Individual Marketplace Overview

1. Individual Marketplace Overview Date or subtitle

2. What is Connect for Health Colorado? An open, competitive marketplacefor individuals and small employers to: • Compare information regarding cost and quality • Shop health plan features containing the same base benefits • Determine eligibility for and access new federal financial assistance, based on income • Call, chat or sit down with trained representatives for help • Enroll in a health plan

3. Connect for Health Colorado is NOT • Areplacement for the current market or brokers • Engaged with negotiating rates between carriers and providers • Part of Medicaid • Offering Medicare or supplemental health plans • Anew government health care system • AState agency or regulatory body • An organization that receives funding from Colorado General Fund

4. What is the Individual Marketplace? • One of two shopping paths offered by Connect for Health Colorado (other is for small employers) • A new resource for Coloradans seeking health coverage • Providing individual and family health plans that take effect starting Jan. 1 2014 • Online shopping, with assistance by phone and in-person • The only place where Coloradans can access new federal financial assistance to lower premiums, co-pays and deductibles

5. Who can shop? • Coloradans who currently buy insurance on their own • Coloradans who are uninsured • Coloradans who are self-employed • Coloradans who don’t have access to affordable coverage through their employer • Coloradans with legal immigration status • Family members/dependents of employees who are offered employee-only coverage by employer • Not for those eligible for Medicare or seeking supplemental plans

6. Ways to shop • Starting October 1: go to www.ConnectforHealthCO.com • Answer a few questions and browse health plan prices and features • Answer a few questions and get an estimate of eligibility for new financial assistance • Shop for commercial health plans without financial assistance • Fill out the application for new financial assistance and insurance affordability programs (Medicaid and CHP+) and find out what you are eligible for • Enroll in health coverage that takes effect starting Jan. 1 2014

7. What can you shop for? • New health plans (Qualified Health Plans) that all include a comprehensive set of medical services and benefits • Health plans offered by a wide range of carriers*: • All Savers Insurance Company (part of UnitedHealthcare), Anthem Blue Cross and Blue Shield, Cigna, Colorado Choice, Colorado HealthOP, Denver Health, Humana, Kaiser Permanente, New Health Ventures, Rocky Mountain Health Plans • PPO, HMO, HSA, CYA (high deductible plans for young adults) • Health plans with dental coverage and without • Separate dental plans • Find out eligibility for Medicaid and CHP+ and enroll • A link to vision plans * These companies have requested permission from Colorado Division of Insurance to provide plans, final information will be known in August

8. Who can help you use the Marketplace? • Customers can get help online, over the phone and in- person • Online chat and decision-support tools • Help over the phone by Customer Service Center Representatives through toll-free number • Impartial help in-person by trained and certified Health Coverage Guides located at over 50 community-based Assistance Sites statewide • Help in person and by phone by licensed and certified health insurance agents and brokers located statewide

9. Key changes • Starting in 2014, you can not be denied or cancelled for health coverage based on a pre-existing condition or your health history • You will not be asked about your health history or medical needs when you apply for health insurance (other than pregnancy, tobacco use and disability status) • Starting in 2014, about 160,000 Coloradans will be newly eligible for Medicaid because of a state law passed this year; adults earning up to about $15,000 a year, couples earning up to about $21,000 and families of four earning up to about $32,000 will be eligible for Medicaid and the Marketplace will help you access Medicaid and CHP+

10. Other facts to know • There will be set open enrollment periods for commercial health plans that will provide coverage for the calendar year • Oct. 1 2013 to March 31 2014 • Oct. 15, 2014 to Dec. 7, 2014 for future years • Customers who sign up by the 15th of the month will have coverage begin on the first of the next month; if you sign up after the 15th, you will wait until the following month • There will be ways to sign up for coverage outside of open enrollment periods (loss of job, marriage or divorce, move into the state, birth of child, change in income, etc)

11. Comprehensive Coverage Health plans will provide, at a minimum, the following categories of services, also known as essential health benefits: • Ambulatory patient services • Emergency Services • Hospitalization • Maternity/newborn care • Mental health/substance abuse • Prescription drugs • Rehab/habilitative services and devices • Laboratory services • Preventive and wellness care/chronic disease management • Pediatric services, including oral and vision care

12. How much will I pay? • Carriers submitted proposed rates to the Colorado Division of Insurance (DOI) in May • DOI reviewing carrier filings and final rates are expected to be known in August • Prices depend on age, the region of the state in which you live, how many people are in your family, and whether you use tobacco products • Prices will not be affected by your health needs or history • Preliminary filings show a wide range of prices: • Rates for a 21-year-old living in Denver from the majority of carriers range from $146 to $234 a month for bronze plans and from $192 to $279 for silver plans, before cost-reductions based on income. • Rates for a 40-year-old living in Denver from the majority of carriers will range from $186 to $299 for bronze plans and from $245 to $357 for silver plans

13. How can I organize my options? • Health plans will be organized by coverage levels based on how much of the services, on average, are paid for by the carrier and how much are paid for by the customer • Bronze (60% paid by carrier/ 40% paid by customer) • Silver (70/30) • Gold (80/20) • Platinum (90/10) • You can look for health plans by • medical provider and facility • Carrier • Coverage level • Premium

14. Cost reductions for Individuals & Families New financial help to reduce the cost of premiums • Individual earning between $15,856 to $45,960/year • Couple earning between $21,404 to $62,040/year • Family of four earning $32,499 to $94,200/year • Tax credit applied up-front by IRS • Tax credit is higher for older Coloradans, especially for those ages 55-64 New financial help to reduce out of pocket costs (co-pays and deductibles) • Individuals earning $15,856 to $28,725/year • Family of 4 earning $32,499 to $58,875/year

15. Example of Cost Reductions* • Bill is a 40-year-old male making $30,000 per year • Bill enters the marketplace through the website and applies for assistance paying for his coverage. • Bill qualifies for $166 per month in premium reduction (tax credit). • Bill shops for and compares health plans with the same base benefits. • Bill finds a plan that costs $375 per month. The tax credit brings his total cost to $209 per month. * Estimate not based on actual prices

16. How does the new tax credit work? • Customers will fill out the financial assistance application, providing information about future income, tax household, identity and other details to determine eligibility • Customers will learn how much financial assistance they can receive • Customers will choose a health plan and decide how much of the tax credit to use right away to reduce the monthly premium vs. claiming the credit on taxes • The amount of tax credit will be the same regardless of the health plan you choose • Customers will need to report change in income to Marketplace to re-determine eligibility for financial assistance

17. How do the new cost-sharing reductions work? • Customers will fill out the financial assistance application, providing information about future income, tax household, identity and other details to determine eligibility • Customers will learn how much financial assistance they can receive with the tax credit and reduced co-pays and deductibles • It is possible for customers to receive both forms of financial assistance, based on income • If eligible, customers can enroll in health plans that have lower co-pays and deductibles – like an upgrade • Eligible Native Americans can enroll in health plans that have no co-pays and deductibles for in-network services

18. Financial Assistance Application

19. Application Process

20. Information for financial application • Estimated household income for coming year (adjusted gross income reported on 1040 with some additional information, not including assets such as property) • Identity info, such as Social Security numbers, for each person to be covered • If you have other coverage through an employer, Medicare, Medicaid and/or pediatric dental through a separate policy • Info about tax household, Colorado residency status, immigration status • Other questions specific to public programs and specialized populations such as Native Americans

21. Benefits for You • Makes comparing and purchasing commercial health insurance plans more convenient and competitive • Provides broad array of choices in one place • Helps you make an informed decision by creating transparency about your options • Only place to check eligibility for new tax credits and apply them right away to reduce your costs • Offers you statewide network of trained professionals to help you access the new financial help and find the health plan that is right for you and your family • A new service operated by a non-profit with the mission to help Coloradans

22. Contact • Website: www.ConnectforHealthCO.com • Questions: Info@ConnectforHealthCO.com • Consumer questions: 855-PLANS4YOU (855-752-6749) • Social Media: @C4HCO (consumers) @COHBE (stakeholders)