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

2. 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

3. 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)

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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