Agenda - 10-12-2010 - Board of Health Meeting

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11 Can more than one health insurance exchange exist in a state? Yes-more than one exchange can exist in a state, and a state can choose to form a regional exchange, but each exchange must cover a distinctive geographic area. Can employers with more than 100 employees purchase coverage for their employees from the exchange? Not initially-however, in 2017, states have the option to allow businesses with more than 100 employees to purchase insurance from an exchange. Will there be subsidies to help low-income individuals afford coverage through the exchange? Yes-there will be premium credits for individuals and families with incomes between 133-400%FPL based on a sliding income scale to help them purchase coverage through the exchanges as well as cost-sharing subsidies for individuals and families with incomes between 100-400% FPL based on a sliding income scale to help pay for high out-of-pocket costs. Will plans within the exchange need to meet certain benefit package standards? Yes-the Secretary of the Department of Health and Human Services will define an essential health benefits package which provides a comprehensive array of services and meets certain criteria, such as limits on annual cost sharing and that it is not more expensive than an average employer plan. All plans offered through the exchange aswell asnon- grandfathered (new plans created after March 23, 2010) individual and employer sponsored plans offered outside of the exchange are required to provide at a minimum the essential health benefits package. What specific levels of coverage will be available through the exchange? The exchange will have five benefit categories of plans offering different levels of coverage, as follows: • Bronze: Offers minimum essential health benefits; covers at least 60 percent of the benefit costs of the plan; out- of-pocket limit same as current limit on Health Savings Accounts ($5,950 for individuals, $11,900 for families) • Silver: Offers minimum essential health benefits; covers at least 70 percent of the benefit costs of the plan;. out-of- pocket limits same as current limit on Health Savings Accounts • Gold. Offers minimum essential health benefits; covers at least 80 percent of the benefit costs of the plan; out-of- pocket limits same as current limit on Health Savings Accounts • Platinum: Offers minimum essential health benefits; covers at least 90 percent of the benefit costs of the plan; out-of-pocket limits same as current limit on Health Savings Accounts • Catastrophic: Only available to individuals up to age 30 or individuals who are exempt from the insurance coverage mandate; will operate like ahigh-deductible health plan and will offer catastrophic coverage only; also, this plan is only available on the individual market, and not through an exchange. Will individuals with pre-existing conditions be able to obtain coverage through the health insurance exchanges? Yes-in 2014, insurers will not be permitted to deny coverage to any individual based on pre-existing health conditions, including plans offered through the exchange. What will individuals with coverage through state-based high-risk pools do when the state-based health insurance exchanges are created in 2014? Individuals that receive coverage through state-based high-risk pools will most likely transition into the American Health Benefit Exchanges because they may be able to obtain more affordable coverage through the exchanges, since the plans on the exchanges cannot deny coverage or charge higher rates due to health status. Will there be assistance for individuals enrolling in the exchanges? Yes-there will be a web portal will help consumers navigate their options in the individual and small business private market so they can determine if they may be eligible for a variety of existing public programs, including existing state 5