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ILLINOIS COVERED CHOICE

This overview discusses the expansion of public programs in Illinois, including the Illinois Covered Rebate and Covered Choice, a program that subsidizes the purchase of employer-sponsored insurance. It also covers the funding sources and regulatory differences in the individual and small group markets, available rates, the CHIP High Risk Pool strategy, and the challenges of offering a reinsured product in the non-CR market.

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ILLINOIS COVERED CHOICE

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  1. ILLINOIS COVEREDCHOICE Reinsurance Institute Washington, D.C. July 19, 2007

  2. ILLINOIS COVERED -- OVERVIEW -- • EXPANSION OF PUBLIC PROGRAMS • Targets Working Parents, Workers w/ Disabilities, Adults Below 100% FPL • ILLINOIS COVERED REBATE • Subsidize Purchase of Employer-Sponsored Insurance, Including Covered Choice • Up to 400% FPL, Premium Cap (Varies Based on Income) • ILLINOIS COVERED CHOICE

  3. COVERED CHOICE HEALTHY NY MODEL, ILLINOIS PLAN

  4. ELIGIBLE SMALL EMPLOYER • 25 or Fewer Employees • Contributes 70%+ of Employee Premium • 2/3 of Employees < 400% FPL • 50% Eligible Employee Participation

  5. ELIGIBLE INDIVIDUAL • Unemployed • Employed But No Employer-Sponsored Insurance for 18 Months • Not a Covered Choice Eligible Employee (Works <25 Hrs. p/wk) • Solely Self-Employed

  6. FUNDING SOURCES • Employer Assessment • 3% Gross Payroll Assessment if Employers with 10+ Employees Spend Less than 4% Gross Payroll on IL Employee Health Care • Estimated $1.3 billion • CHIP Baseline Assessment • If Enough High Risk Pool Enrollees Take Up Covered Choice, State Will Use Some High Risk Pool Assessments to Fund Covered Choice • Estimate Uncertain

  7. New York Guarantee Issue Community Rating No High Risk Pool Illinois No Guarantee Issue No Rating Structure (NEW RULE PROPOSED JULY 2007) High Risk Pool REGULATORY DIFFERENCE-- INDIVIDUAL MARKET -- KEY MARKET DYNAMIC Healthy Lives in IL Can Purchase Cheaper Products

  8. New York Guarantee Issue Community Rating Illinois Guarantee Issue Liberal Rate Bands (+/- 25%) REGULATORY DIFFERENCE-- SMALL GROUP MARKET -- KEY MARKET DYNAMIC Healthy Lives in IL Can Purchase Cheaper Products

  9. INDIVIDUAL MARKET GUARANTEE ISSUE Source: Kaiser Family Foundation

  10. AVAILABLE RATES • Illinois • 30/male/non-smoker/Chicago • $135.67 BCBS PPO ($1000 deduct – 80/20) • $196.78 BCBS PPO ($1000 deduct) • $301.72 BCBS PPO ($0 deduct) (Data Collected June 2007)

  11. Illinois 59/male/non-smoker Chicago $409.80 BCBS PPO ($1000 deduct – (80/20)) $741.07 BCBS PPO ($1000 deduct) $1136.25 BCBS PPO ($0 deduct) AVAILABLE RATES (Data Collected June 2007)

  12. CHIP High Risk Pool Strategy – Isolate High Risks Enrollment = 16,543 CHIP Rates 30/male/non-smoker/Chicago $345 CHIP PPO ($1000 deduct) $390 CHIP PPO ($0 deduct) 59/male/non-smoker/Chicago $1,037 CHIP PPO ($1000 deduct) $1,134 CHIP PPO ($0 deduct) RATES FOR “UNINSURABLES”-- Isolating High Risks -- (Data Collected June 2007)

  13. CHALLENGE: REINSURED PRODUCT IN NON-CR MARKET • Diverse Risks Must Take-Up Reinsured Product • Significant Reinsurance (80% of Claims Above $40k) and Subsidies (Illinois Covered Rebate) • Covered Choice = Cheapest Comprehensive Coverage • Limited Rate Variation • (e.g., Age =+/- 25%, Minimum 5-Yr. Age Brackets) • Aggressive Marketing • Flexibility to Adjust to Unanticipated Market Dynamics • Retain Necessary Rulemaking Authority • Adjust Eligibility, Benefits and Reinsurance Corridor • New Health Insurance Rules = Better Market Data • Insurers Must Fairly Price Reinsured Product • Base Rate Review Considers Loss Ratio and Surplus

  14. MANAGED CARE NETWORK CHALLENGES • Ensure Meaningful, Statewide Coverage • Illinois HMO Penetration Low, Particularly Downstate, So Product Delivered Through HMOs and PPOs • Address PPO “Network” Challenges • Provide Access to All Networks • Providers Otherwise Contracted as Network Provider Must Be A Network Provider for Covered Choice • “Adequate Network” Burden Remains with Insurer • Manage Provider Costs • Regulate Provider Reimbursement Rates

  15. BIG-PICTURE ISSUES • ERISA and Employer Assessment • Retail Industry Leaders Assoc. v. Felder (4th Cir. 2007) • HIPAA Group Availability Requirement • 42 U.S.C. 300gg-11(a)(1)(A) • Free Market Rhetoric • Inter-Department Coordination

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