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Stay informed about the latest updates and information regarding Delaware's health insurance marketplace, including enrollment updates, important consumer reminders, special enrollment periods, and regulatory updates.
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Delaware’s Health Insurance Marketplace:Update on Activity Delaware Health Care Commission, June 5, 2014 Secretary Rita Landgraf, Department of Health and Social Services Commissioner Karen Weldin Stewart, Department of Insurance
Agenda • Secretary Landgraf • Enrollment Update • Important Consumer Information • Commissioner Stewart • Regulatory Updates • Employer-based Coverage and SHOP for 2015 • The Role of Agents and Brokers • Plan Management Update
Marketplace Enrollment Update: Paid Premiums 14,397: Marketplace plan enrollment for first Open Enrollment (as reported by the Insurers) as of April 15, 2014, and communicated at the May 6, 2014, HCC meeting. 11,961 (83%): Number of enrollees who have paid the first month’s premium to effectuate (begin) coverage.
Total Enrollment Update As of May 30, 2014, 5,793 individuals have enrolled in Medicaid through the expansion. This is a 37% increase since April 15th. 20,190 Delawareans have enrolled in health care coverage through expanded Medicaid and the Marketplace since October 1, 2013.
Special Enrollment Period: COBRA coverage Individuals who have COBRA continuation coverage may qualify for a Special Enrollment Period for a limited time. This allows them to enroll in a Marketplace plan instead. The deadline to enroll in a new plan during this one-time Special Enrollment Period is July 1, 2014. To do this, contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). Once individuals are approved for a Special Enrollment Period, they can apply for and enroll in a Marketplace plan either online or by phone. For more information: https://www.healthcare.gov/what-if-i-currently-have-cobra-coverage/
Special Enrollment Period: Complex Cases • Although open enrollment is closed, Delawareans with certain complex cases will be allowed additional time to complete the Marketplace enrollment process. This may include consumers: • Awaiting Medicaid eligibility results • That received incorrect subsidy determinations or calculations at Healthcare.gov • That encountered problems verifying an eligible immigration status • Delawareans with complex cases will have 60 days from the date their issue is resolved in which to apply for and select a Marketplace plan
Special Enrollment Period: Qualifying Life Events Individuals who qualify for a special enrollment period because of a life change can also enroll in the Marketplace outside of open enrollment. Among these qualifying life events: • Getting married • Birth or adoption of a child • Moving to Delaware • Losing minimum essential coverage • Consumers who have enrolled in coverage and experience one of the above events must report the life change to the Federal government
Reporting Changes Consumers who enrolled through the Marketplace must also report any other relevant changes: • Having a change in income • Getting health coverage through a job or a program like Medicare or Medicaid • Having a change in disability status (A comprehensive list is available at: https://www.healthcare.gov/how-do-i-report-life-changes-to-the-marketplace/) Consumers should report these changes online at www.healthcare.govand by calling the Marketplace Call Center at 1-800-318-2596. Marketplace Guides are available to assist with reporting life and income changes. Consumers will then find out whether they qualify for a special enrollment period that allows them to change plans, and/or whether they are eligible for lower costs based on new income, household size, or other changed information. Consumers could become ineligible for savings.
Key Dates for Consumers • Notes: • Medicaid enrollment can occur at anytime. • Employers may continue to enroll in SHOP on a rolling monthly basis. The deadline to enroll is always the 15th of the month for coverage to be effective the 1st of the following month.
Landscape of Delaware Employers *Based on information provided by Delaware Department of Labor as of December 2013 Like many states, Delaware has a large percentage of small employers. The Kaiser Family Foundation reports that approximately 40% of small businesses in Delaware (<50 FTEs) offer health insurance to their employees (Based on a 2012 study by the Agency for Healthcare Research and Quality, Center for Cost and Financing Studies) The Delaware Department of Insurance (DOI) is working to determine the impact of upcoming market reforms, effective in 2015 and 2016, on Delaware’s small employer community.
Employer Shared Responsibility • *As defined by the statute, a full-time employee is one who works on average at least 30 hours per week. Full-time equivalency may be estimated by a combination of full-time and part-time employees. • ** Employee’s premium contribution for self-only coverage for the lowest cost plan cannot exceed 9.5% of household income. The plan must also cover at least 60% of all medical expenses.
Employer Shared Responsibility • Large employers (100+) who fail to offer plans that meet ACA affordability and minimum essential coverage (MEC) standards may be penalized as follows: • Affordability Penalty: $3,000/per employee (after 30 employees) • MEC Penalty: $2,000/per employee (after 30 employees) • A recent IRS ruling supports the ACA requirement and establishes a penalty for large employers that do not establish a health plan for their employees, but instead reimburse those employees with tax-free dollars for premiums they pay for health insurance (either inside or outside the Marketplace). • Large employers are not permitted to incentivize employees to purchase health care coverage through the Individual Marketplace. • Remember: Small employers (<50 FTE) are not required to offer health care coverage and thus can refer their employees to the Individual Marketplace.
2015 SHOP • The eligibility provisions for the FF-SHOP will not change from 2014 to 2015 • However, a small employer that becomes a large employer during the plan year will continue to be rated as a small employer. • SHOP participation will no longer allow employers to enroll directly with the insurance company. Any employer that utilized this process in 2014 and wishes to continue must apply and enroll though the FF-SHOP online portal to renew their coverage.
SHOP—When will it be available for DE Employers? The FF-SHOP goes live for all states on November 15, 2014. CMS is planning a “soft launch” in 5 states. What this means: • Early September: CMS SHOP Team will train stakeholders and Marketplace staff in participating states. • Mid-to-late October: Employers will be able to: • Register for an account, • Upload employee roster data, • Establish a relationship and authorize an Agent/Broker, • Enter basic information about business, and • Receive an eligibility determination. • Early November: Browse available plans Delaware has been invited to participate in the soft launch.
Resources for Small Businesses The FF-SHOP now has tools—available on Healthcare.gov—to help employers get ready for the next Open Enrollment period: • Full-time Equivalent (FTE) Employee Calculator: https://www.healthcare.gov/fte-calculator/ • SHOP Tax Credit Estimator: https://www.healthcare.gov/small-business-tax-credit-calculator/
Enrollment Pathway for Agents and Brokers • The launch of the FF-SHOP online experience will change how Agents and Brokers interact with SHOP consumers and the FF-SHOP. • Agents and Brokers who choose to work with the FF-SHOP will do so through the “SHOP Enrollment Pathway,” by directly accessing the SHOP online system. The “side-by-side” approach, where enrollments can be facilitated through the Agent or Broker’s website, will not be supported in the 2015 FF-SHOP.
Agent and Broker Registration and Training Requirements In addition to having an active state insurance license, Agents and Brokers are: • Encouraged to complete the FF-SHOP Agent/Broker Training available on the Medicare Learning Network; • Required to complete the SHOP Privacy and Security agreement available on the Medicare Learning Network; • Required to complete identity proofing on the CMS Enterprise Portal (new for 2015). Agents and Brokers who wish to participate in the FF-SHOP must complete required agreement(s) and/or training on an annual basis.
FF-SHOP Agent/Broker Portal Functionality Agents/Brokers may: • Search for prospective FF-SHOP clients based on: • Username • Application ID • Business Name • Monitor enrollment progress and status of employer clients. • Update employee rosters of employer clients. • Receive messages (monthly invoices and late payment warnings).
Consumer Assistance: Marketplace Guides and Agents/Brokers Marketplace Guides Agents/Brokers Can assist individuals in enrolling in a QHP Can recommend a specific plan or carrier Can enroll a business in SHOP Are not paid by the consumer • Can assist individuals in enrolling in a QHP • Cannot recommend a specific plan or carrier • Cannot enroll a business in SHOP • Are not paid by the consumer or insurance company
Consumer Assistance: Marketplace Guides and Agents/Brokers • Agents and Brokers continue to play a key role in assisting consumers and business owners in selecting a QHP that fits their needs. • DOI and DHSS will continue to dialogue with the Agent and Broker community to explore ways to increase their visibility to consumers and to allow Marketplace Guides to make referrals for those individuals who need additional support.
Delaware QHP Standards: Plan Year 2016 The Marketplace Program is working with the HCC to review current state-specific QHP Standards and develop recommendations for changes for implementation in Coverage Year 2016.
