Presentation Transcript

1. The NEWRetail Market An Overview The Health Insurance Marketplace and the NEW CO-OP Option Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
2. New Retail Market Presented By: Anita Maxwell Director of Community Relations 864.527.5904 amaxwell@cchpsc.org Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
3. New Retail Market What’s It All About? Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
4. New Retail Market Health Insurance Marketplace Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
5. New Retail Market Health Insurance Marketplace Coverage to fit individual needs Financial assistance based on income through new premium tax credit (immediate, not filed) Unbiased help and customer assistance and a toll-free phone number Qualified health plans that meet new standards Options are grouped for easy comparison Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
6. New Retail Market Health Insurance Marketplace Single application determines eligibility for: Qualified Health Plan through the Marketplace Newtax credits or subsidies to lower premiums Medicaid Children’s Health Insurance Program (CHIP) Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
7. New Retail Market Financial Assistance, 2013 FPL, subject to change Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
8. New Retail Market Health Insurance Marketplace A Qualified Health Plan Is offered by an issuer that is licensed by the state and in good standing Covers Essential Health Benefits Offers at least one plan at the “silver” level and one at the “gold” level of cost sharing Agrees to charge the same premium rate whether offered directly through the Marketplace or outside Marketplace Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
9. New Retail Market Health Insurance Marketplace Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
10. New Retail Market Health Insurance Marketplace Source: CMS National Training March 2013 Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
11. New Retail Market The ACA and Insurance Rates Pre ACA Individual rates are based on the age, sex and health. Some groups rates are based on age, sex and health. Insurers increase profits by: Denying coverage due to pre-existing conditions Including riders and/or exclusions for certain conditions Pricing the plan according to illnesses and conditions of the individual or in the group Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
12. New Retail Market The ACA and Insurance Rates Post ACA Insurers must comply with new Medical Loss Ratio (MLR) rules that control profits. Insurers may not Deny coverage due to pre-existing conditions Terminate coverage due to illnesses Price plans based on medical conditions Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
13. CO-OP Health Plans A New Model of Healthcare Coverage The Affordable Care Act (ACA) included legislation and funding to establish CO-OP Health Plans. CO-OPs (Consumer Oriented and Operated Plans) provide more competition in the healthcare marketplace and more choices for consumers and small businesses. The Difference is Clear. Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
14. CO-OP Health Plans How Are CO-OPs Different? NON-PROFIT MEMBER GOVERNED PREVENTION FOCUSED Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
15. CO-OP Health Plans Who can be covered? Consumers’ Choice Health Plan is now enrolling members and businesses across South Carolina. Current Offices: Charleston & Greenville with additional offices planned Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
16. CO-OP Health Plans Important Dates to Remember Coverage Effective Dates Begin January 1, 2014 Open Enrollment Began October 2013 Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
17. CO-OP Health Plans Enrollment Information Through the Health Insurance Marketplace located at www.healthcare.gov or with the help of an insurance agent, broker, navigator or at a qualified clinic Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
18. CO-OP Health Plans Need More Information? CO-OP Information Source: Healthcare.gov Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company
19. CO-OP Health Plans Need More Information? QUESTIONS? Consumers' Choice Health Insurance Company Consumers' Choice Health Insurance Company