1 / 29

HealthPass New York New York’s Commercial Health Insurance Exchange

HealthPass New York New York’s Commercial Health Insurance Exchange A Presentation for South Carolina Business Coalition on Health Healthcare Reform Seminar - October 20, 2010. Agenda. Review of NYBGH’s Commercial Health Insurance Exchange: HealthPass New York Structure Financing

quasim
Download Presentation

HealthPass New York New York’s Commercial Health Insurance Exchange

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HealthPass New York New York’s Commercial Health Insurance Exchange A Presentation for South Carolina Business Coalition on Health Healthcare Reform Seminar - October 20, 2010

  2. Agenda • Review of NYBGH’s Commercial Health Insurance Exchange: HealthPass New York • Structure • Financing • Enrollment • Health Insurance Exchanges under Health Reform

  3. HealthPass • Commercial Health Insurance Exchange Started in 1999 • Joint-stakeholder collaboration between: • New York Business Group on Health • The City of New York • Health insurance industry • Our Mission: • Grant small businesses greater access to healthcare • Help stem the tide of the working uninsured

  4. What is HealthPass? • Fortune 500 benefits for small businesses • Employee-Choice model • Menu of carriers and benefits • 4 Categories of Medical Plans • - In Network Only - Cost Sharing • - In & Out of Network - HSA • 2 Dental Options • - DMO • - Dual Option (DMO/PPO) • 2 EverGuard Options (Life/AD&D/LTD package) • Health Advocate & Medical Cost Advocate • COBRA & Mini-COBRA Administration

  5. How HealthPass Works • Employers Choose: • Tier Structure, Defined Contribution amount • Ancillary offerings • Employees Choose: • From 5 carrier networks • EmblemHealth • Oxford • Health Net • From 25+ medical plan designs • From available ancillary lines (through Guardian) • Group Health Inc. (GHI) • HIP Health Plans of New York

  6. Employer Benefits No need to pick one plan for different employees Curbs wasted healthcare spending Helps to attract and retain key employees Empowers employees to participate in making informed healthcare decisions Defined contribution sets a benefits budget Simplified administration Robust client support Home billing of COBRA and COBRA administration No need to shop for insurance every year Employee Benefits A voice in a personal decision – healthcare Choice of HMO, EPO, POS, PPO or HSA coverage Voluntary options - Dental and EverGuard Annual choice to meet individual healthcare and budget requirements Pre-Tax contributions minimize out of pocket costs Account Management, Health Advocate and Medical Cost Advocate provide personalized support Employer & Employee Benefits

  7. Meeting Our Mission • Greater access to healthcare for small businesses • Multiple medical carriers/networks • 250,000+ providers • over 25 medical plan options • 2 dental plans • 2 bundled security products • Advocacy Services • Stemming the tide of the working uninsured • 46% of participating employers had no prior insurance • 26% of employees had no prior insurance

  8. Organizational Staffing • NY Office - Sales, Marketing, Member Services • Executive Director • Sales and Marketing • Directors – Broker Sales (1) GA Sales (1) Business Development (1) Health Policy (1) Strategic Initiatives (1) • Marketing Manager (1) • Account Executives (4) • Account Liaisons (4) • Member Services • Director of Administration (1) • Renewal/Benefits Manager (1) and Executive (1) • Member Services Representatives (4) • Internal Staff • Financial Manager • HR/Office Manager • Receptionist

  9. Third Party Administrator • Workable Solutions Inc (Orlando, FL) • Staff of ~50 ee’s • ~15 dedicated to HealthPass • 4 Case Managers • Data entry representatives • Financial oversight and reconciliation • Billing and Commissions • Baseline Customer Service • IT department (maintains HP system) • Ancillary product management

  10. Governance • Subsidiary of NYBGH • Board of Directors • Chair of Board – NYBGH Executive Director • Healthcare leaders • Taxable not-for-profit • Setup as a Health Insurance Trust • NY Law 4235 (c) (1) (D)

  11. Start Up Financial Considerations • Started in 1999 with $1 million in seed money from NYC • ~$3 million more over next 4 years between direct and indirect funding • Self sustaining by early 2005

  12. Ongoing Financial Considerations • Revenues of ~$3.8 million in 2009 • Expenses of ~$3.3 million • Includes ~$1 million to TPA • Revenue earned via: • Administrative fees based on membership • % of premium • PEPM • Ancillary products

  13. Enrollment Figures • As of August, 2010 • ~4,000 employers covered • ~17,000 employees covered • ~33,000 members covered • Tremendous growth during 2009 • 1/1/09 ~21,000 members covered

  14. Health Insurance Exchanges Under the Affordable Care Act

  15. Exchange Basics • Health insurance marketplace using principles of managed competition (Alain Enthoven) • Transparent and standardized benefit packages • Offers choice of plans, carriers, networks (comparison shopping) • Develops menu of choices based on quality, access, and premium costs • Enhances consumer experience

  16. Exchange Legislation • Patient Protection and Affordable Care Act (PPACA) • State-based health insurance exchanges • - American Health Benefit Exchange (AHBE) (for individuals) and Small Business Health Options Program (SHOP) Exchange • - Govt. agencies and non-profits eligible • - Regional sub-exchanges optional • Must be established by 2014 & self-sustaining by 2015 • Exchanges will offer only “qualified health plans” • Creates single risk pools (one each for individual and small group markets) • Option to merge individual and small group risk pools

  17. Exchange Legislation (cont.) • Initially open only to small groups (with state discretion) • - Defines small group as up to 100 employees • - State discretion to define small group as 50 employees • Open to large groups in 2017 (state discretion) • 2014 and beyond: Sole source of small business tax credits • Simplification of choices – standardized tiers • - Bronze (60%), Silver (70%), Gold (80%), Platinum (90%) • - Catastrophic plan & young adult plan also available

  18. Exchanges Timeline

  19. Exchange Functions • Health plan certification, recertification, decertification • Operate a toll-free member services hotline • Create and operate Internet portal to compare plan and benefit options • Rate each qualified health plan based on price and quality • Determine subsidy eligibility for AHBE and administer small business health care tax credits • Establish “Navigator” member education programs

  20. Health Plan Measurement • Health plan ratings based on quality and cost (i.e., value) • Legislation requires Exchange-based plans: • Patient experience surveys • CAHPS & HEDIS accreditation • Implement a quality improvement strategy • Publicly report on quality measures • Many of the items already used in eValue8 RFI • Thus, potential opportunity for eValue8 coalitions to leverage experience

  21. What Else to Expect (That’s not in the reform bill) • Exchanges must add value via a robust set of administrative services • - streamlining HR for small businesses • COBRA/NY State Continuation Coverage administration • Advocacy services • Ancillary offerings: dental, vision, AD&D, life, LTD, Rx discount cards, and other benefits

  22. American Health Benefit Exchange Subsidy Payment and Carrier Reconciliation Carrier A CarrierB Carrier C Carrier D Subsidy Payment E P S Reporting IRS Broker/ Navigator Medicaid/CHIP Facilitate Compensation Exchange P (S) – Determine Subsidy Eligibility/Amount E I S (P) – Non-Subsidy Premium Payment (E) – Plan Selection, Enrollment (I) – Premium Invoice Individual

  23. One-Stop SHOP Carrier A CarrierB Carrier C Carrier D Carrier E E P E P P P E E E P Carrier Reconciliation Broker/ Navigator Facilitate Compensation Exchange P E I: One consolidated “list” bill (P) – Group Premium Payment Tax Credit Mechanism (E) – Plan Selection, Enrollment IRS (I) – Premium Invoice Employer

  24. Exchange Comparison • Success depends on regulatory environment • Must be set-up to reflect and respond to unique, local insurance and health care market conditions • Mass.: first focused on individuals; current small business pilot (“Business Express”) • CBIA (CT): open to groups of 3-100 employees • Utah: Small business focus • HealthPass NY: Serves 2-50 small group • California – first state to pass legislation establishing Exchange under PPACA • Active purchaser model: negotiates with plans

  25. Carrier Participation • Currently, participation is voluntary • Participation in exchanges will continue to be voluntary • - A market inside and outside exchange • Seal of approval as a “qualified health plan” • Importance of mirrored market rules and dynamics inside and outside Exchange market • Leverage of uninsured population to engage carrier participation

  26. Member-Centricity • Information on quality ratings, enrollee satisfaction levels to assist with purchasing decisions • Easy-to-use Internet portal • No wrong door • Navigators • - Public education • - Facilitate enrollment • - Info of availability of subsidies and tax credits

  27. Contact Information • Phone: 888.313.PASS (7277) • On the web: www.HealthPass.com • Vince Ashton, Executive Director: • 212.252.8010 x211 or vashton@healthpass.com • Shawn Nowicki, Director, Health Policy: 212.252.8010 x227 or snowicki@healthpass.com

  28. Questions Q & A

  29. HealthPass New York New York’s Commercial Health Insurance Exchange

More Related