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NY State of HealthSmall Business Marketplace

Broker WebinarSeptember 24, 2015

Today’s Webinar• Dial in to the audio portion of the webinar using the

telephone number on the Audio tab. Audio is transmitted through the telephone only, not through computer speakers

• All participants will remain muted for the duration of the program

• Questions can be submitted using the Q&A tab on your Webex control panel; we will answer questions at two separate points during the presentation.

• A recording of the webinar and any related materials will be emailed to all registrants within 24 hours

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Sara Rothstein – Director of Policy and Planning

Amy Grabek – Regional Director, Small Business Marketplace

Joe Muldoon, Director of Small Business Marketplace

NYSOH Presenters

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AGENDA

• Introductions• Enrollment in the Individual Marketplace• Review of Essential Plan• Small Business Marketplace Updates/Changes - 2016• Upcoming Webinar• Questions

Enrollment Fast Facts• More than 2.5 million New Yorkers have enrolled in health

coverage through the Marketplace

– That’s more than 10 percent of New York’s population

• Eighty-nine percent of Marketplace enrollees reported that they were uninsured at the time they applied

• State’s uninsured rate declined from 10.7% to 8.7% between 2013-14 (US Census Bureau)

• Over 92% satisfied with Marketplace coverage (NYS Health Foundation)

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2016 Goal

1 MILLION fewer

uninsured

by end of 2016

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2013

2016

Why People Say They Have Not Enrolled

National Survey Findings:

• Most think having insurance is important

• Cost – premiums and out-of-pocket expenses – are a concern

• Many are able to get care and pay for it out-of-pocket (free or sliding scale)

• Many have knowledge gaps about tax credits and the tax penalty

(Robert Wood Johnson Foundation/Perry Undem, June 2015)

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You’d be surprised…

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Individual Marketplace:You’d be surprised

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• New design • Revised rack cards• New fact sheet on

Essential Plan• Available in 18

languages• Other fact sheets

“refreshed” for 2016

Direct Targeted Communications

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ESSENTIAL PLAN

The Essential Plan (Basic Health Program) is a new Insurance Affordability

Program in the Individual Marketplace starting in 2016, that will offer

qualified individuals and families a choice of plans from high-quality private

health insurers through the NY State of Heath.

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ELIGIBILITY

• Below age 65 at the beginning of the plan year

• Reside in New York State

• Not eligible for Medicaid or Child Health Plus (CHPlus)

• Have income at or below 200% Federal Poverty Level and not eligible for Medicaid or Child Health Plus.

• Not eligible for affordable Minimum Essential Coverage (MEC)

• Individuals eligible for the Essential Plan are not eligible to receive Advance Premium Tax Credits

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Benefits• All plans cover the same benefits.

• Applicants with income above 138% FPL have the choice of selecting:

o An Essential Plan with just the Essential Health Benefits, or

o An Essential Health Benefits plus Adult Vision and Dental services for an additional cost, or

o An Essential Plan and a separate Stand Alone Dental Plan

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SELECTING AN ESSENTIAL PLAN CARRIER

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SELECTING AN ESSENTIAL PLAN CARRIER - CONTINUED

Cost• Most costs for covered services in Essential Plan are

standardized

• There is no deductible for any of the Essential Plan variations

• Premium, co-pays and maximum out of pocket limits will be the same across carriers.

• However, premiums for optional vision and dental coverage will vary across carriers.

ESSENTIAL PLAN COST SHARING

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http://info.nystateofhealth.ny.gov/invitationAttachment F – BHP Benefits and Cost Sharing

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ESSENTIAL PLAN PREMIUMS

• Individuals with income below 138% of the FPL will have no premium

• Individuals with income between 138-150% of the FPL will have no premium for standard coverage, but have the option of purchasing vision and dental benefits at an additional cost

• Individuals with income between 150-200% of the FPL will have a premium of $20 per individual per month and a higher premium if selecting a dental and vision plan

Applicants can enroll all year long and change their plan at anytime throughout the year. (i.e. there is no need for a Special Enrollment Period).

Enrollees are required to report changes in circumstance within 30 days of the event and eligibility will be re-determined during the 12 month enrollment period.

Eligibility for the Essential Plan will be re-evaluated 12 months after the enrollee's recent determination.

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ENROLLMENT PERIODS

EFFECTIVE DATE OF COVERAGE

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January 1, 2016 effective date of coverage:

• Applicants with income between 138% - 200% of the FPL and who have selected a plan between before December 16th, 2015.

• Applicants with income below 138% of the FPL and who have selected a plan before January 1, 2016.

TRANSITION – CURRENT ENROLLEES

Starting October 1, 2015 eligibility notices will be sent to current enrollees that have been identified as Essential Plan eligible for 2016.

• They will be prompted to update their account information in the NY State of Health if necessary.

• Individuals currently enrolled in a QHP who are now determined to be eligible for Essential Plan, will start coverage the 1st of the next month following the 15th day rule.

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Questions?

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Small Business MarketplaceUpdates and Changes for 2016

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• Definition of small group will expand to include employers with 100 or fewer full time equivalent employees

• Eligible employees must include those working 30 or more hours per week

– Employers are not required to but may offer coverage to part-time employees who work on average a minimum of 20 hours or more per week

• In order for a business to be considered an eligible small group, at least one common law employee must be enrolled in the group plan.*

* Per Federal Regulation 29 C.F.R. 2510.2-3(b), an "employee benefit plan" does not exist if no "employees" are covered by the plan. Pursuant to 29 C.F.R. 2510.3-1 and 29 C.F.R. 2590.732(d) an "employee" does not include the sole owner of a business or a spouse of the business owner.

Small Business Changes for 2016

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Full-time Equivalent Calculator

• All groups must enter total number of FTE employees when enrolling in the Small Business Marketplace

• IF FTE number is 100 or fewer you may be eligible for coverage in the Small Business Marketplace

• Number of FTE should be updated throughout the year, although eligibility will not change. i.e. if a group grows to over 101 during the plan year, but had 100 or fewer FTEs at plan inception, the group will continue to be eligible to participate in SBM

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Retiree Coverage

Employer groups can now expand their coverage offerings to their Retirees.

• Retiree class must be set up during Open Enrollment• Employers are not required to contribute to the Retiree class.

Coverage can be offered at any of the tier levels. (subscriber only, subscriber + spouse etc.)

• Current retirees will have the one time option to enroll during the group’s initial Open Enrollment

• Employees, who retire from employment during the plan year, will have the one time option to enroll at that time

• Retiree coverage is not required; it is an elective option at the employer group level.

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Broker Recertification Information

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Broker Recertification

• Two separate courses, one for the Individual Marketplace and one for the Small Business Marketplace (SBM).

• Both courses are completely on-line.

• Courses are available now and can be accessed through a link on your NY State of Health broker dashboard.

• You complete the recertification course(s) at your convenience. Each course will take an estimated 2 to 3 hours to complete.

*Courses do not qualify for Continuing Education Credits.

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Broker Recertification

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Small Business Marketplace:Value for Small Employers

Choice• Employers and employees regard expanded choice as a key advantage to using the Marketplace.

Administrative Simplicity• The Marketplace provides monthly billing to employers along with other administrative

simplifications.

Tax Credits• The Marketplace will be the exclusive place to access small business tax credits starting in 2014

Contribution Options• 76% of respondents believe this feature helps predict costs.

No Minimum Participation or Contribution

• NYSOH does not require a minimum number of employees be enrolled in a QHP nor require an employer to contribute an amount towards premium

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Administrative Simplicity

• The Marketplace provides employers with a single monthly bill– Monthly bill will include breakdown of

employer/employee contribution due to each health and dental insurer (employers remain responsible for collecting premiums from employees).

• The Marketplace collects monthly payment from the employer and remits payment to insurers

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• A tax credit is available to small businesses that offer insurance coverage to employees:– Must have fewer than 25 FTE employees – With an average annual salary of $50k or less (As adjusted for inflation

beginning in 2014. Excludes the owner and his family)– Employer must contribute at least 50% of premium

• As of 2014, the tax credit amounts are as follows:– Up to 50% of employer contribution for a traditional businesses (35% for tax-

exempt)– The maximum tax credit of 50% may be claimed by businesses that have 10

or fewer employees with an average annual salary of $25k or less– As the number of employees and average salary increases, the credit

decreases• Marketplace is the only place to access the tax credit

Small Business Health Care Tax Credit

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Next webinar –October• Renewal Process• Plan information• 2016 rates

Producer Toolkit Link: http://info.nystateofhealth.ny.gov/ProducerToolkit

Additional Resources

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QUESTIONS?

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Joe Muldoonjoseph.muldoon@health.ny.gov

Amy Grabekamy.grabek@health.ny.gov

Stana Nakhlestana.nakhle@health.ny.gov

David Pitaniellodavid.pitaniello@health.ny.gov

NYSOH Small Business Team: