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Oregon’s HIX: An Update

Oregon’s HIX: An Update. Barney Speight Portland Actuarial Club Feb. 22, 2011. Today’s Topics. Overview of components in pending legislation that establishes Oregon’s Health Insurance Exchange (HIX) SB 99-1 Addressing children’s coverage in Oregon before 2014. Type of Entity: Choices.

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Oregon’s HIX: An Update

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  1. Oregon’s HIX: An Update Barney Speight Portland Actuarial Club Feb. 22, 2011

  2. Today’s Topics • Overview of components in pending legislation that establishes Oregon’s Health Insurance Exchange (HIX) • SB 99-1 • Addressing children’s coverage in Oregon before 2014

  3. Type of Entity: Choices • State agency • Public corporation • Contract with private not-for-profit

  4. Type of Entity: Proposed • Public corporation  

  5. Number of Entities: Choices • Individual HIX + Small Group HIX • Combined HIX with 2 business lines • Statewide • In-State Regions • Multi-State

  6. Number of Entities: Proposed • Combined HIX with 2 business lines   • Statewide  

  7. Governance: Proposed • 9 member Board • 6 members appointed by Governor • With Senate confirmation • 4-year terms • US citizens & residents of Oregon • No more than 2 from “industry” • Insurance, Trade Assns., Providers • At least 2 consumers (individual & small group) • 3 ex-officio • OHA, DCBS, OHPB Chair (or designee)

  8. Advisory Committees: Proposed • Consumer Advisory Committee • Individual consumers, small group purchasers, enrollment assisters • Advisory & Technical Committees • Business sector, insurance carriers, producers, providers

  9. HIX Duties: Proposed - 1 • Uniform information for consumers • Cost, benefits, networks, etc. • Screen, certify & recertify health plans as Qualified health plans • Use federal & state guidelines • Ensure QHPs provide meaningful coverage choices • Decertify QHPs that fail to meet federal & state standards

  10. HIX Duties: Proposed - 2 • Promote fair competition of carriers participating & not participating in HIX • Standardized health benefit plan options • Web-based clearinghouse for comparison of health plan coverage & cost • Make QHPs available to individuals & small employers, assist with enrollment, collect/remit premium where appropriate

  11. HIX Duties: Proposed - 3 • Facilitate community-based enrollment assistance (navigators) • Grade health plans using federal criteria & distribute grading information • Certify exemptions from individual mandate • Establish various open enrollment periods • Provide information on eligibility for publicly funded programs & assist with enrollment

  12. HIX Duties: Proposed - 4 • Establish an electronic calculator to assist consumers in determining cost of coverage net of tax credits • Provide necessary information to federal government • Adopt necessary administrative rules • Etc.

  13. Exchange Operations - 1 • January 1, 2014 • Individuals • Employers with <51 employees • January 1, 2016 • Employers with 51 to 100 employees • “Groups meeting additional criteria established by the exchange for qualified purchasers”

  14. Exchange Operations - 2 • A health plans shall be certified as a QHP if: • It provides coverage that, at minimum, include the “essential health benefits” & • “Making the health plan available is in the best interests of the individuals & employers in Oregon”

  15. Exchange Operations - 3 • The HIX is authorized to limit the number of QHPs available in each level of coverage (bronze, silver, gold & platinum) • The HIX shall establish a streamlined & seamless application & enrollment process for both the HIX & state medical assistance (OHP)

  16. Exchange Operations - 4 • The HIX shall coordinate the federal & state risk mediation programs: • Federal reinsurance • Federal risk corridors • State risk adjustment • The HIX shall define the role of insurance agents & brokers in accordance with federal guidelines & HIX policies • The HIX shall assure premium parity for plans sold inside & outside the exchange

  17. Assessments for HIX Expenses • HIX authorized to impose & collect assessments on all insurers • Carrier Assessment = Total Assessment x carrier market share % • Market share calculation excludes: • Medicaid, disability income, hospital only, dental, vision, accident only, auto, specific disease, Medicare supplement, TRICARE, CHAMPUS, Rx only, LTC, FEHBP

  18. More Information on SB 99-1 • http://www.leg.state.or.us/committees/ • Senate Subcommittee on Health Care • February 17 Exhibits

  19. Early Innovator Grants • Grantee: Oregon Health AuthorityAward Amount: $48,096,307 • Oregon is using commercially available, off-the-shelf software to create the Exchange. The Exchange Early Information Technology Innovation Grant will help Oregon create a modular, reusable IT solution that will provide the Exchange’s customers with seamless access to information, financial assistance and easy health insurance enrollment, with no gaps in coverage or assistance cliffs for anyone up to 400% of the federal poverty level. The OHA estimates that 516,000 Medicaid clients and 277,000 commercial insurance consumers will use the Health Insurance Exchange to shop for and enroll in health coverage.

  20. Children’s Reinsurance Program • Addresses guaranteed issue requirements for kids < age 19 prior to 2014 • SB 514 will be vehicle for amendments • Financial risk ceded to OMIP • Kids remain enrolled with carrier • Watch for hearing & amendments

  21. Contact Information Barney Speight Vice President, Health Care Reform speighb@odscompanies.com (503) 412-4008

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