Presentation is loading. Please wait.

Presentation is loading. Please wait.

Health Plan Market & Benefit Comparison Part II Presented by Cliff Craig Health Plan Account Manager for Connect for Health Colorado.

Similar presentations


Presentation on theme: "Health Plan Market & Benefit Comparison Part II Presented by Cliff Craig Health Plan Account Manager for Connect for Health Colorado."— Presentation transcript:

1 Health Plan Market & Benefit Comparison Part II Presented by Cliff Craig Health Plan Account Manager for Connect for Health Colorado

2 2 2 Key Topics to be Discussed Family Deductible & Out-of-Pocket maximum Accumulation High Deductible Health Plan (HDHP) / Health Savings Account (HSA) Key Features of the SBC & Plan Document Page Market Place Carrier Review & Product Offering o Health Shop / Small Group o Health Individual o Dental Shop / Small Group o Dental Individual Carriers Benefit Comparison by Metal Tiers Carrier Specific Key Points & Service Area

3 3 3 Market Place Plan Types Health Maintenance Organization (HMO) A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. (No Out of Network Coverage) Preferred Provider Organization (PPO) A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals and providers outside of the network for an additional cost. (Out of Network Coverage but at Higher Cost-sharing) Exclusive Provider Organization (EPO) A more restrictive type of preferred provider organization plan under which employees must use providers from the specified network of physicians and hospitals to receive coverage; there is no coverage for care received from a non-network provider except in an emergency situation. (No Out of Network Coverage)

4 4 Family Deductible and Out-of-Pocket Maximum Accumulation This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

5 5 5 What Applies to Maximum Out-of-Pocket HMO & EPO Plans Copayments Deductibles Coinsurance Maximum Out-of-Pocket $6,350 / $12,700 Maximum Out-of-Pocket $6,350 / $12,700 Rx Deductibles Rx Copayments Rx Copayments Rx Coinsurance Rx Coinsurance Prevention

6 6 6 Embedded VS Aggregate Family Deductibles & Out-of-Pocket Maximums There are two different types of deductibles: traditional, also called Embedded(Per- Member), and Aggregate (Single), also known as non-embedded. Embedded Family Deductible & Out-of-Pocket maximum (Most Common) If you are on a family (two or more members covered) medical plan with an Embedded deductible, your plan contains two components, an individual deductible and a family deductible. Having two components to the deductible allows each member of your family the opportunity to get her medical bills covered prior to the entire dollar amount of the family deductible being met. The individual deductible is embedded in the family deductible. Aggregate Family Deductible & Out-of-Pocket maximum (Primarily Used with HSA’s) If your insurance policy contains a Aggregate family deductible, an individual deductible is not embedded in the family deductible. In this situation, before your insurance helps you pay for any of your family's medical bills, the entire amount of the deductible must be met. It can be met by one family member or by a combination of family members. There are no benefits until expenses equaling the deductible amount have been incurred.

7 7 7 Embedded / Per-Member Family Deductible & Out-of-Pocket Maximum Father $2000 Father $2000 Mother $3000 Mother $3000 Child $500 Child $500 $3000 Individual $6000 Family Deductible $3000 Individual $6000 Family Deductible Father Mother $6350 Mother $6350 Child Coinsurance $6350 Individual $12700 Family OOP Max. $6350 Individual $12700 Family OOP Max. Prevention Each family member must meet the Individual Deductible before coinsurance applies for them only

8 8 8 Embedded / Per-Member Family Deductible & Out-of-Pocket Maximum Father $3000 Father $3000 Mother $3000 Mother $3000 Child $3000 Individual $6000 Family Deductible $3000 Individual $6000 Family Deductible Father $6350 Father $6350 Mother $6350 Mother $6350 Child Coinsurance $6350 Individual $12700 Family OOP Max. $6350 Individual $12700 Family OOP Max. Prevention Each family member must meet the Individual Deductible before coinsurance applies for them only or combined by two or more then the family moves to coinsurance

9 9 9 Embedded / Per-Member Family Deductible & Out-of-Pocket Maximum Father $2000 Father $2000 Mother $3000 Mother $3000 Child $500 Child $500 $3000 Individual $6000 Family Deductible $3000 Individual $6000 Family Deductible Father Mother $6350 Mother $6350 Child Coinsurance $6350 Individual $12700 Family OOP Max. $6350 Individual $12700 Family OOP Max. Prevention The mother was the only family member accessing care. She met her Individual Deductible & Out-of-Pocket max so she is the only family member covered at 100%

10 10 Aggregate / Single Family Deductible & Out-of-Pocket Maximum Father $2000 Father $2000 Mother $3500 Mother $3500 Child $500 Child $500 $3000 Individual $6000 Family Deductible $3000 Individual $6000 Family Deductible Prevention The family as a group can meet the Family Deductible Coinsurance for all Family members Coinsurance for all Family members

11 11 Aggregate / Single Family Deductible & Out-of-Pocket Maximum $3000 Individual $6000 Family Deductible $3000 Individual $6000 Family Deductible Father $6000 Father $6000 Mother $5000 Mother $5000 Child $1700 Child $1700 $6350 Individual $12700 Family OOP Max. $6350 Individual $12700 Family OOP Max. Prevention The family as a group has met the Family Out-Of-Pocket Max. Coinsurance for all Family members Coinsurance for all Family members

12 12 Aggregate / Single Family Deductible & Out-of-Pocket Maximum Father $2000 Father $2000 Mother $3500 Mother $3500 Child $500 Child $500 $3000 Individual $6000 Family Deductible $3000 Individual $6000 Family Deductible Father $6000 Father $6000 Mother $5000 Mother $5000 Child $1700 Child $1700 Coinsurance $6350 Individual $12700 Family OOP Max. $6350 Individual $12700 Family OOP Max. Prevention The family as a group met the Family Deductible & the Family Out-of-Pocket Max.

13 13 Aggregate / Single Family Deductible & Out-of-Pocket Maximum Father Mother $6000 Mother $6000 Child $3000 Individual $6000 Family Deductible $3000 Individual $6000 Family Deductible Father Mother $12700 Mother $12700 Child Coinsurance $6350 Individual $12700 Family OOP Max. $6350 Individual $12700 Family OOP Max. Prevention The mother was the only family member accessing care. She met the Family Deductible & Out-of-Pocket max for the entire family

14 14 RMHP West Focus HMO Silver $2500/Copay $40 Medical Deductible = $2,500 / $5,000 Drug Deductible = $500 / $1000 Out-of-Pocket Max. = $6,350 / $12,700 PCP visit = $40 Copay / Specialist = $55 Copay Prescription Drugs = $15 Generic / 30% (After Ded.) Preferred Brand / 40% (After Ded.) Non- Preferred & Specialty Facilities = 30% Coinsurance (After Ded.) Outpatient / Inpatient Surgery Emergency Care = 30% Copay Urgent care / $250 Copay Emergency Room / 30% coin. (After Ded.) Ambul. Testing = 30% coinsurance (After Ded.) CT/PET Scans, MRIs / X-rays / Lab. Sample of How Benefits Accumulate for a Family of Three Policy Dads Medical ServicesCost of services Family expenses Applies to Med Ded Applies to Rx Ded Applies to OOP max RMHP expenses Prevention visit$100$0 $100 PCP visit$100$40$0 $40$60 PCP orders meds Preferred$140 $0$140 $0 Inpatient Hospital (2nd)$5,000$3,600$3,000 $3,600$1,400 (Dad paid $3000 & $600 (30% of $2000)Family Ded met X-rays & Lab$1,000$300done$0$300$700 Physician surgery$1,000$300done$0$300$700 InptHospmeds 1 Pref / 1 Spec$400 $0$400 $0 Emergency visit (4th)$2,000$600done$0$600$1,400 Dads Total$9,740$5,380$3,000$540$5,380$4,360 Moms Medical Services Prevention visit$150$0 $150 OB/GYN Visit$200$40$0 $40$160 PCP visit$100$40$0 $40$60 OutPatient Surgery (3rd)$2,000$600done$0$600$1,400 Lab$500$150done$0$150$350 Outpt meds Preferred$110 $0$110 $0 Outpt meds Preferred$200$60$0done$60$140 Outpt meds Generic$75$15$0done$15$60 Moms Total$3,335$1,015$0$110$1,015$2,320 Baby Bears Medical Services Prevention visit$80$0 $80 Emergency visit (1st)$1,000$250$0 $250$750 Ambulance ride to ER$1,000 $0$1,000$0 ER test MRI$1,000 $0$1,000$0 ER meds Specialty Drug$200 $0$200 $0 ER med Preferred$150 $0$150 $0 ER med Generic$75$15$0 $15$60 Baby Bears Total$3,505$2,615$2,000$350$2,615$890 Family Total$16,580$9,010$5,000$1,000$9,010$7,570

15 15 High Deductible Health Plan (HDHP) & Health Savings Account (HSA) This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

16 16 Health Savings Account (HSA) A medical savings account available to taxpayers who are enrolled in a qualified High Deductible Health Plan (HDHP). The funds contributed to the account aren’t subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical expenses. Unlike a Flexible Spending Account (FSA), funds roll over year to year if you don’t spend them. HDHP / HSA can be associated with any plan types – HMO, PPO, & EPO To open an HSA account the plan type MUST be a QUALIFIED HDHP product The amount a person can contribute to their HSA account on an annual basis is based on the plan types Deductible level. Employers can also contribute to their employees HSA account, but the employer and the employees contribution cannot exceed the Deductible level. A person can use funds from their HSA account to pay for covered & non-covered medical services, a Federal regulation list will show qualified medical expenses. There is a tax penalty for withdrawing funds from your HSA account to pay for non- medical expenses, before the age 65.

17 17 HSA Contribution Limits for 2014 Contribution and Out-of-Pocket Limits for Health Savings Accounts and for High-Deductible Health Plans For 2014For 2013 Changes HSA contribution limit (employer + employee) Individual: $3,300 Family: $6,550 Individual: $3,250 Family: $6,450 Individual: +$50 Family: +100 HSA catch-up contributions (age 55 or older)* $1,000 No change** HDHP minimum deductibles Individual: $1,250 Family: $2,500 No change HDHP maximum out-of-pocket amounts (deductibles, co- payments and other amounts, but not premiums) Individual: $6,350 Family: $12,700 Individual: $6,250 Family: $12,500 Individual: +$100 Family: +$200 * Catch-up contributions can be made any time during the year in which the HSA participant turns 55. ** Unlike other limits, the HSA catch-up contribution amount is not indexed; any increase would require statutory change.

18 18 HSA Penalties & Children Coverage Penalties for Nonqualified Expenses Those under age 65 (unless totally and permanently disabled) who use HSA funds for nonqualified medical expenses face a penalty of 20 percent of the funds used for such expenses. Funds spent for nonqualified purposes are also subject to income tax. Coverage of Adult Children While the Patient Protection and Affordable Care Act allows parents to add their adult children (up to age 26) to their health plans, the IRS has not changed its definition of a dependent for health savings accounts. This means that an employee whose 24-year-old child is covered on his HSA-qualified high-deductible health plan is not eligible to use HSA funds to pay that child’s medical bills. If account holders can't claim a child as a dependent on their tax returns, then they can't spend HSA dollars on services provided to that child. According to the IRS definition, a dependent is a qualifying child (daughter, son, stepchild, sibling or stepsibling, or any descendant of these) who: Has the same principal place of abode as the covered employee for more than one-half of the taxable year. Has not provided more than one-half of his or her own support during the taxable year. Is not yet 19 (or, if a student, not yet 24) at the end of the tax year or is permanently and totally disabled.

19 19 Health Savings Account (HSA) / High Deductible Health Plans (HDHP) Eligible Plans

20 20 What Applies to Maximum Out-of-Pocket HSA & HDHP Plans Copayments Deductibles Coinsurance Maximum Out-of-Pocket $6,350 / $12,700 Maximum Out-of-Pocket $6,350 / $12,700 Rx Copayments Rx Copayments Prevention

21 21 Benefit Comparison for HSA Products Kaiser Permanente Sample Kaiser Permanente H.S.A Plans BenefitsBronze 5000/30% H.S.ABronze 4500/50 H.S.ASilver 1750/25% H.S.A. Ded Individual$5,000$4,500$1,750 Ded Family$10,000$9,000$3,500 OOPMax Ind$6,530$6,350$5,000 OOPMax Family$12,700 $10,000 Primary Care30% Coin / After Ded$50 Copay / After Ded25% Coin / After Ded Specialist visit30% Coin / After Ded$70 Copay / After Ded25% Coin / After Ded Prevention visitNo Charge $0 Copay Diagnostic Test30% Coin / After Ded 25% Coin / After Ded Imaging30% Coin / After Ded$500 Copay / After Ded25% Coin / After Ded Generic Drugs$20 copay / After Ded$20 Copay / After Ded$15 Copay / After Ded Preferred Drugs30% Coin / After Ded$50 Copay / After Ded$45 Copay / After Ded Non-Preferred30% Coin / After Ded 25% Coin / After Ded Specialty Drugs30% Coin / After Ded 25% Coin / After Ded Facility Outpatient30% Coin / After Ded 25% Coin / After Ded Facility Inpatient30% Coin / After Ded$500 Copay / After Ded25% Coin / After Ded Emergency visit30% Coin / After Ded$500 Copay / After Ded25% Coin / After Ded Emergency Trans30% Coin / After Ded 25% Coin / After Ded Urgent Care30% Coin / After Ded 25% Coin / After Ded Premium$158.37$164.97$208.52 % increase Lowest Plan4%24%

22 22 Benefit Comparison for HSA Products Rocky Mountain Health Plan Sample Rocky Mountain Health Plans H.S.A Plans BenefitsBronze $6300/100% H.S.ABronze PPO 6300/100% H.S.ASilver PPO 2500/100% H.S.A Ded Individual$6,300 $12,600$2,500$5,000 Ded Family$12,600 $25,200$5,000$10,000 OOPMax Ind$6,300 $12,600$6,350$12,700 OOPMax Family$12,600 $25,200$12,700$25,400 Primary CareNo Charge After Ded Specialist visitNo Charge After Ded Prevention visitNo Charge $0 Copay VariesNo Charge $0 CopayVaries Diagnostic TestNo Charge After Ded ImagingNo Charge After Ded Generic DrugsNo Charge After Ded Not CoveredNo Charge After DedNot Covered Preferred DrugsNo Charge After Ded Not CoveredNo Charge After DedNot Covered Non-PreferredNo Charge After Ded Not CoveredNo Charge After DedNot Covered Specialty DrugsNo Charge After Ded Not CoveredNo Charge After DedNot Covered Facility OutpatientNo Charge After Ded Facility InpatientNo Charge After Ded Emergency visitNo Charge After Ded Emergency TransNo Charge After Ded Urgent CareNo Charge After Ded Premium$226.90$258.06$323.61 % increase Lowest Plan12%30%

23 23 Key Features of the SBC & Plan Document Page This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

24 24 Plan Documents Can Help Make Final Decision Evidence of Coverage, Policy, Summary of Benefits: It’s the members Contract with the carrier (about 80 plus pages) varies by carrier English only Summary of Benefits and Coverage, is a summary of benefits (not a binding contract), standard benefit Layout (9 pages) English & Spanish Company Profile: Standard document Covers – Company at a glance, Medical Loss Ratio, Unique Offerings & Programs, Awards & Recognition,& In the Community. English & Spanish Quality Overview: Standard Document Covers – Accreditations, Consumer Complaints, How the plan makes members healthier / works with providers / examples of innovative approaches, Quality Ratings. English & Spanish Carrier Marketing materials: Not Standard, Varies by carrier English & Spanish

25 25 Key Things to Know When Using Plan Compare Function Issue with the Plan Compare is neither product has an In Network Tier Two benefit listed and the PPO plan is not illustrating the Out of Network Tier benefit information

26 26 The compare function is utilized best when comparing two different carriers or plans that are close in premium and now its which one provides the best benefit for the COST Key Things to Know When Using Plan Compare Function

27 27 Key Things to Know When Using Plan Compare Excel File In Network (Tier 1)In Network (Tier 2)In Network (Tier 1)In Network (Tier 2) Primary Care Visit to Treat an Injury or Illness Copay$30 CoinsuranceNo Charge Other Practitioner Office Visit (Nurse, Physician Assistant) Copay$60 CoinsuranceNo Charge Preventive Care/Screening/Immunization Copay$0 CoinsuranceNo Charge Specialist Visit Copay$60 CoinsuranceNo Charge Nutritional Counseling CopayNo Charge Coinsurance35% Coinsurance after deductible This is a snapshot of 2 Colorado HealthOP Bighorn EPO ($276.42) & PPO ($315.78) Issue with the Plan Compare is neither product has an In Network Tier Two benefit listed and the PPO plan is not illustrating the Out of Network Tier benefit information

28 28 Colorado HealthOP Bison PPO Plan Benefits Page Information Notice the Enhance benefit information is not listed on the Plan Benefits Page. The In-Network Tier 2 benefit is unique to CO HealthOP only

29 29 Colorado HealthOP Bison EPO Plan SBC Information Once You and Your enrolled Spouse (if applicable), complete the personal health actions identified under You personal account on Our website, www.COHealthOp.org or upon request Our Customer Service, You will be rewarded with financial incentives. The incentive types and amounts vary by the Plan(s) elected. See the Enhanced Network Coinsurance/Copayments column on the Schedule of Benefits in this Certificate for details regarding Your plan incentives. Note: Charges for medical care required under the personal health actions will be covered under the Preventive and Wellness Services and Chronic Disease Management provision of the Benefits/Coverages (What is Covered) section of this Certificate

30 30 Plan Page Benefit Clarification HMO & EPO All HMO & EPO products only offer In Network (Tier 1) benefits, the Out of Network benefits $0 & 100% should be clarified as Not Covered. PPO plans will have benefit levels listed in both In Network & Out of Network tiers

31 31 Sample of an HMO SBC Regarding Emergency Room Benefits All Emergency Services are treated as In Network benefits regardless of Facility. The Plan Page is miss leading because it shows Out of Network benefits as $0 & 100% Urgent care is listed In Network only and at a Copay level for some plans

32 32 Sample of an HMO SBC Regarding Unique Five Tier Rx Benefits This plan has a five tier Rx benefit: Tier 1 Preferred Generic, Tier 2 Non-Preferred Generic Tier 3 Preferred Brand, Tier 4 Non-Preferred Brand, Tier 5 Specialty Drugs. The Tier 2 Non-preferred Generic is very unique Carriers only use one Pharmacy Network, for PPO plans when Out of Network providers write a script there is no difference in cost sharing

33 33 Sample of an HMO SBC Regarding Outpatient & Inpatient Benefits Outpatient Surgery & Hospital Stay separate Facility fees and Physician fees benefits for this example both are at a coinsurance level. Some plans will provide a copay at the Facility fee level benefit

34 34 Sample of An UnitedHealthcare SBC Single Individual Family Deductible Notice UHC does not provide a Family Deductible level. Each family member must meet a $5000 per person Deductible before coinsurance applies

35 35 Sample Colorado HealthOP SBC Mental Health Benefits

36 36 Sample Kaiser Permanente’s SBC Rehabilitation Benefits

37 37 Sample of The SBC’s Excluded & Other Covered Services Section This section could vary by carrier & plan type, notice the disclaimer “ Check your policy or plan document”

38 38 Each SBC Provides A Coverage Sample

39 39 Market Place Carrier Review & Product Offering This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

40 40 C4HCO Carrier Partners' by Market Carrier Consumer Facing Name / DBAT Individual Health PlansGroup Health PlansDental Individual PlansDental Group Plans Access Health Colorado H X Colorado Choice Health Plans H XX Colorado HealthOP H XX Denver Health Medical Plan H X Humana H X Kaiser Permanente H XX Rocky Mountain Health Plans H XX SeeChange Health H X UnitedHealthcare / All Savers H X Anthem Blue Cross & Blue Shield / HMO Colorado B XXXX Cigna B X X Best Life & Health Insurance Company D XX Delta Dental of Colorado D XX Dentegra Insurance Company D XX Guardian D X Premier Access Dental & Vision D XX MetLife D X Total by Participation10667

41 41 SHOP Small Group Market Analysis This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

42 42 Small Group Market Company ( * Trading Partners) Level of Coverage*Off the Market PlaceOn the Market PlaceGrand Total Colorado Choice *Bronze336 Gold336 Silver6410 Colorado HealthOP *Bronze224 Gold224 Silver224 Anthem *Bronze11112 Gold26228 Platinum22 Silver30232 Kaiser Permanente *Bronze9918 Gold15621 Silver19928 Rocky Mountain Health Plans *Bronze12 24 Gold12 24 Silver20 40 SeeChange *Bronze516 Gold112 Silver314 UnitedHealthcareBronze12 Gold23 Platinum44 Silver44 Grand Total 26692358

43 43 Small Group Medical Plans On & Off the Market Place 65% More Plans OFF the Market Place

44 44 Small Group Market by Carrier

45 45 Small Group Market by Metal Tier 48% more Bronze Plans 69% more Silver Plans 68% more Gold Plans

46 46 Small Group Medical Plans On & Off the Market Place by Product Type

47 47 SHOP Silver Rate Comparison Plans ON the Market Place Plans On The Market PlaceColo SpringsDenverFort Collins CompanyPlanLowHighLowHighLowHigh Colorado ChoiceHMO$242.50$253.14$270.38$282.24$328.91$343.34 CoOpStateWideOnePPO$334.70 $340.66 $373.76 CoOpStateWideTwoPPO$264.83 $269.68 $296.58 Kaiser Permanente DBHMO $251.96$259.43 Kaiser Permanente N CoHMO $239.36$246.46 Kaiser Permanente S CoHMO$277.16$285.37 Athem / RMHMSPPO$278.88 $299.93 $336.17 RMHP HCOPPO$288.84$299.48$325.78$337.78$406.38$421.35 RMHP CHP NetworkHMO$266.35$277.32$300.42$312.80$374.74$390.19 RMHP NWP NetworkHMO$252.42$262.97$284.71$296.60$355.15$370.00 RMHP Statewide NetworkHMO$280.28$292.10$316.13$329.46$394.34$410.97 SeeChangePPO$300.30 $320.83 $357.09 Rates Based on a 27 Year Old

48 48 SHOP Rating Area Comparison Low End Plans State Wide Carriers Only Plans ON The Market Place Area 1Area 2 Area 3 Area 4Area 5 Area 6Area 7Area 8Area 9 Area 10Area 11 BoulderCoSprDenver Ft Collins Grand JunctionGreeleyPuebloS EastN EastWestResort CompanyPlanLow COOP (Metro)PPO$332.11$334.70$340.66$373.76$442.54$361.38$366.28$350.65$447.22$481.48$578.38 43% COOP (State)PPO$262.73$264.83$269.68$296.58$350.87$286.55$290.52$277.80$354.63$382.37$460.78 43% Athem / RMHMSPPO$289.09$278.88$299.93$336.17$307.81$357.07$296.12$302.63$383.11$344.71$422.90 34% RMHP HCOPPO$372.81$288.84$325.78$406.38$288.84$389.59$372.81$356.01$456.77$339.22$470.20 39% RMHP CHP NetworkHMO$343.78$266.35$300.42$374.74$266.35$359.26$343.78$328.29$421.20$312.81$433.59 39% RMHP NWP NetworkHMO$325.79$252.42$284.71$355.15$252.42$340.47$325.79$311.12$399.17$296.45$410.91 39% RMHP Statewide NetworkHMO$361.76$280.28$316.13$394.34$280.28$378.05$361.76$345.46$443.23$329.17$456.27 39% SeeChangePPO$281.05$300.30$320.83$357.09$349.71$401.04$274.31$401.04 $462.00 41% Rates Based on a 27 Year Old Small Group Silver Plans

49 49 Plans ON The Market Place Area 1Area 2 Area 3 Area 4Area 5 Area 6Area 7Area 8Area 9 Area 10Area 11 BoulderCoSprDenverFt Collins Grand JunctionGreeleyPuebloS EastN EastWestResort CompanyPlanHigh COOP (Metro)PPO$332.11$334.70$340.66$373.76$442.54$361.38$366.28$350.65$447.22$481.48$578.38 43% COOP (State)PPO$262.73$264.83$269.68$296.58$350.87$286.55$290.52$277.80$354.63$382.37$460.78 43% Athem / RMHMSPPO$289.09$278.88$299.93$336.17$307.81$357.07$296.12$302.63$383.11$344.71$422.90 34% RMHP HCOPPO$386.52$299.48$337.78$421.35$299.48$403.94$386.52$369.12$473.58$351.71$487.51 39% RMHP CHP NetworkHMO$357.94$277.32$312.80$390.19$277.32$374.06$357.94$341.82$438.56$325.70$451.46 39% RMHP NWP NetworkHMO$339.42$262.97$296.60$370.00$262.97$354.71$339.42$324.13$415.87$308.84$428.10 39% RMHP Statewide NetworkHMO$377.01$292.10$329.46$410.97$292.10$394.00$377.01$360.03$461.92$343.04$475.51 39% SeeChangePPO$281.05$300.30$320.83$357.09$349.71$401.04$274.31$401.04 $462.00 41% SHOP Rating Area Comparison High End Plans State Wide Carriers Only Rates Based on a 27 Year Old Small Group Silver Plans

50 50 Small Group Market Analysis 65% More Plans OFF the Market Place than ON the Market Place. 266 OFF the Market Place / 92 ON the Market Place Anthem has 93% more plans OFF the Market Place (58 VS 4) United HealthCare has 71 plans OFF the Market Place, none ON the Market Place Plans ON the Market Place Colorado Springs average 25% difference between the lowest & highest price plan Denver average 30% difference between the lowest & highest price plan Fort Collins average 47% difference between the lowest & highest price plan Plan Types 191 HMO, 102 PPO, 42 POS, 23 EPO Most C4HCO carriers offer equal rates ON & OFF the Market Place, except KP offers 2% lower rates for plans ON, SeeChange offer additional plans OFF at 4% lower rate, Anthem for the Silver tier offers 30 plans OFF & 2 plans ON, the plans OFF are 7% lower & 9% higher For Statewide carriers, Boulder & COS offer the lower rates & the Resort area the Highest at about 40%

51 51 Individual Market Analysis This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

52 52 Individual Market (section 1) Company ( * Trading Partners) Level of Coverage* Off the Market Place On the Market PlaceGrand Total UnitedHealthCare All Savers * Bronze 22 Catastrophic 11 Gold 22 Platinum 11 Silver 33 Cigna * Bronze336 Gold336 Silver5510 Colorado Choice * Bronze336 Catastrophic112 Gold336 Silver5510 Colorado HealthOP * Bronze224 Catastrophic 22 Gold224 Silver224 Denver Health Medical * Gold 22 Silver 22 Anthem * Bronze6612 Catastrophic112 Gold224 Silver6511

53 53 Individual Market (section 2) Company ( * Trading Partners) Level of Coverage* Off the Market Place On the Market PlaceGrand Total Kaiser Permanente * Bronze9918 Catastrophic336 Gold6612 Silver9918 Access Health Colorado * Bronze 22 Gold 22 Silver 22 Rocky Mountain Health Plans* Bronze142034 Catastrophic246 Gold246 Silver162440 Time Insurance Company Bronze14 Catastrophic2 2 Gold4 4 Platinum4 4 Silver8 8 Humana * Bronze8210 Catastrophic415 Gold112 Platinum112 Silver8210 Grand Total 159150309

54 54 Individual Medical Plans On & Off the Market Place 6% More Plans OFF the Market Place

55 55 Individual Market by Carrier

56 56 Individual Market by Metal Tier

57 57 Individual Medical Plans On & Off the Market Place by Product Type

58 58 Plans ON The Market PlaceColo SpringsDenverFort Collins CompanyPlanLowHighLowHighLowHigh United HC / All SaversEPO $312.14$318.57 CignaPPO $260.91$292.65 Colorado ChoiceHMO$216.55$223.42$241.44$249.10$293.72$303.02 COOP (Metro)EPO $223.78 $245.75 COOP (State)PPO$252.98 $257.54 $282.80 Denver Health closed networkHMO $225.37 Denver Health Exp networkHMO $261.52 Anthem / HMO ColoradoHMO$245.78$272.66$262.17$290.85$276.48$306.73 Anthem / HMO ColoradoHMO$245.78$272.66$262.17$290.85$276.48$306.73 Humana Health PlanHMO$198.58$201.44$205.32$208.27 Kaiser Permanente DBHMO $201.04$213.77 Kaiser Permanente N CoHMO $190.99$203.08 Kaiser Permanente S CoHMO$221.15$235.14 CO Access / New VenturesPPO$340.80$345.07$372.33$377.00$405.45$410.53 RMHP CHP NetworkHMO$231.57$255.07$261.18$287.70$325.80$358.88 RMHP MesaHMO$233.91$271.91$263.83$306.70$329.11$382.58 RMHP NWP NetworkHMO$224.90$241.75$253.67$272.67$316.43$340.14 RMHP Statewide NetworkPPO$243.71$283.28$274.88$319.51$342.90$398.56 Rates Based on a 27 Year Old Individual Silver Rate Comparison Plans ON the Market Place

59 59 Plans ON The Market Place Area 1Area 2 Area 3 Area 4Area 5 Area 6Area 7Area 8Area 9 Area 10Area 11 BoulderCoSprDenver Ft Collins Grand JunctionGreeleyPuebloS EastN EastWestResort CompanyPlanLow COOP (State)PPO$251.01$252.98$257.54$282.80$334.44$273.38$277.12$265.17$338.01$364.22$437.6243% Anthem / HMO ColoradoHMO$256.66$245.78$262.17$276.48$294.46$293.76$290.97$289.39$368.04$330.52$406.8940% Anthem / HMO ColoradoHMO$256.66$245.78$262.17$276.48$294.46$293.76$290.97$289.39$368.04$330.52$406.8940% CO Access / New VenturesPPO$376.31$340.80$372.33$405.45$412.33$408.28$310.43$359.22$419.18$484.22$540.2743% RMHP CHP NetworkHMO$298.88$231.57$261.18$325.80$231.57$312.34$298.88$285.41$366.19$271.95$376.9739% RMHP MesaHMO$301.91$233.91$263.83$329.11$233.91$315.51$301.91$288.32$369.91$274.71$380.7939% RMHP NWP NetworkHMO$290.28$224.90$253.67$316.43$224.90$303.35$290.28$277.21$355.66$264.13$366.1239% RMHP Statewide NetworkPPO$314.56$243.71$274.88$342.90$243.71$328.73$314.56$300.39$385.40$286.22$396.7339% Individual Rating Area Comparison Low End Plans State Wide Carriers Only Rates Based on a 27 Year Old Individual Silver Plans

60 60 Plans ON The Market Place Area 1Area 2 Area 3 Area 4Area 5 Area 6Area 7Area 8Area 9 Area 10Area 11 BoulderCoSprDenver Ft Collins Grand JunctionGreeleyPuebloS EastN EastWestResort CompanyPlanHigh COOP (State)PPO$251.01$252.98$257.54$282.80$334.44$273.38$277.12$265.17$338.01$364.22$437.6243% Anthem / HMO ColoradoHMO$284.74$272.66$290.85$306.73$326.67$325.91$322.80$321.05$408.30$366.67$451.4140% Anthem / HMO ColoradoHMO$284.74$272.66$290.85$306.73$326.67$325.91$322.80$321.05$408.30$366.67$451.4140% CO Access / New VenturesPPO$381.02$345.07$377.00$410.53$417.50$413.39$314.32$363.72$424.43$490.29$547.0443% RMHP CHP NetworkHMO$329.22$255.07$287.70$358.88$255.07$344.05$329.22$314.39$403.36$299.56$415.2339% RMHP MesaHMO$350.96$271.91$306.70$382.58$271.91$366.78$350.96$335.15$430.02$319.35$442.6539% RMHP NWP NetworkHMO$312.02$241.75$272.67$340.14$241.75$326.07$312.02$297.97$382.30$283.91$393.5439% RMHP Statewide NetworkPPO$365.63$283.28$319.51$398.56$283.28$382.10$365.63$349.16$447.98$332.69$461.1539% Rates Based on a 27 Year Old Individual Rating Area Comparison High End Plans State Wide Carriers Only Individual Silver Plans

61 61 Individual Market Analysis 6% More Plans OFF the Market Place than ON the Market Place. 159 OFF the Market Place / 150 ON the Market Place RMHP has 35% more plans ON the Market Place(52 VS 34) Humana has 68% more plans OFF the Market Place (22 VS 7) Plans ON & OFF the Market Place Colorado Springs average 40% difference between the lowest & highest price plan Denver average 48% difference between the lowest & highest price plan Fort Collins average 53% difference between the lowest & highest price plan Most C4HCO carriers offer equal rates ON & OFF the Market Place, except KP on average offers 3% lower rates for plans ON. For Statewide carriers, Boulder & COS offer the lower rates & the Resort area the Highest at about 40%

62 62 Dental Small Group Market Analysis This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

63 63 Dental Small Group Market Company ( * Trading Partners)Level of Coverage* Off the MarketOn the MarketGrand Total Best Life Insurance Company * High336 Low336 Delta Dental / Colorado Dental * High1193122 Low314 Dentegra Insurance Company * High336 Low336 Metropolitan Life Insurance Company * High224 Low224 Premier Access *Low336 Renaissance Life and Health IC of America High1 1 Low1 1 Anthem / Rocky Mountain Hospital and Medical Serv. * High6612 Low9716 See Change Insurance Company High1 1 Low 8 8 The Guardian Life * High44 8 Low75 12 Grand Total 17845223

64 64 Small Group Dental Plans On & Off the Market Place 75% More Plans OFF the Market Place Delta Dental has 97% More Plans OFF the Market Place

65 65 Small Group Dental Plans On & Off the Market Place by Product Type

66 66 Small Group Market by Carrier

67 67 Dental Individual Market Analysis This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

68 68 Dental Individual Market Company Level of Coverage* Off the Market On the Market Grand Total Best Life Insurance Company High336 Low336 CIGNALow123 Delta Dental / Colorado Dental High336 Low123 Dentegra Insurance Company High336 Low336 Premier AccessLow336 Renaissance Life and Health IC of America High2 2 Low2 2 Anthem High2 2 Low2 2 Grand Total 282250

69 69 Individual Dental Plans On & Off the Market Place 18% More Plans OFF the Market Place Small Group has 77% More Plans than the Individual Market

70 70 Individual Market by Carrier

71 71 Individual Dental Plans ON & OFF the Market Place by Product Type

72 72 Carriers Benefit Comparison By Metal Tier This is a representative sample of the Carrier's plans and rates. It is not intended to promote one Carrier over another Carrier

73 73 Cost-Sharing and Metal Tiers ACA Precious Metal Tiers Plan Tier Actuarial Value Platinum 90% Gold 80% Silver 70% Bronze 60% In general, lower member cost-sharing and higher premiums In general, higher member cost-sharing and lower premiums Actuarial value percentages represent how much of a typical population’s medical spending a health insurance plan would cover.

74 74 Access Health Colorado BenefitsBronze PPOSilver PPOGold PPO Ded Individual$5,000$10,000$4,000$8,000$2,000$4,000 Ded Family$10,000$20,000$8,000$16,000$4,000$8,000 OOPMax Ind$6,350$12,700$6,350$12,700$4,000$8,000 OOPMax Family$12,700$25,400$12,700$25,400$8,000$16,000 Primary Care40% Coin After Ded50% Coin After Ded$25 Copay50% Coin After Ded$10 Copay40% Coin After Ded Specialist visit40% Coin After Ded50% Coin After Ded$50 Copay50% Coin After Ded$20 Copay40% Coin After Ded Prevention visitNo Charge $0 Copay50% Coin After DedNo Charge $0 Copay50% Coin After Ded No Charge $0 Copay40% Coin After Ded Diagnostic Test40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After Ded20% Coin After Ded40% Coin After Ded Imaging40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After Ded20% Coin After Ded40% Coin After Ded Generic Drugs40% Coin After Ded50% Coin After Ded$10 Copay50% Coin After Ded$5 Copay40% Coin After Ded Preferred Drugs40% Coin After Ded50% Coin After Ded$20 Copay50% Coin After Ded$10 Copay40% Coin After Ded Non-Preferred40% Coin After Ded50% Coin After Ded$40 Copay50% Coin After Ded$15 Copay40% Coin After Ded Specialty Drugs40% Coin After Ded50% Coin After Ded$3050% Coin After Ded20%40% Coin After Ded Facility Outpatient40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After Ded20% Coin After Ded40% Coin After Ded Facility Inpatient40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After Ded20% Coin After Ded40% Coin After Ded Emergency visit40% Coin After Ded $250 Copay Emergency Trans40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After Ded20% Coin After Ded40% Coin After Ded Urgent Care40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After Ded20% Coin After Ded40% Coin After Ded Premium$302.59$386.19$448.94 % increase Lowest Plan 22%33% Benefit Comparison By Metal Tier Access Health Colorado Sample

75 75 Anthem / Blue Cross Blue Shield /HMO Colorado BenefitsCatastrophic DirectAccessBronze DirectAccess cabzSilver DirectAccess cbmaGold DirectAccess ccab Ded Individual$6,530$5,750$1,250$750 Ded Family$12,700$11,500$2,500$1,500 OOPMax Ind$6,530$6,350 $6,000 OOPMax Family$12,700 $12,000 Primary Care3 OV / 0% Coin After Ded435 Copay (2V) / 30% Coin$35 Copay (2V) / 35% Coin$30 Copay Specialist visit0% Coin After Ded30% Coin After Ded35% Coin After Ded0% Coin After Ded Prevention visitNo Charge $0 Copay Diagnostic Test0% Coin After Ded30% Coin After Ded35% Coin After Ded0% Coin After Ded Imaging0% Coin After Ded30% Coin After Ded35% Coin After Ded0% Coin After Ded Generic Drugs0% Coin After Ded30% Coin After Ded$15 Copay Preferred Drugs0% Coin After Ded30% Coin After Ded$40 Copay Non-Preferred0% Coin After Ded30% Coin After Ded35% Coin After Ded0% Coin After Ded Specialty Drugs0% Coin After Ded30% Coin After Ded35% Coin After Ded0% Coin After Ded Facility Outpatient0% Coin After Ded30% Coin After Ded35% Coin After Ded0% Coin After Ded Facility Inpatient0% Coin After Ded$500 Copay /30% Coin AD$500 Copay /35% Coin AD$500 Copay / 0% Coin AD Emergency visit0% Coin After Ded$200 Copay / 30% Coin AD$200 Copay / 35% Coin AD$200 Copay / 0% Coin AD Emergency Trans0% Coin After Ded30% Coin After Ded35% Coin After Ded0% Coin After Ded Urgent Care0% Coin After Ded$50 Copay / 30% Coin AD$50 Copay / 35% Coin AD$50 Copay / 0% Coin AD Premium$188.27$221.81$291.12$372.82 % increase Catastrophic Plan15%35%50% Benefit Comparison By Metal Tier Anthem BC/BS Sample No Rx Deductible

76 76 Cigna BenefitsmyCigna Health Flex 5500myCigna Health Flex 1500myCigna Health Flex 1900 Ded Individual$5,500$12,500$1,500$12,500$1,900$12,500 Ded Family$11,000$25,000$3,000$25,000$3,800$25,000 OOPMax Ind$6,350$25,000$6,350$25,000$6,350$25,000 OOPMax Family$12,700$50,000$12,700$50,000$12,700$50,000 Primary Care1-2 $30 Copay / 40% C A D50% Coin After Ded1-2 $30 Copay / 40% C A D50% Coin After DedNo Charge $0 Copay50% Coin After Ded Specialist visit1-2 $60 Copay / 40% C A D50% Coin After Ded1-2 $60 Copay / 40% C A D50% Coin After DedNo Charge $0 Copay50% Coin After Ded Prevention visitNo Charge $0 Copay 50% Coin After DedNo Charge $0 Copay50% Coin After Ded Diagnostic Test40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After DedNo Charge $0 Copay50% Coin After Ded Imaging40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After DedNo Charge $0 Copay50% Coin After Ded Generic Drugs$4 CopayNot Covered$4 CopayNot CoveredNo Charge $0 CopayNot Covered Non-Preferred G40% Coin After DedNot Covered$20 CopayNot CoveredNo Charge $0 CopayNot Covered Preferred Drugs40% Coin After DedNot Covered$60 CopayNot CoveredNo Charge $0 CopayNot Covered Non-Preferred50% Coin After DedNot Covered50% Coin After DedNot Covered50% Coin After DedNot Covered Specialty Drugs40% Coin After DedNot Covered40% Coin After DedNot CoveredNo Charge $0 CopayNot Covered Facility Outpatient40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After DedNo Charge $0 Copay50% Coin After Ded Facility Inpatient40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After DedNo Charge $0 Copay50% Coin After Ded Emergency visit40% Coin After Ded 30% Coin After Ded50% Coin After DedNo Charge $0 Copay50% Coin After Ded Emergency Trans40% Coin After Ded50% Coin After Ded30% Coin After Ded50% Coin After DedNo Charge $0 Copay50% Coin After Ded Urgent Care$75 Copay50% Coin After Ded$75 Copay50% Coin After DedNo Charge $0 Copay50% Coin After Ded Premium$238.68$270.62$312.43 % increase Lowest Plan 12%24% Benefit Comparison By Metal Tier Cigna Plan Sample

77 77 Colorado Choice Health Plan BenefitsBronze Choice 3000/50Silver Choice 2000/CopayGold Choice 1500/20 Ded Individual$3,000$2,000$1,500 Ded Family$6,000$4,000$3,000 OOPMax Ind$6,350 $4,000 OOPMax Family$12,700 $8,000 Primary Care50% Coin After Ded$20 Copay$15 Copay Specialist visit50% Coin After Ded$40 Copay$25 Copay Prevention visitNo Charge $0 Copay Diagnostic Test50% Coin After Ded40% Coin After Ded20% Coin After Ded Imaging50% Coin After Ded$150 Copay20% Coin After Ded Generic Drugs$25 Copay$15 Copay$10 Copay Preferred Drugs50% Coin After Ded$40 Copay$35 Copay Non-Preferred50% Coin After Ded$60 Copay Specialty Drugs50% Coin After Ded$60 Copay20% Coin Ded Waived Facility Outpatient50% Coin After Ded40% Coin After Ded20% Coin After Ded Facility Inpatient50% Coin After Ded40% Coin After Ded20% Coin After Ded Emergency visit50% Coin After Ded$150 Copay After Ded$150 Copay Emergency Trans50% Coin After Ded$100 Copay After Ded20% Coin After Ded Urgent Care50% Coin After Ded40% Coin After Ded20% Coin After Ded Premium$206.08$261.20$292.59 % increase Catastrophic Plan21%30% Benefit Comparison By Metal Tier Colorado Choice Health Plan Sample

78 78 Colorado HealthOP BenefitsHealthOP Bear EPOHealthOP Bison EPOHealthOP Bighorn EPO Ded Individual$5,500$2,600$1,000 Ded Family$11,000$5,200$2,000 OOPMax Ind$6,350$6,000$3750 / $3250 OOPMax Family$12,700$12,000$7500 / $6500 Primary Care1st Free / 50% Coin After Ded1st Free / 40% Coin After Ded1st Free / $30 Copay Primary Care Enhanced1st Free / 50% Coin After Ded$30 Copay1st Free / $20 Copay Specialist visit50% Coin After Ded40% Coin After Ded$60 Copay Specialist Enhanced50% Coin After Ded$60 Copay$40 Copay Prevention visitNo Charge $0 Copay Diagnostic Test50% Coin After Ded40% Coin After Ded35% Coin After Ded Imaging50% Coin After Ded40% Coin After Ded35% Coin After Ded Generic Drugs$15 Copay / After Ded$15 Copay Preferred Drugs50% Coin After Ded$40 Copay$30 Copay Non-Preferred50% Coin After Ded40% Coin Ded Waived35% Coin Ded Waived Specialty Drugs50% Coin After Ded40% Coin Ded Waived35% Coin Ded Waived Facility Outpatient50% Coin After Ded40% Coin After Ded35% Coin After Ded Facility Inpatient50% Coin After Ded40% Coin After Ded35% Coin After Ded Emergency visit50% Coin After Ded$500 Copay$350 Copay Emergency Trans50% Coin After Ded40% Coin After Ded35% Coin After Ded Urgent Care50% Coin After Ded40% Coin After Ded35% Coin After Ded Premium$173.01$232.10$276.42 % increase Catastrophic Plan25%37% Benefit Comparison By Metal Tier Colorado HealthOP Plan Sample

79 79 Denver Health Medical / ELEVATE Benefits ELEVATE Silver Basic HMO ELEVATE Gold Basic HMOELEVATE Silver Expanded HMOELEVATE Gold Expanded HMO Ded Individual$2,500$1,600$2,500$1,600 Ded Family$5,000$3,200$5,000$3,200 OOPMax Ind$6,250$5,000$6,250$5,000 OOPMax Family$12,500$10,000$12,500$10,000 Primary Care$40 Copay$15 Copay$40 Copay$15 Copay Specialist visit$65 Copay$25 Copay$65 Copay$25 Copay Prevention visitNo Charge $0 Copay Diagnostic Test25% Coin After Ded10% Coin After Ded25% Coin After Ded10% Coin After Ded Imaging25% Coin After Ded10% Coin After Ded25% Coin After Ded10% Coin After Ded Generic Drugs$20 Copay$10 Copay$20 Copay$10 Copay Preferred Drugs$45 Copay$35 Copay$45 Copay$35 Copay Non-Preferred$80 Copay$60 Copay$80 Copay$60 Copay Specialty Drugs$80 Copay$60 Copay$80 Copay$60 Copay Facility Outpatient25% Coin After Ded10% Coin After Ded25% Coin After Ded10% Coin After Ded Facility Inpatient25% Coin After Ded10% Coin After Ded25% Coin After Ded10% Coin After Ded Emergency visit$250 Copay$150 Copay$250 Copay$150 Copay Emergency Trans25% Coin After Ded10% Coin After Ded25% Coin After Ded10% Coin After Ded Urgent Care$125 Copay$75 Copay$125 Copay$75 Copay Premium$233.76$269.58$271.25$269.58 % increase Catastrophic Plan13%14%13% Benefit Comparison By Metal Tier Denver Health Medical Sample

80 80 Humana BenefitsBronze 4850/6350 HMOSilver 4600/6300 HMOGold 2500/3500 HMOPlatinum 1000/1500 HMO Ded Individual$4,850$4,600$2,500$1,000 Ded Family$9,700$9,200$5,000$2,000 Rx Ded Individual$1,500 $500 Rx Ded Family$3,000 $1,000 OOPMax Ind$6,350$6,300$3,500$1,500 OOPMax Family$12,700$12,600$7,000$3,000 Primary Care$50 Copay$25 Copay Specialist visit$75 Copay$35 Copay Prevention visitNo Charge $0 Copay Diagnostic Test20% Coin After Ded Imaging20% Coin After Ded Generic Drugs$28 Copay$17 Copay$8 Copay Preferred Drugs$75 Copay After Ded$50 Copay After Ded$20 Copay After Ded Non-Preferred50% Coin After Ded 35% Coin After Ded Specialty Drugs50% Coin After Ded 35% Coin After Ded Facility Outpatient20% Coin After Ded Facility Inpatient20% Coin After Ded Emergency visit20% Coin After Ded Emergency Trans20% Coin After Ded Urgent Care$100 Copay$50 Copay Premium$202.41$212.96$242.90$273.85 % increase Catastrophic Plan5%17%26% Benefit Comparison By Metal Tier Humana Sample

81 81 Kaiser Permanente BenefitsKP CO Bronze 4500/50KP CO Silver 2500/30KP CO Gold 1000/20 Ded Individual$4,500$2,500$1,000 Ded Family$9,000$5,000$2,000 OOPMax Ind$6,350 OOPMax Family$12,700 Primary Care$50 Copay$30 Copay$20 Copay Specialist visit$70 Copay$50 Copay$40 Copay Prevention visitNo Charge $0 Copay Diagnostic Test20% Coin After Ded30% Coin After Ded20% Coin After Ded Imaging$500 Copay$300 Copay$150 Copay Generic Drugs$25 Copay$15 Copay$10 Copay Preferred Drugs45% Coin Ded Waived$45 Copay$35 Copay Non-Preferred50% Coin Ded Waived30% Coin Ded Waived20% Coin Ded Waived Specialty Drugs50% Coin Ded Waived30% Coin Ded Waived20% Coin Ded Waived Facility Outpatient20% Coin After Ded30% Coin After Ded20% Coin After Ded Facility Inpatient20% Coin After Ded30% Coin After Ded20% Coin After Ded Emergency visit20% Coin After Ded$400 Copay$250 Copay Emergency Trans20% Coin After Ded30% Coin After Ded20% Coin After Ded Urgent Care$100 Copay$75 Copay Premium$193.68$214.79$244.82 % increase Catastrophic Plan10%21% Benefit Comparison By Metal Tier Kaiser Permanente Plan Sample

82 82 Benefit Comparison By Metal Tier Rocky Mountain Health Plan Sample Rocky Mountain Health Plan BenefitsNW Bronze $4500/$55 HMONW Silver $2500/$40 HMOGold PPO $500/Copay $35 Ded Individual$4,500$2,500$500$1,000 Ded Family$9,000$5,000$1,000$2,000 Rx Ded IndividualN/A$500N/A Rx Ded FamilyN/A$1,000N/A OOPMax Ind$6,350 $4,000$8,000 OOPMax Family$12,700 $8,000$16,000 Primary Care$55 Copay$40 Copay$35 Copay50% Coin After Ded Specialist visit40% Coin After Ded$55 Copay$50 Copay50% Coin After Ded Prevention visitNo Charge $0 Copay Diagnostic Test40% Coin After Ded30% Coin After Ded20% Coin After Ded50% Coin After Ded Imaging40% Coin After Ded30% Coin After Ded20% Coin After Ded50% Coin After Ded Generic Drugs$20 Copay$15 Copay Not Covered Preferred Drugs40% Coin After Ded30% Coin After Ded20%Not Covered Non-Preferred40% Coin After Ded 40%Not Covered Specialty Drugs50% Coin After Ded40% Coin After Ded40%Not Covered Facility Outpatient40% Coin After Ded30% Coin After Ded20% Coin After Ded50% Coin After Ded Facility Inpatient40% Coin After Ded30% Coin After Ded20% Coin After Ded50% Coin After Ded Emergency visit$350 Copay$250 Copay20% Coin After Ded Emergency Trans40% Coin After Ded30% Coin After Ded20% Coin After Ded Urgent Care40% Coin After Ded30% Coin After Ded20% Coin After Ded50% Coin After Ded Premium$233.31$263.11$365.79 % increase Lowest Plan11%36%

83 83 Benefit Comparison By Metal Tier UnitedHealthcare Sample UnitedHealthcare / All Savers Individual Plans BenefitsCatastrophic PlanCopay Bronze PlanCopay Silver Plan CCopay Gold Plan CCopay Plan Platinum Ded Individual$6500 per person$5500 per person$5000 per person$1500 per person$500 per person Ded FamilyN/A Ded Rx IndN/A $500 per person T2-4$150 per person T2-4N/A Ded Rx FamilyN/A OOPMax Ind$6,350 $3,200$1,500 OOPMax Family$12,700 $6,400$3,000 Primary Care3 OV per person$50 Copay / 20% Coin$35 Copay / 20% Coin$20 Copay / 20% Coin$10 Copay / 10% Coin Specialist visitNo Charge after Ded$100 Copay / 20% Coin$60 Copay / 20% Coin$40 Copay / 20% Coin$20 Copay / 10% Coin Prevention visitNo Charge $0 Copay Diagnostic TestNo Charge after Ded20% Coin 10% Coin ImagingNo Charge after Ded20% Coin 10% Coin Generic DrugsNo Charge after Ded20% Coin$15 Copay $10 Copay Preferred DrugsNo Charge after Ded20% Coin$40 Copay/After Ded$35 Copay/After Ded$35 Copay Non-PreferredNo Charge after Ded20% Coin$80 Copay/After Ded$70 Copay/After Ded$60 Copay Specialty DrugsNo Charge after Ded20% Coin25% of nego. Rate / AD$250 Copay/After Ded$250 Copay Facility OutpatientNo Charge after Ded20% Coin 10% Coin Facility InpatientNo Charge after Ded20% Coin 10% Coin Emergency visitNo Charge after Ded20% Coin $300 Copay$250 Copay Emergency TransNo Charge after Ded20% Coin $300 Copay10% Coin Urgent CareNo Charge after Ded20% Coin $75 Copay Premium$288.49$322.22$343.75$395.19$470.62 % increase Catastrophic Plan10%16%27%39%

84 84 Carrier Specific Key Points & Service Area This is a representative sample of the Carrier's Key Points and Service Area. It is not intended to promote one Carrier over another Carrier

85 85 Colorado has 11 rating areas based on varies counties o Rating Area 1 & 2 have the lowest rates & Rating Area 11 the highest (rates average about 40% difference) o Some zip codes will cross multiple counties If your coverage is through your employer, the rate is based on the employers zip code & county Colorado Rating Areas by County

86 86 Colorado Rating Area Map 10 11 5 1 2 3 4 6 7 8 9 10 Rating Area 1 = Boulder ( Counties 1 ) Rating Area 2 = Colorado Springs ( Counties 2 ) Rating Area 3 = Denver ( Counties 10 ) Rating Area 4 = Fort Collins ( Counties 1 ) Rating Area 5 = Grand Junction ( Counties 1 ) Rating Area 6 = Greeley ( Counties 1 ) Rating Area 7 = Pueblo ( Counties 1 ) Rating Area 8 = South East ( Counties 20 ) Rating Area 9 = North East ( Counties 6 ) Rating Area 10 = West ( Counties 17 ) Rating Area 11 = Resort ( Counties 4 ) 8

87 87 Access Health Colorado / New Health Ventures Individual Market Unique Offerings and Programs Statewide PPO – see any provider in Colorado More specialists Behavioral health providers and primary care providers have the same low copay Local call center Integrated care with complete health and wellness programs Parent company, Colorado Access has more than 18 years of experience as a public insurance carrier Many avenues for member input and engagement – we listen to you Service Area Statewide Coverage

88 88 Anthem BlueCross and BlueShield Individual & Small Group Market Unique Offerings and Programs Once you’re a member, these tools and services will help put you in control: 24/7 NurseLine: access to a registered nurse who’s trained to help you make informed health care decisions. Find a Doctor: helps you find doctors, hospitals, pharmacies and specialists in your area. Zagat Health Survey: see what other patients have said about doctors and hospitals before you use them. Service Area Statewide Coverage

89 89 Cigna Individual Market Unique Offerings and Programs 24/7 Call Center making Cigna the first national health service company to offer customer service call center hours 24 hours a day, 7 days a week to answer questions at any time. Online Tools to compare the cost and quality of medications, medical services, and hospital care. Health Information Line Staffed by Trained Nurses who can offer detailed answers to health questions, available 24 hours a day, 7 days a week. Door-to-Door Home Delivery Pharmacy that offers both convenience and reduced costs for prescription drugs. Healthy Rewards® Discount Program for weight management and nutrition products, tobacco cessation, fitness club memberships and more. Service Area NO Statewide Coverage, limited 6 counties rating area 3

90 90 Cigna Individual Service Area Cigna

91 91 Colorado Choice Health Plans Individual & Small Group Market Unique Offerings and Programs Care Management Programs with Nurse Navigators to help guide patients towards their health care goals Health and Wellness programs and educational materials that are member centric Best Practice Protocols developed by physicians and nationally recognized provider organizations Pilot programs: Prometheus – provides physicians with individually-based patient information designed to avoid unnecessary costs and improve health outcomes Engaged Benefit Design – engages both the patient and provider in shared decision making and provides incentives for the use of high value, evidence-based services Colorado Primary Care Initiative – provides primary care physicians with data and tools to improve the health of their patient populations Service Area: No Statewide, 30 counties & 6 rating areas

92 92 Colorado Choice Health Plans Service Area CO Choice

93 93 Colorado HealthOP Individual & Small Group Market Unique Offerings and Programs Colorado HealthOP offers incentives for preventive care. That means that our members receive rewards for doing a few simple screenings each year. Rewards may include money in health incentive accounts, smaller out-of-pocket maximums or credits toward deductibles. As a cooperative (CO-OP), Colorado HealthOP also offers members the chance to affect what is covered in their benefit structure. Starting in 2014, members will be elected to the CO-OP’s board of directors. Board members will guide the future of the CO-OP, including what is covered in benefit plans. Service Area: Statewide coverage for PPO plans EPO accesses to Central Metro Network – limited 17 counties & 7 rating areas

94 94 Colorado HealthOP Central Metro Network (EPO) COOP

95 95 Denver Health Medical Plan / ELEVATE Individual Market Unique Offerings and Programs Mom’s To Be: A program offering incentives to encourage pregnant women to get prenatal care. Incentives include two months of diapers, an umbrella stroller, and a car seat. Baby’s First Year: Preventive care is especially important during a child’s first year of life. This is when vaccinations are given and growth patterns can be watched. This program encourages this care by offering incentives such as a baby monitor, diapers and a play gym. Take Control Of Your Health: An extensive health and wellness program that includes classes on general health topics, living with chronic diseases, and Cooking Matters, a hands-on healthy cooking class. In addition, we also offer a shopping class — learn how to buy healthy foods on a budget. Health Coaching: One-on-one health coaching for members to achieve health- related goals, like quitting smoking and weight loss. Service Area No Statewide coverage limited to 3 counties & 1 rating area

96 96 Denver Health Medical Plan / ELEVATE Service Area DH

97 97 Humana Individual Market Company at a glance Works with you to put you in control of your healthcare costs. Offers access to valuable tools to give you greater control of your healthcare dollar. Gives you access to health and well-being tools that remind you to live well. Service Area No Statewide coverage limited to 8 counties & 2 rating areas

98 98 Humana Service Area Humana

99 99 Kaiser Permanente Individual & Small Group Market Thrive is the philosophy we live by. It’s the belief that being healthy is the basis for living well and embracing all the possible ways you can flourish and prosper. To help you reach your highest state of well-being we offer convenience, patient- centered care, online accessibility, tips and tools for wellness, and more. CONVENIENCE — At most Kaiser Permanente facilities and medical centers, you get one-stop service for primary care, lab tests, X-rays, and pharmacy. CHOICE — Make an informed choice by reviewing our doctors’ credentials online — education, certifications, secondary languages, and specialties. And you have the option of changing your primary care physician any time. INNOVATIVE TOOLS — Stay connected to your health 24/7 with your electronic health record. You can refill most prescriptions, schedule routine appointments, email your doctors, view most lab results, and much more — all from the convenience of your computer or phone. Service Area: No Statewide coverage limited to 24 counties & 8 rating areas

100 100 Kaiser Permanente Service Area KPDB KPNC KPCS

101 101 Rocky Mountain Health Plans Individual & Small Group Market Rocky Mountain Health Plans believes preventive care and a healthy lifestyle are key to maintaining good health. We offer a variety of health and wellness programs which give our Members the tools to stay in control of their health. Rocky Mountain Health Plans’ worksite wellness programs provide the tools and resources to assist employers in improving the health of their employees. Rocky Mountain Health Plans offers Disease Management Programs that help our Members manage chronic health conditions. Our programs offer learning materials, advice and care tips. Rocky Mountain Health Plans’ Foundation funds projects that: Help pregnant women to stop smoking by providing free diapers as an incentive to quit. Support weight management programs for kids and their parents. Promote physical activities for students during the school day. Help homeless students maintain good hygiene by providing hygiene kits. Service Area – Statewide coverage both PPO & HMO

102 102 SeeChange Health Insurance Small Group Market SeeChange Health focuses on wellness and prevention, which is why we pay you to see your doctor. Employees (and spouses/domestic partners) earn rewards for completing easy, voluntary preventive Health Actions: a short, online Health Questionnaire a Biometric Screening (basic lab tests) a Preventive Exam including cancer screenings. It’s that easy. And we pay 100% of the cost of for completing your preventive Health Actions. It pays to be proactive. Members receive financial rewards each year for completing their preventive Health Actions. Rewards vary based on the plan selected, including: Deposits into a Health Incentive Account (HIA) Deductible reimbursement When preventive Health Actions uncover specific chronic conditions members can earn more rewards for completing additional Health Actions aimed at helping them manage those conditions. Service Area – Statewide coverage

103 103 UnitedHealthcare / All Savers Individual Market Unique Offerings and Programs : At Home and on the Go: We are here when you need us and where you need us. You can reach us on the phone (Customer Service line), online (myuhc.com) or your cell phone (Health4Me app). Source4Women is an online resource on myuhc.com where women can find information and tools for health, fitness, nutrition and more. The website offers a community where women can learn from one another, share stories and attend free webinars on many women’s health issues. UHC.TVSM is the first-ever online TV channel dedicated to making health care more human. This public website explains health care benefits in everyday language and features humorous and heart-warming videos Premium Designation: The UnitedHealth Premium® designation program is a simple two-star rating system to help you see which doctors and specialty centers in your area are recognized for providing quality and cost-efficient care. Service Area: No Statewide coverage limited to 47 counties & 5 rating areas (Not in Denver)

104 104 UHC United HealthCare / All Savers Individual Service Area


Download ppt "Health Plan Market & Benefit Comparison Part II Presented by Cliff Craig Health Plan Account Manager for Connect for Health Colorado."

Similar presentations


Ads by Google