Market Consumers' Choice Health Insurance Company

8 A Qualified Health Plan Is offered by an issuer that is licensed by the state and in good standing Covers Essential Health Benefits Offers at least one plan at the “silver” level and one at the “gold” level of cost sharing Agrees to charge the same premium rate whether offered directly through the Marketplace or outside Marketplace Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Health Insurance Marketplace New Retail Market Consumers' Choice Health Insurance Company

9 Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Health Insurance Marketplace New Retail Market Consumers' Choice Health Insurance Company

10 Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Health Insurance Marketplace New Retail Market Consumers' Choice Health Insurance Company

11 Pre ACA Individual rates are based on the age, sex and health. Some groups rates are based on age, sex and health. Insurers increase profits by: Denying coverage due to pre-existing conditions Including riders and/or exclusions for certain conditions Pricing the plan according to illnesses and conditions of the individual or in the group Consumers' Choice Health Insurance Company The ACA and Insurance Rates New Retail Market Consumers' Choice Health Insurance Company

12 Post ACA Insurers must comply with new Medical Loss Ratio (MLR) rules that control profits. Insurers may not Deny coverage due to pre-existing conditions Terminate coverage due to illnesses Price plans based on medical conditions Consumers' Choice Health Insurance Company The ACA and Insurance Rates New Retail Market Consumers' Choice Health Insurance Company

13 CO-OP Health Plans The Affordable Care Act (ACA) included legislation and funding to establish CO-OP Health Plans. CO-OPs (Consumer Oriented and Operated Plans) provide more competition in the healthcare marketplace and more choices for consumers and small businesses. The Difference is Clear. Consumers' Choice Health Insurance Company A New Model of Healthcare Coverage Consumers' Choice Health Insurance Company

14 NON-PROFIT MEMBER GOVERNED PREVENTION FOCUSED Consumers' Choice Health Insurance Company How Are CO-OPs Different? CO-OP Health Plans Consumers' Choice Health Insurance Company

15 Consumers’ Choice Health Plan is now enrolling members and businesses across South Carolina. Current Offices: Charleston & Greenville with additional offices planned Consumers' Choice Health Insurance Company Who can be covered? CO-OP Health Plans Consumers' Choice Health Insurance Company

16 Coverage Effective Dates Begin January 1, 2014 Consumers' Choice Health Insurance Company Important Dates to Remember Consumers' Choice Health Insurance Company Open Enrollment Began October 2013 CO-OP Health Plans

17 Enrollment Information CO-OP Health Plans Consumers' Choice Health Insurance Company Through the Health Insurance Marketplace located at or with the help of an insurance agent, broker, navigator or at a qualified clinic Consumers' Choice Health Insurance Company

18 Need More Information? CO-OP Health Plans Consumers' Choice Health Insurance Company CO-OP Information Source: Healthcare.gov Consumers' Choice Health Insurance Company

19 Need More Information? CO-OP Health Plans Consumers' Choice Health Insurance Company QUESTIONS? Consumers' Choice Health Insurance Company


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