Health Care Cabinet

March 10, 2015

1

2

Agenda

A. Open Enrollment Update

B. Benefits available for individuals using Methadone or other opioids

C. Anticipated costs and subsidies available to the individuals at 138% of poverty who are anticipated to move from Medicaid to AHCT

3

Open Enrollment Update

4

Operating Metrics

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

Sep 2014

Oct 2014

Nov 2014

Dec 2014

Jan 2015

Feb 2015

-

100,000

200,000

300,000

400,000

500,000

600,000

Total Volume - 536,436

Insured without APTC Insured with APTC Medicaid22,920 80,087 433,429

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Operating Metrics

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

Sep 2014

Oct 2014

Nov 2014

Dec 2014

Jan 2015

Feb 2015

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Insured Membership- 103,007

Insured without APTC Insured with APTC22,920 80,087

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Open Enrollment Activity Update (2/13/15)

• Current enrollment volume across all plans and programs stands at 536,436 individuals• Since the start of this open enrollment, we have processed more than 103k QHP enrollments and

235k Medicaid enrollments.– Of these 35,887 were new QHP customers, and 153,828 were new Medicaid applicants.– Net new enrollment for the OE period thus far stands at 189,715 (81% Medicaid/19% QHP)

TotalEnrollment

NewEnrollment

RepeatEnrollment

103,007 35,887

67,120

TotalEnrollment

NewEnrollment

RepeatEnrollment

433,429 153,828

81,170

ExistingMembership

198,431

QHP Membership Medicaid Volume

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Additional Membership Information (2/13/15)

• To date, ConnectiCare continues to see the majority of new enrollments (42%)• Anthem is currently taking 1 out of every 3 new enrollments (30%)• Healthy CT has seen a dramatic uptick in selection, with nearly a quarter of individuals

selecting their plans. • Newly offered dental plans and our SHOP program continue to show solid gains

Anthem Blue Cross and Blue Shield 10,893 30%ConnectiCare Benefits Inc 15,235 42%

HealthyCT Inc 8,182 23%UnitedHealthcare 1,577 4%

35,887 100%

2015 OE Carrier EnrollmentNew 2015 Enrollees Dental = 1,565

SHOP:Groups = 173Members = 1,148

173 groups with 1148

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Post Open Enrollment

• Another round of our new member census research will be conducted to gather information on key demographic and attitudinal variables.

• This will include questioning in the areas of :– Prior uninsured status– Race and ethnicity– Enrollment channel use– Reasons for sign up– Post enrollment expectations– Expected plan use

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Benefits available for individuals using Methadone or other opioids

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Benefits available for individuals using Methadone or other opioids

Carrier Coverage

Anthem • Methadone maintenance is covered on all policies/products. • Opioid treatment such as ambulatory detox, with the use of

suboxone, is also covered as well as other levels of care such as inpatient, PHP, IOP and Residential when it meets medical necessity.

• Anthem formulary includes the Methadone and the generic form of Soboxon.

Connecticare • Methadone treatment is not specified within CBI’s EOC. • Based on the definition for coverage for Behavioral Health,

Inpatient, Outpatient regarding Substance Abuse, Methadone may get covered under the umbrella outlining the coverage.

HealthyCT • Methadone Treatment is covered. • Prior Authorization is required for Inpatient services but is

not required for Outpatient services.• HealthyCT formulary includes Methadone. Soboxon as well as

the generic form is available. This drug is used for opioids.United Healthcare • Methadone is not covered.

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Anticipated costs and subsidies available to the individuals at 138% of poverty who are anticipated

to move from Medicaid to AHCT

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2015 Silver and 2015 Silver Cost-sharing Reduction Alternatives – Qualified Health Plans - Single Individual, age 30, Hartford County

Income Band (FPL)

FPL Level

used for premiu

m example Plan

Monthly Premiums (cheapest

silver plan)

Medical Deductible

Pharmacy Deductible

Inpatient Co-Pays

Emergency Departmen

t Co-Pay

Primary Care Co-Pays

Specialists Co-Pay

Pharmacy Co-Pays

Out-of-Pocket

MaxPer Day

Max per Stay

Preventative

Non-Preventative

Tier 1 Generic

Tier 2Preferred

Brand

Tier 3 Non-Preferred

Brand

Tier 4 Specialt

y

138-150%* 139%

94% CSR $49.74 $0 $0 $100 $400 $75 $0 $20 $35 $5 $20 $35 $50 $600

150-200% 185%

87% CSR $102.56 $400 $25 $200 $800 $100 $0 $20 $35 $5 $20 $35 $50 $1,750

200-250% 201%

73% CSR $125.66 $1,900 $25 $500 $2,000 $150 $0 $30 $50 $5 $30 $55 $60 $5,200

>250% 263%70%

Silver $218.07 $2,600 $25 $500 $2,000 $150 $0 $30 $50 $5 $30 $55 $60 $6,600 Subject to the Medical deductible before listed cost-sharing benefit will apply Subject to the Pharmacy deductible before listed cost-sharing benefit will apply

* 94% CSR plan is available to those who are eligible for APTCs and whose household MAGI is between 138% and 150% of the federal poverty level. The threshold drops to 0-150% for those HHs who do not qualify for HUSKY due to immigration prohibitions such as the 5 year bar.

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2015 Silver and 2015 Silver Cost-sharing Reduction Alternatives - Qualified Health Plans - Single Parent age 30,

child age 20, Hartford County

Income Band (FPL)

FPL Level used for premium example Plan

Monthly Premiums (cheapest

silver plan)Medical

DeductiblePharmacy Deductible

Inpatient Co-Pays

Emergency Depart-

ment Co-Pay

Primary Care Co-Pays

Specialists Co-Pay

Pharmacy Co-Pays

Out-of-Pocket

MaxPer Day

Max per Stay

Preventative Visit

Non-Prevent

ativeTier 1

Generic

Tier 2Preferred Brand

Tier 3 Non-

Preferred

BrandTier 4

Specialty

138-150%* 141%

94% CSR $67.83 $0 $0

$100 $400 $75 $0 $20 $35 $5 $20 $35 $50 $1,200

150-200% 185%

87% CSR $138.82 $800 $50

$200 $800 $100 $0 $20 $35 $5 $20 $35 $50 $3,500

200-250% 201%

73% CSR $174.36 $3,800 $50

$500 $2,000 $150 $0 $30 $50 $5 $30 $55 $60 $10,400

>250% 263%70%

Silver $293.48 $5,200 $50 $500 $2,000 $150 $0 $30 $50 $5 $30 $55 $60 $13,200

Subject to the Medical deductible before listed cost-sharing benefit will apply Subject to the Pharmacy deductible before listed cost-sharing benefit will apply

* 94% CSR plan is available to those who are eligible for APTCs and whose household MAGI is between 138% and 150% of the federal poverty level. The threshold drops to 0-150% for those HHs who do not qualify for HUSKY due to immigration prohibitions such as the 5 year bar.