1. Marcia Benshoof Strategic Business Development

2. What is a Health Benefit Exchange?
An online marketplace for individuals and small employers:
Shop features of plans containing the same base benefits
Compare information regarding cost and quality
Determine eligibility for tax credits (premium relief)
Call or sit down with someone for help
Enroll in a plan

3. Colorado’s Healthcare Story
Rising health care costs are unsustainable for businesses
Approximately 800,000 Coloradans are uninsured
Roughly half of uninsured Americans are small business owners, their families and employees
Improving healthcare system and lowering costs are key to business growth and Colorado’s competitiveness
Blue Ribbon Commission for Healthcare Reform .

4. SB11-200: The Colorado Health Benefit Exchange Act of 2011
Passed in May 2011
SB 200 establishes the framework for the state Exchange
Governed by a Board of Directors
Legislative Implementation Review Committee  
Mission is to increase access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado.

5. Stakeholder Engagement
Open Board and Committee meetings
Advisory Groups
Ad hoc meetings
Outreach

6. Key Features Exchange will be a new gateway to the marketplace
Two marketplaces: Individual and SHOP (for businesses with up to 50 employees)
This is not a new government healthcare system
Coloradans can still buy outside the Exchange and inside or outside of the Exchange through brokers
Plans cost same inside and outside the Exchange
Only the Exchange will provide subsidies

7. Premium Subsidies
Access to financial help to reduce the cost of premiums
Subsidy applied up-front for individuals and families
Individuals and families earning from 133% to 400% of the federal poverty level
Subsidy is higher for older Coloradans
Available to small businesses and non-profits with fewer than 25 employees earning less than $50, sliding scale up to 50% of the premium

8. Cost Reductions for Individuals and Families
Financial help to reduce the cost of premiums
Individual earning between $15,282 to $45,960/year
Couple earning between $20,628 to $62,040/year
Family of 4 earning $31,322 to $94,200/year
Tax credit applied up-front by IRS
Tax credit is higher for Coloradans ages 55-64
Financial help to reduce out of pocket costs (co-pays and deductibles)
Individuals earning $15,282 to $28,725/year
Family of 4 earning $31,322 to $58,875/year

9. Example Bill is a 40 year old male making $30,000 per year
Bill enters the marketplace through the website and applies for assistance paying for his coverage.
Bill qualifies for $166 per month in premium reduction (tax credit).
Bill shops for and compares health plans with the same base benefits.
Bill finds a plan that costs $375 per month. The tax credit brings his total cost to $209 per month. 9

10. Qualified Health Plans
Plans sold in the Exchange will be organized in tiers:
Platinum: Plan covers 90% of average medical costs; consumer pays 10%
Gold: 80% -- 20%
Silver: 70% -- 30%
Bronze: 60% -- 40%
The Exchange will not offer every health plan that exists in the market. We will offer plans that fall into 4 tiers of coverage, with bronze plans offering the most basic coverage and bronze plans offering the highest level of coverage.

11. Impact to Businesses GUARANTEED ISSUE GRANDFATHERED PLANS PENALTIES
In 2014, all health plans must guarantee the availability and renewal of coverage regardless of health status (can’t be turned down because of pre-existing condition)
GRANDFATHERED PLANS
Existing plans that are kept in 2014 are exempt from new requirements (EHBs and covering preventive services without cost sharing)
PENALTIES
Businesses with fewer than 50 combined Full-Time and FTE employees are exempt from penalties related to mandate for coverage
There is no penalty for part-time employees not offered coverage

12. Impact to Businesses
Employers who currently provide insurance don’t need to change unless coverage is unaffordable
SHOP will provide employers with opportunity to give employees more choice of plans
SHOP will provide administrative services, such as premium aggregation, to reduce burden on employers

13. Opportunities for Large Employers
Re-think your COBRA strategy
COBRA participants as a group have a disproportionate effect on loss ratios
Represent a disproportionate administrative load
More likely to qualify for premium subsidies
Likely to have greater choice in the Exchange
May still use the tax benefits of HSAs
Rethink your early retirement strategy
Consider assistance and education for Part-Time employees

14. COHBE Update
One of first six states to receive approval from federal government in December to open in October
Annual Report presented to General Assembly on January 24, posted on website
Board approved new name: Connect for Health Colorado (to be launched in Spring with marketing campaign)
Board completed dozens of policy decisions
Convened about 100 public meetings in 2012 (Board, board committees, advisory groups, joint stakeholder feedback meetings)

15. 2013 Key Activities Review Applications for Navigator Entities
Work with DOI to certify health plans
Open Customer Service Phone Center
Launch broad marketing and outreach campaign
Apply for Level 2 Grant from federal government
Test technology systems and back-office functions
Train thousands of navigators, brokers, customer service representatives, partners
Open October 1

16. Coming in May 2013…

17. 2012-2014 Exchange Timeline 2014 Coverage Begins 2012 2013
Create policies for finance, audit, and prevention of fraud
Develop, implement and test web portal and customer service functions
Exchange launch
(Oct. 2013)
Test all
systems
2014
Coverage Begins
2012
2013
Certify benefits and health plans
Implement Navigator program

18. www.getcoveredco.org Unsubscribe
We launched an informational website in November, where you can learn about our work and about why it is important to be covered. We invite you to get involved.

19. James L. Sugden, SHOP Exchange Manager
Contact
James L. Sugden, SHOP Exchange Manager
@COHBE