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2015

Key Aspects for Employers. 2015 Will Arkansas be operating as a State Partnership Marketplace or will Arkansas become a State-Based Marketplace? Implications for the Small Group Market and Small Employer Health Options Program (SHOP): Employer or employee choice model

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2015

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  1. Key Aspects for Employers • 2015 • Will Arkansas be operating as a State Partnership Marketplace or will Arkansas become a State-Based Marketplace? • Implications for the Small Group Market and Small Employer Health Options Program (SHOP): • Employer or employee choice model • Active purchaser or market based

  2. Known Changes to the Market beyond 2015 • New definition of Small Group moves to 100 employees in 2016 • Rating rules apply to 50-100 groups • Essential Health Benefits (EHB) package applies to 50-100 groups • New way rates are built for 50-100 groups • HHS has reserved the right to define “Essential Health Benefits” Package for 2016 • May result in a standardized EHB in all 50 States • State waiver for private option ends in 2016

  3. New Rating Methodology for 50-100 in 2016 • Gender rating removed • Industry rating removed • Common geographic rating established by regulators • Tobacco load nationally 50% (Arkansas 20%) • Health status and pre-existing conditions no longer considered • Age rating reduced from 6:1 ratio oldest to youngest to 3:1

  4. Essential Health Benefits Non-grandfathered small group health plans – offered on or off the SHOP, must provide these government-mandated essential health benefits Essential health benefits include services in the following 10 categories: • Prescription drugs • Rehabilitative and “habilitative”services and devices • Laboratory services • Preventive and wellness servicesandchronic disease management • Pediatric services, including dentaland vision care 1 6 2 7 3 8 4 9 5 10 Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substanceuse disorder services, including behavioral health treatment

  5. Premium Rate Calculation • Unique rate calculation for every member • Member-level, rather than employee-level, census required to comply • Every member on an employee contract has a unique rate • Rates developed for up to 3 minor children • 4th minor child (and any additional) is free • Children age 21+ must be rated as adults

  6. 2017 Marketplace • Marketplace can allow large groups (100+) to purchase through online marketplaces similar to SHOP for small employer groups. • Implications

  7. “Large Group” Purchasing on Marketplace • Essential Health Benefits Package • Employee Choice Model • Employer Open Enrollment Period

  8. Employer Strategies to Stay “Outside Marketplace” • Self-Funding • Grandfathering • Defined contribution through private exchanges

  9. ACA Impact on Employer Group Coverage Cost

  10. Employer Strategies to Control Costs • Employee/Incentives to drive engagement (Wellness and Health Management Incentives/Programs) • Medical Home Models • Health Improvement Tools

  11. Employer Strategies to Stay“Off Exchange” and Control Costs • Management of “pre-crisis” chronic conditions – new models of Case Management • Focused Provider Panels • Home Monitoring, Electronic Health • Reference-based pricing • Onsite health care • New payment mechanism

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