Colorado HealthOP

1. Colorado HealthOP A Health Insurance Cooperative That Is Turning Health Insurance Upside Down Colorado HealthOP Slides

2. Introductions • Denise Denton, Rural Outreach Advisor • denise.denton@cohealthop.org • (303) 941-0181 • Jack Westfall, MD, Chief Medical Officer • jack.westfall@cohealthop.org • (303)927-0770 Colorado HealthOP Slides

3. Colorado HealthOP Overview • Created through funds from the Affordable Care Act. • Developed with the partnership of the Rocky Mountain Farmers Union. • A new, statewide, non-profit health insurance cooperative. • Board will be a majority of members who purchase CO-OP insurance and will help to make decisions about how funds are spent. • Commitment to community health through on-going partnerships and campaigns Colorado HealthOP Slides

4. History of Health Insurance Cooperatives • ACA included provisions for states to create non-profit, private, Consumer Operated and Oriented Plans, called CO-OPs. • Provided an application process and low interest loans for entities in each state to develop CO-OP health insurance plans. Colorado HealthOP Slides

5. ACA CO-OP Requirements • Must be private, non-profit organizations that sell health coverage. • Subject to the same state rules and regulations as other health insurers. • Focused on – but not limited to – individual and small group markets. • Consumer oriented and operated. Colorado HealthOP Slides

6. Map of Health CO-OPs Colorado HealthOP Slides

7. Colorado HealthOP • July 2012 – DHHS awarded Colorado CO-OP a loan of $69,396,000. • $12Mstart up (to be paid back in 5 years) • $57Mreserves (paid back in 15 years) • MISSION: To improve the health of individuals and communities through trusted partnerships with members, employers, and providers. Colorado HealthOP Slides

8. Cooperative Principles • Governed by the people who use their products or services • Controlled by their members, not outside investors • Surplus revenues used to improve member services or lower member costs • Motivated by service and members’ needs, not by profit • Concerned for their communities Colorado HealthOP Slides

9. A Consumer Operated and Oriented Health Plan • Members have a voice • No profits As a CO-OP, we are specifically designed for people who want to make a difference in their own health and that of their community. Colorado HealthOP

10. Insurance Designed to Make Members Sustainably Healthy • Preventive care incentives • Shared responsibility • Primary care provider partnerships Insurance is supposed to help when people get sick or injured; we think insurance should also be there to help people stay healthy. Colorado HealthOP

11. Get Healthy! Stay Healthy! Save Money! • Rewards members for staying healthy • Partners with providers that cost less • Helps children remain cavity-free at three • Covers home blood pressure monitoring • Gives members tools to price shop Colorado HealthOP Slides

12. “No Surprises” Philosophy of Customer Service • Philosophy of resolution • Exceptional customer service • Committed to paying members’ healthcare • Easier claims process for all When it comes to customer service, we are not like other insurance companies; we aim to design it right the first time and do it right every time. Colorado HealthOP

13. Advancing Health in Colorado • Bending the cost trend • Healthcare decisions by members and providers • Statewide partnerships   We are more than just an insurance company; we want to change the way healthcare is delivered now and in the future. Colorado HealthOP

14. A Collaborative Relationship Among Patient, Provider, and Payer • Healthier patients • Reduced costs • Reduced inefficiencies • www.COHealthOP.org Colorado HealthOP

15. To Get Involved With CO-OP Efforts • Host an educational event for your office, group, or association • Volunteer at a local community event • Share information with your network • “Opt in” to join the movement • Join us on social media • Facebook: https://www.facebook.com/COHealthOP • Twitter: @COHealthOP • YouTube:http://www.youtube.com/user/COHealthOP Colorado HealthOP Slides

16. A brief overview of the ACA • Health Insurance Marketplace for individual and small group market • No annual dollar limits on essential health benefits • No preexisting condition restriction for ANY enrollee • No lifetime maximum dollar limits on essential health benefits • Children eligible to remain covered under parents health plan until age 26 • Individual mandate means there will be a penalty for not having minimal coverage; increases over time Colorado HealthOP Slides

17. Connect for Health Colorado (the Marketplace) • Colorado HealthOP is one of the options on the marketplace (AKA: Exchange) • Works like a airline booking website – you can compare plans and rates • Guides/Navigators are individuals/organizations working across the state to help educate and sign people up on the marketplace (Certified agents/brokers can be guides.) • Metal tiers help to distinguish each plan and its benefits (bronze, silver, gold, platinum) Colorado HealthOP Slides

18. Subsidies Available • Tax Credits/Subsidies are available for many individuals and small businesses • Individuals – generally earning $15,000-$46000; for families of four - $31,000-$94,000 • Small Business – under 25 FTE; pay at least 50% of insurance cost; pay average annual wages below $50,000. • With the expansion of Medicaid many new Coloradans may qualify • The Marketplace will help identify any benefits a person would qualify for and send them to the right site to complete their sign-up or purchase Colorado HealthOP Slides

19. Connect for Health Colorado (the Marketplace) • Plans available starting on October 1st • Coverage begins on January 1st2014 • www.connectforhealthCO.com Colorado HealthOP Slides

20. QUESTIONS? Thank you! Colorado HealthOP Slides