Health Insurance Exchanges (HIX)

1. Health Insurance Exchanges (HIX) Insurance pools by state

2. Health Insurance Exchanges • Required for 2014 in every state and U.S. territory • Affordable Care Act 2010 • Administered by • State Alone • Federal Alone • Combination of State and Federal • To Date • 18 states and District of Colombia are electing to do it alone • 26 states are choosing the Federal Exchange • 7 states are choosing a combination

3. Exchanges & Policies • Government Regulated • Standardized health care plans • Must provide basic coverage • Eligible for Government Subsidies • Low income individuals can select plan and part of cost paid by Federal Government • Guaranteed Issue • Must be available to all and cannot exclude based on pre-existing condition • Exchange must be Government Certified • Exchanges do not offer policies themselves but regulate which companies can offer policies through the Exchange

4. Exchanges & Policies • What Exactly Does an Exchange Do? • Allows individuals and small businesses to shop and compare different private health care offerings • Provide information on the various plans and their coverage options, subsidies available • Market place for private insurance companies to list their insurance coverage and prices • Intent is to provide lower cost for individuals and small business by providing a competitive market place • What do you do? • If you need insurance or are a small business providing insurance, compare and sign-up for policies

5. Exchanges & Policies • Key Features of the Law (Exchanges) • Plans must supply Summary of Benefits and Costs (SBC) • Glossary of terms standardized • Examples of how coverage works for Type 2 Diabetes or delivery of a baby • Federal Support of Consumer Assistance Programs • Rules for appeal of a claim denial and requirements of the policy issuer • Free access to preventive care (detailed on next slide) • Patients Bill of Rights • From right to choose doctor to eliminating exclusion for pre-existing conditions to review of premium increases

6. Exchanges & Policies • Preventive Care Free Access for • Blood pressure, diabetes and cholesterol tests • Cancer screenings for mammograms and colonoscopies • Programs for quitting smoking, weight loss, healthy eating, alcohol dependency, and treating depression • Well baby and Well child visits • Routine vaccinations • Measles • Polio • Meningitis • Flu • Healthy pregnancies (counseling, screenings, vaccinations)

7. Exchanges & Policies • About the Plans • Four levels (Bronze, Silver, Gold, Platinum) • Bronze – cheapest and most basic coverage • Platinum – Highest cost with greatest coverage • 80/20 Rule • Only 20% of your premium can be for administrative costs • 80% must be spent on actual coverage of patients (in pool) • Pricing Variations • Smokers can be charged 1.5 times higher • Age differences up to 3.0 times higher • Premium plans cannot exceed 4.5 times the lowest cost plan • Some variations within state regions and family composition

8. Exchanges & Policies • What is coming in 2014? • Fully operational exchanges in all fifty states, District of Columbia and U.S. territories • Tax credits for families making between 100% and 400% of the federal poverty level for policy purchases with about 9 out of 10 policy holders in exchanges receiving some type of subsidy • Tax penalties for not getting insurance coverage • 12 million Americans purchasing insurance through the health insurance exchanges growing to 29 million by 2021 • QUESTIONS?