Connecticut Health Insurance Exchange A Vision for the Future CBP Kevin J. Counihan October 16, 2012

What Is An Insurance Exchange? Organized marketplace for health plans to compete and offer services efficiently in the small group and individual markets Not exclusive – markets will exist outside exchange All enrollees in/outside exchange in single risk pool Provides level playing field for health plans to comply with benefit requirements and consumer protections Facilitates competition based on price, quality, and value

What Is An Insurance Exchange? Options: State-Based Exchange (CT) Federal Partnership Program Federal “Default” Exchange Medicaid Expansion – 133% of FPL Subsidized Coverage – 134%-400% of FPL receive tax credits to offset premium costs Eligibility for subsidies and public coverage based on IRS Modified Adjusted Gross Income (MAGI)

Customer Service Functions Create an “easy and simple” web portal for consumers, small businesses, brokers to shop and compare for health insurance Provide call center for eligibility, subsidy, selection, and enrollment assistance Brokers and “Navigators” for individual customer information and enrollment support Assist determining eligibility for tax credits and subsidies

Enter Applicant Information How It Works The Exchange enrollment process is defined by 6 major steps 1 Enter Applicant Information Carrier Medicaid 6 2 Process Application Verify With Data “Hub” 5 3 Complete Enrollment Display Plan Options 4 Select Plan

Existing State Exchanges Massachusetts Connector Merged Individual and Small Group markets Quasi-governmental organization 220,000 enrollees Utah Exchange Defined Contribution small group model Part of Governor’s Office of Economic Development 5,000 enrollees Roughly 13 state-based exchanges in progress

CT Exchange - Opportunity 10% of state residents uninsured 344,000 individuals 585,000 Medicaid enrollees Project Medicaid increase of 115K enrollees Expect 150-160K in state exchange Majority newly eligible for subsidies Roughly 10-20% will be small business enrollees

Employer Penalties Penalties Apply to “Large” Employers >50 Full-time “Equivalent” Employees Based on Hours Worked – 30 per week Excludes Seasonal Ees - <120 days per year Large Employer Liabilities At least 1 Ee receives Advance Premium Tax Credit (APTC) No Coverage Offered FTEs – 30 * $2,000 Coverage Offered 1 Ee Receives APTC Ee’s Contribution to Single Coverage > 9.5% of household income Coverage Offered below “Bronze” level (60% actuarial value) Penalty = $3,000 per Ee – limited to Maximum of FTEs – 30 * $2,000

Key Functional Areas IT Systems Integrated Eligibility – “No Wrong Door” Gap analysis complete Business requirements IT and Integration Architecture Systems Integrator Procurement Program Integration Rules and support for DSS program management Roles and responsibilities for CID, OPM, DRS

Vision For The Future Create User-Friendly Shop and Enrollment Experience Reduce Level of Uninsured Provide for Health Insurance Options Promote Innovation and Competition Facilitate Discussion to Create More Affordable Health Insurance Coverage