The Basics of the DC Health Link Early, Cassidy & Schilling, Inc.

Why?  Why?  After the passage of the Patient Protection and Affordable Care Act of 2010 (PPACA), each state and territory had the option to set up a Marketplace or Exchange in order for individuals and small businesses to purchase health insurance.  The District of Columbia has such a small population that it was considered economically disadvantageous to have a Marketplace that incorporated only individuals in DC.  To solve this Law of Large Numbers problem, the District Government required all businesses with less than 51 employees to use their Marketplace to purchase group health insurance.

How and When?  How and When?  The passage of the law has been phased in for DC Small Businesses.  In 2014 the Small Business Marketplace came online, and businesses purchasing new coverage were required to use the DC Health Link (Marketplace).  Changing insurance carriers at this time became equated to buying new coverage.  On January 1, 2016 all DC Businesses with under 51 employees were to begin renewing on the DC Health Link. Due to concerns about the readiness of systems and carriers being able to upload census information to the DC Health Link, this deadline was pushed to 7/1/16.  There have been no other delays and appears there will be no other.

How will this work in practice?  Step 1  Three months prior to a group’s renewal date, the renewal premiums will be released to the DC Health Link. (January 1, 2017 will be released October 1, 2016.)  An Employer will need to establish their Employer Account.  The contact person listed on your renewal must create an Employer Account  This information will be verified, and the account with employee and basic plan data already loaded will be able to be accessed.  In the Employer application the Employer:  Confirms the data on their census.  Chooses a reference plan.  Reference Plan is the plan on which the Employer bases their contribution.  Reference Plan is often the current “base plan”.  Sets the Percentage contribution they will cover of the plan.  Because premiums are age based, it must be a percentage.  The DC Health Link will calculate the maximum cost based on the census.

How will this work in practice?  Step 2  Open Enrollment (Employer)  May begin at the earliest 2 months prior to group’s renewal date.  Must begin at the latest by the first week of the month prior to the renewal date. (January 1, 2017, must begin December 5, 2016.)  Must be completed by approximately the end of the second week of the month. 30 days prior to the renewal date. (January 1, 2017 renewal date, open enrollment must be completed by approximately December 13, 2016.)  Open Enrollment (Employee)  Will receive a notification when their Employer has completed the Employer Application to log into the DC Health Link and make their choice of plans.  When they log in they will see:  Their per-payroll cost based on the Reference Plan and Employer Contribution.  Have the option to add dependents to their plan; this cost will also be reflected,  Have the option to shop for alternate coverage to the Reference Plan.  Per paycheck costs will be reflected based on the Reference Plan.  Decision Tools will include Plan Types, Carriers, Coverage Area (Nationwide vs. Local), etc.

How will this work in practice?  Step 3  Finalizing Open Enrollment  Open Enrollment must be completed by approximately the end of the second week of the month, 30 days prior to the renewal date. (January 1, 2017 renewal date, open enrollment must be completed by approximately December 13, 2016.)  Billing by DC Health Link will begin immediately after open enrollment closes.  Ongoing Plan Service  Billing and Enrollment for Health Insurance will occur only on DC Health Link.  Invoices will come from DC Health Link.  Employees need to be added and deleted on the DC Health Link.  Ongoing Enrollments will not receive an ; they will need to go to DC Health Link to establish an account and choose you as their employer to apply shop for coverage.  Claim and Coverage Issues  The Employee’s carrier will handle these issues.  When escalation is needed an Employer can still get a Broker involved.

What To look forward to: ▫Employee Choice  Horizontal: Employer chooses all carrier plans in one Metal Level to be available to all employees. Employees can pick the carrier that works for them and often will “buy down” their coverage.  Vertical: Employer chooses all Metal Levels for a single carrier to be available. ▫Tight Timelines  Renewal dates are disclosed.  Employers are not left to wait. To watch out for: ▫No Exceptions  Employees must comply to timelines or risk losing coverage.  Invoices must be paid on time and in full or employers risk losing coverage. ▫What is the Long Term  Carriers are not happy with having to conform to the system and may pull out.  Claim Losses may lead to:  Carriers pulling out  Carriers limiting choice  Ever increasing premium

Early, Cassidy & Schilling, Inc. and the DC Health Link We have served businesses in The District for our entire lifetime, and we plan to continue to do so going forward. We placed our first business on the DC Health Link 9/1/14. A very large portion of our client base (in terms of premium) is being forced on to the DC Health Link. Our entire Employee Benefit Team ▫Is trained on The Health Link. ▫Strategized on our approach to the DC Health Link. ▫Will continue to serve DC Small Employers.

Early, Cassidy & Schilling, Inc. and the DC Health Link 7/1/16-6/1/17 - DC Small Business Renewal Strategy at Early, Cassidy & Schilling, Inc. ▫We will sit with clients either in person or teleconference to complete Employer Application on DC Health Link.  Consulting on Reference Plan Choices  Employer Funding Models ▫We will present Open Enrollments at client’s office for employees. Open Enrollments will cover:  Metal Levels  Basic Insurance Terms so that Employees know what they are shopping for  Differences in plan types, carriers and networks ▫We will stay involved beyond first invoice till next renewal with:  Assistance on the DC Health Link  Providing tools for HR Support and Regulatory Assistance  Continuing our decades of superior client support

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