IDAHO HEALTH INSURANCE EXCHANGE WORKING GROUP October 26, 2012

1. IDAHOHEALTH INSURANCE EXCHANGE WORKING GROUPOctober 26, 2012

2. Leveraging the Federal Services for the: • Determination of Advanced Premium Tax Credits and Cost Sharing Reductions • Exemption Determination • Risk Adjustment • SERFF enhancements for Plan Management Idaho can build a State Based Exchange By… • Acting Now!

3. State Based Exchange Functions NAVIGATOR PROGRAM Portal / Web site Guidance Federal Data Services HUB & APTC/CSR Verify Income IRS Brokers Tax Credits Enrollment and Eligibility Interface TREASURY Subsidies Cost Reduction STATE MEDICAID SYSTEM Eligibility SOCIALSECURITY Verify Citizenship HOME LAND SECURITY Verify Residency HHS Reporting Plan Comparison Interface ONLINE CALCULATOR Display Total Costs APTC Health Plan #1 Health Plan #2 Health Plan #3 Health Plan #4 Employee or Consumer Administration Interface EXCHANGE CUSTOMERSERVICE Notifications Admin, Life Events, etc. Customer Service SERFF PLAN MANAGEMENT Communication Interface FINANCIAL SERVICES Premium Billing Employee or Consumer Carrier 1 Carrier 2 Carrier 3 Carrier 4 RISK ADJUSTMENT STATE FEDERAL TECH VENDORS CARRIERS

4. Scope of Control in a State-based vs. Federal Exchange • State-based Exchange • State / Federal Partnership • Federally Facilitated Exchange • Reflective of Idaho’s unique demographic and insurance market needs • State maintains ability to manage and control ongoing costs • Federal funds available for establishment • Feds accountable for exchange performance • Does not meet the state’s unique needs • State still responsible for operational costs and resources • Relinquish all control to the Federal Government • State can retain control of plan management, navigator, and Medicaid eligibility functions • Limited control of design and ongoing operational costs • Does not meet the state’s unique needs

5. Costs & Timing to Build the Idaho Exchange Attainable