Different Perspectives Healthcare Exchanges

2 Today’s Speakers  Rick Elliot - President and CEO United Healthcare of Georgia What to Expect in 2014  Lurline Craig-Burke, Partner GHSC Atlanta Business Leader – Mercer The State of the States  Makela McDermott – Total Rewards Director – Euramax International Our Radical Change to a Private Exchange

3 Level Setting: What Are We Talking About??  What is an Exchange? NEAR TERM ● Mechanism for individuals and groups to gain access to health care financing options through a program administered by the state and/or Federal government (PUBLIC EXCHANGES) American Health Benefits Exchanges (AHBE) for individuals & Small Health Options Plans (SHOP) for small groups (under 50 or 100 defined by state) Can be combined

4 Things an Exchange Must Do  Implement procedures for certification, recertification, and decertification of health plans  Operate a toll-free hotline  Maintain Internet website with standardized information  Assign a rating to each plan  Utilize standardized format for presenting options  Inform individuals of eligibility for Medicaid, CHIP or other applicable state or local public programs  Certify exemptions from individual mandate 2011 National Association of Health Underwriters

5 Things an Exchange Must Do  Make available a calculator to determine the actual cost of coverage after tax credits/subsidies  Grant a certification attesting that the individual is not subject to the coverage mandate because: ● there is no affordable option, or ● the individual is exempt from the mandate  Transfer to the Treasury a list of exempt individuals and employees eligible for tax credits/subsidies  Provide to each employer the name of employees eligible for tax credit  Establish a Navigator program 2011 National Association of Health Underwriters

6 Exchange Basics  The Exchange must be operated by a governmental agency or nonprofit entity created by the state.  The Exchange must make “qualified” plans available to individuals or employers.  The Exchange must provide for: ● Initial open enrollment period ● Annual open enrollment period ● Special enrollment periods 2011 National Association of Health Underwriters

7 Exchange Basics  Must offer Qualified Health Benefits and offer at least one Silver and Gold option ● Meeting Network Adequacy requirements ● Provide Essential Health Benefits ● Meet Actuarial Value benefits requirement Bronze (60%) Silver(70%) Gold(80%) Platinum(90%)  Originally SHOP was to allow employees to choose from multiple plan options, but…..won’t happen in 2014

8 Private Exchanges  Carriers may not be required to participate in Public Exchanges  Potential to participate in both; expect to see an uptick in Private Offerings  Subsidies not available in Private Exchange ● Carrier sponsored, Vendor Sponsored, Association Sponsored ● Differentiation based on services and coverage provided, administrative services, billing consolidation, ancillary benefit offerings, wellness, and more

9 What Else???  Don’t Panic - It’s just insurance!  Pay or Play Decision guides your decision process  Expect Changes – and look beyond the cost ● Defined Contribution and Productivity will be the new watch words ● Self-funding is coming And, from one of the driver’s of Reform

10 Senator Max Baucus  D – Montana, Senate Finance Committee Chairman  "We need data. "You never give me any data. You give me concepts, frankly.“  “My main concern is that when I ask them for information about the navigators … that I don’t get anything back,” Baucus told reporters.