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SHOP Advisory Group

This agenda outlines the topics and discussions for the .SHOP Advisory Group meeting on July 12, 2012, including updates on individual and health plans, employer and employee choice architecture, and display and pricing of supplemental plans.

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SHOP Advisory Group

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  1. SHOP Advisory Group July 12, 2012

  2. Agenda • Welcome & Introductions 5 min • 6/28 Meeting Review 5 min • Individual & Health Plan AG updates 10 min • Policies • Employer & Employee Choice Architecture 40 min • Display & Pricing of Supplemental Plans 45 min • Public Forum 10 min • Wrap-up 5 min

  3. Plan Options Reviewed 3

  4. Plan Option Recommendations COHBE Board requested we revisit options 3 & 5 in their 7/9 meeting. 4

  5. Display & Pricing of Supplemental Plans Shall carriers be allowed to bundle vision and dental plans into QHPs? Shall dental and vision plans be available in a standalone add-on fashion on the Exchange? Shall there be both options 1 & 2 offered on the Exchange, bundles and standalone add-ons? Shall only the mandated pediatric benefit be available both bundled or standalone add-on? Target Decision Date – July 23, 2012

  6. Display & Pricing of Supplemental Plans 45 CFR Parts 155, 156, and 157 Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers 1311 (d) REQUIREMENTS.—(2) OFFERING OF COVERAGE.— (A) IN GENERAL.—An Exchange shall make available qualified health plans to qualified individuals and qualified employers.(B) LIMITATION.— (i) IN GENERAL.—An Exchange may not make available any health plan that is not a qualified health plan. (ii) OFFERING OF STAND‐ALONE DENTAL BENEFITS.—Each Exchange within a State shall allow an issuer of a plan that only provides limited scope dental benefits meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986 to offer the plan through the Exchange (either separately or in conjunction with a qualified health plan) if the plan provides pediatric dental benefits meeting the requirements of section 1302(b)(1)(J)). (3) RULES RELATING TO ADDITIONAL REQUIRED BENEFITS.— (A) IN GENERAL.—Except as provided in subparagraph (B), an Exchange may make available a qualified health plan notwithstanding any provision of law that may require benefits other than the essential health benefits specified under section 1302(b).(B) STATES MAY REQUIRE ADDITIONAL BENEFITS.— (i) IN GENERAL.—Subject to the requirements of clause (ii), a State may require that a qualified health plan offered in such State offer benefits in addition to the essential health benefits specified under section 1302(b).(ii) STATE MUST ASSUME COST.— A State shall make payments— (I) to an individual enrolled in a qualified health plan offered in such State; or (II) on behalf of an individual described in subclause (I) directly to the qualified health plan in which such individual is enrolled; to defray the cost of any additional benefits described in clause (i). Federal Law

  7. Carriers provide a single price for all components covered by the QHP and identifies whether pediatric dental is covered or not and any other additional coverage • OR • Carriers are required to submit two pricing models • A single price that covers all components covered by the QHP, including EHB and any additional coverage included AND • A price for the medical only components of the QHP, the pediatric dental benefits, and any additional coverage included (the price if each were purchased separately) • Carrier A Unbundled Pricing • Medical Benefits $ • Pediatric Dental $ • Chiropractic Rider $ • Carrier A Single Pricing • QHP $$ • Includes Mandated Pediatric Dental • Includes Chiropractic Rider • Carrier B Unbundled Pricing • Medical Benefits $ • Pediatric Dental $ • Carrier B Single Pricing • QHP $$ • Includes Mandated Pediatric Dental • Carrier C Base Pricing • QHP $$ • Does not include Mandated Pediatric Dental • Carrier C Unbundled Pricing • Medical Benefits $$ • Standalone Dental Pricing • Dental Carrier X Mandated Pediatric Dental $$ • Dental Carrier X Family Dental $$ • Dental Carrier Y Mandated Pediatric Dental $$ • Dental Carrier Y Family Dental $$

  8. Back Up

  9. ER/EE ChoicePlan Options Federal Requirement Absolute Employer Choice One Insurer – all metal tiers One insurer – limited metal tiers Two insurers – two metal tiers Two insurers – limited metal tiers Two insurers – “buy-up” or “buy-down” Two entire metal tiers One metal tier – “buy-up” or “buy-down” Popcorn – discreet selection among insurer & metal Absolute Employee Choice – all plans

  10. Topic Summary & Board Target Decision Dates Standard Comparative Plan Information 6/25 Employer & Employee Choice Architecture 7/9 Display & Pricing of Supplemental Plans 7/23 Broker Relationship & Compensation TBD Customer Service Center TBD Consumer & Employer Rights & Responsibilities TBD Single Streamlined Application TBD Certification of Health Issuers & QHPs TBD

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