Nevada Health LinkMay 15, 2013Northern Nevada Association ofHealth UnderwritersOperated by the Silver StateHealth Insuranc...
Agenda1. What is an online marketplace?• Elements of the Nevada Health Linkweb portal2. Goals of the Exchange3. Status of ...
What is an online marketplace?• Farmer’s market for health insurance• Web portal- Select and enroll in health insurance- A...
Snapshot of Sample Portal4
Goals of the Exchange• Increase the number of insured persons in Nevada• Facilitate the purchase and sale of health insura...
• Nevada has received Conditional Certification from the Secretary of U.S.HHS to operate a State-Based Exchange• The Excha...
7Oct Jan Mar May Jul= Xerox Team Activity Duration and Name (parenthesis indicate anticipated roles, responsibilities and ...
• ACA Federal Establishment Grants – Funding available through December 2014• Fees Charged to Carriers for Exchange Enroll...
Outreach and Education• Plan for Navigators, Enrollment Assisters and Producers- 44% of enrollees will use Exchange Enroll...
Marketing/Branding/Outreach• $5,419,900 budget for 15 months• Contract began January 2013• Goal: Enroll 118,000 persons, m...
To Date:• Extensive research on/with target population• Pre-campaign surveys to gauge awareness andperceptions• Name, logo...
12
Media Campaign• Advertising for education phase begins July 1• Call to action phase begins at open enrollmentdate, October...
Outreach• Partnering with numerous non profits serving thispopulation• Presence at events, festivals, neighborhood venues•...
Overview of Marketing/Outreach15
Tax Implications Individual SubsidyAnnual Income at 100% of the Federal Poverty Leveland Other Levels (Calendar Year 2013)...
Tax Implications Individual SubsidyMonthly Premiums Under the Second Least ExpensiveSilver Level Plan (Calendar Year 2013)...
Metal Tiers• Catastrophic plan enrollment is limited• The Advance Premium Tax Credit is based on the second least expensiv...
Tax Implications Individual SubsidyAssume:• Second cheapest silver plan inReno is $1,000 per month for agiven family of fo...
Assume:• Second cheapest silver plan inLas Vegas is $800 per month forthe same family of four.• The family, in Las Vegas, ...
Tax Implications Individual Penalty21Family Size 100% FPL 138% FPL 200% FPL 300% FPL 400% FPL1 adult $115 $159 $230 $345 $...
Tax Implications Individual Penalty22Family Size 100% FPL 138% FPL 200% FPL 300% FPL 400% FPL1 adult $695 $695 $695 $862 $...
Impact on Business Tax Credit• Fewer than 25 full time equivalent employees• Cover at least 50% of the cost of employee co...
Impact on Business Tax Penalty• No tax penalty for small business• For companies with more than 50 full time equivalentemp...
Nevada Health LinkOperated by the Silver State Health InsuranceExchange2310 South Carson Street, Suite 2Carson City, NV 89...
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NV Exchange Presentation to NO NV Assn of Health Underwriters

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May 2013

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NV Exchange Presentation to NO NV Assn of Health Underwriters

  1. 1. Nevada Health LinkMay 15, 2013Northern Nevada Association ofHealth UnderwritersOperated by the Silver StateHealth Insurance Exchange
  2. 2. Agenda1. What is an online marketplace?• Elements of the Nevada Health Linkweb portal2. Goals of the Exchange3. Status of Implementation4. Finance and Sustainability Plan5. Outreach and Education6. Tax Implications
  3. 3. What is an online marketplace?• Farmer’s market for health insurance• Web portal- Select and enroll in health insurance- Aggregate premiums- Determine eligibility for individual tax credit• Policies to balance:- Needs of consumers/businesses and insurers- Consumer protections and cost3
  4. 4. Snapshot of Sample Portal4
  5. 5. Goals of the Exchange• Increase the number of insured persons in Nevada• Facilitate the purchase and sale of health insurance• Assist qualified employers in the enrollment and purchase ofhealth coverage and the application for subsidies for enrollees• Provide consumer education on matters relating to enrollment inand effective use of health insurance• Assist residents of Nevada with access to programs, premiumassistance tax credits and cost-sharing reductions5
  6. 6. • Nevada has received Conditional Certification from the Secretary of U.S.HHS to operate a State-Based Exchange• The Exchange Board has approved 35 substantial recommendations of theAdvisory Committees• IT Implementation is on-time: Eligibility Engine (DWSS/Deloitte) andBusiness Operations Solution (Exchange/Xerox) will meet the October 1,2013 deadline for operability• Coordination efforts between the Exchange and Division of Insurancecontinue to provide a safe and seamless transition for Nevada’s citizens6Status of the Development andImplementation of Nevada Health Link
  7. 7. 7Oct Jan Mar May Jul= Xerox Team Activity Duration and Name (parenthesis indicate anticipated roles, responsibilities and other descriptions)IMPLEMENTATIONMANAGEMENTDecNov Feb Apr JunINFRASTRUCTURE Production Environments OnlineLas Vegas Service Center Buildout and Move-in CompleteSOLUTION – RELEASE ARelease Test (Xerox Team with DWSS, Exchange SME clarification)SOLUTION – RELEASE BSprints 4 and 5 (same as Release A)Story Development and System Design (same as Release A)Release Test (same as Release A)Las Vegas Service Center Lease ExecutedSOLUTION – RELEASE C Requirements and Configuration Sessions (same as Release A)OPERATIONALPROCESSESINTEGRATEDVALIDATIONDEPLOYMENT Dry Run v1.0 (Xerox Team in UAT Environment)Baseline ScheduleOct Jan Mar May JulDecNov Feb Apr JunPortal Dev/Test Environments OnlineRelease B Processes Release C ProcessesSilver State Health Insurance Exchange – BOS Schedule Detail Roadmap – March 7, 2013(Partial View – Contract Start through July 2013)Roadmap reflects Xerox/BOS Project Schedule as of 3/7/2013; Schedule Roadmap visual alignswith the underlying Schedule Gantt Chart, but there may be summarizations depicted here that donot exactly map to a Gantt Chart task name (for more information, please consult the NV Exchange)TODAYProof of Concept Connectionbetween BOS and DWSS/HCRXerox Project Management Plan (Xerox development of narrative/processes, NV Exchange approval)Requirements Validation Review (Joint Xerox/NV Exchange review)Carson City Project Office CompleteImplementation Plan (Xerox/Exchange – Certification Checklist)Baseline Infrastructure à UX2014 Look and Feel à Account Creation à BOS/DWSS Interface StandardsSprints 1, 2 and 3 (Xerox Team with DWSS, Exchange clarification)Disaster Recovery Environments OnlineCore CMS Functions: SHOP à Individual and Family à BOS/DWSS Exchanges à Generic QHPs à EnrollmentStory Development and System Design (same as Release A)Technical Processes (Service Management, Support Escalation, Operations and Maintenance Manuals)Core CMS Functions: SHOP à Individual and Family à BOS/DWSS Exchanges à Generic QHPs à Premium Calculator à Billing à IVR à BOS/DOI/Carrier ExchangesRelease A ProcessesBusiness Processes (Release-based/Iterative Service Center Manual, Workflow, and Training Development)Performance Test (Xerox Team with DWSS, NV Exchange or additional SME clarification)System Integration Test (Xerox Team with DWSS, NV Exchange or additional SME clarification)Operations Staff UAT/ORT Training and Preparation (includes State staff as needed)= Complete Green Bar with Green Font indicates activity is complete and milestone is met;if Green Bar is to the right of TODAY line, Activity was completed ahead of schedule= Partial Green indicates Activity is in Progress, but not yet Compete= Partial Green with Yellow Milestone indicates Activity is in Progress, not Complete and Behind ScheduleRoadmap reflects October 2012 through July 2013 schedule bars to configure to 8 ½” x 11" paper;Arrows at end of bars indicate activities continue past July 2013Requirements and Configuration Sessions (Joint DWSS, Exchange, Xerox and additional SMEs)Story Development and System Design (Xerox Team with DWSS, Exchange SME clarification)Requirements and Configuration Sessions (same as Release A)Sprints 6 and 7 (same as Release A)Integrated Application and Operations Validation (UAT conducted by State staff with Xerox Team support, ORT conducted by Xerox Team with State staff review)ININ/Telephony Dev/Test Environment OnlineRemaining Functions: QHP Load, Shop and Compare à Consumer Support (CRM, Imaging/Document Repository, Email, Fax, Chat) à Fulfillment à ReportingSOLUTION – RELEASE D Story Development and System Design (same as Release A)Sprints 8, 9 and 10 (same as Release A)Release D ProcessesUser Acceptance Test (UAT conducted by State staff with Xerox Team support)TIMELINETIMELINEFRAMEWORK AREA
  8. 8. • ACA Federal Establishment Grants – Funding available through December 2014• Fees Charged to Carriers for Exchange Enrollment- Beginning 1/1/14, funds Navigators and Reserves- Beginning 1/1/15, funds all Exchange operations• Advertising8Finance and Sustainability Plan
  9. 9. Outreach and Education• Plan for Navigators, Enrollment Assisters and Producers- 44% of enrollees will use Exchange Enrollment Facilitators• Certified by the DOI – AB425• Navigators - $370,000, ~34 individuals in FY 2014• Enrollment Assisters - $1,826,000, ~169 individuals, FY 2014• Certified Application Counselors – volunteers- 22% of enrollees will use Brokers and Agents• Paid by carriers- 30% of enrollees will use Web Portal with the help of a Call Center• 50 plus individuals in Las Vegas (staff size flexes withdemand)- 4% of enrollees will use Web Portal alone9
  10. 10. Marketing/Branding/Outreach• $5,419,900 budget for 15 months• Contract began January 2013• Goal: Enroll 118,000 persons, mainly in 138% to400% of FPL• Reach hundreds of thousands of Nevadansdirectly with outreach10
  11. 11. To Date:• Extensive research on/with target population• Pre-campaign surveys to gauge awareness andperceptions• Name, logo and tagline decisions by boardcompleted in April11
  12. 12. 12
  13. 13. Media Campaign• Advertising for education phase begins July 1• Call to action phase begins at open enrollmentdate, October 2013• Urgent call to action campaign prior to enrollmentclosing, first quarter of 2014• Separate campaign for B2B/SHOP Exchange13
  14. 14. Outreach• Partnering with numerous non profits serving thispopulation• Presence at events, festivals, neighborhood venues• Outreach presentations• Door to door campaign• Grassroots, person to person approach is critical14
  15. 15. Overview of Marketing/Outreach15
  16. 16. Tax Implications Individual SubsidyAnnual Income at 100% of the Federal Poverty Leveland Other Levels (Calendar Year 2013)16Family Size100%FPL138%FPL200%FPL300%FPL400%FPL1 $11,490 $15,856 $22,980 $34,470 $45,9602 $15,510 $21,404 $31,020 $46,530 $62,0403 $19,530 $26,951 $39,060 $58,590 $78,1204 $23,550 $32,499 $47,100 $70,650 $94,2005 $27,570 $38,047 $55,140 $82,710 $110,280For each additionalperson add$4,020 $5,548 $8,040 $12,060 $16,080
  17. 17. Tax Implications Individual SubsidyMonthly Premiums Under the Second Least ExpensiveSilver Level Plan (Calendar Year 2013)Family Size100%FPL138%FPL200%FPL300%FPL400%FPLPercent of Income 2.0% 3.29% 6.3% 9.5% 9.5%1 $19.15 $43.53 $120.65 $272.89 $363.852 $25.85 $58.76 $162.86 $368.36 $491.153 $32.55 $73.98 $205.07 $463.84 $618.454 $39.25 $89.21 $247.28 $559.31 $745.755 $45.95 $104.44 $289.49 $654.79 $873.05For each additionalperson add$6.70 $15.23 $42.21 $95.48 $127.30
  18. 18. Metal Tiers• Catastrophic plan enrollment is limited• The Advance Premium Tax Credit is based on the second least expensive silverplan• Actuarial Value (AV) is the average cost paid by the insurer• Deductibles are interpolated from reports from the Kaiser Family Foundation,rounded and based on 20% coinsuranceWhat the Actuarial Values in the Affordable Care Act Mean, April 2011Patient Cost-Sharing Under the Affordable Care Act, April 201218Tier Cost AV Estimated DeductiblePlatinum Most Expensive 90% $200Gold More Expensive 80% $1,000Silver Base 70% $2,000 (CSRs applied)Bronze Less Expensive 60% $4,000Catastrophic Least Expensive <60%
  19. 19. Tax Implications Individual SubsidyAssume:• Second cheapest silver plan inReno is $1,000 per month for agiven family of four.• Second cheapest silver plan inLas Vegas is $800 per month forthe same family of four.The Advance Premium Tax Credit isadjusted so the cost for that family isthe same (based only on income) forthe second cheapest silver plan.19** Illustrativecosts$247.28 $247.28$1,000.00$800.00$752.72$552.72*APTC isadjustedFamilyshare isfixedPremium illustration for family of 4 with an annual income of $47,100 (200% FPL)
  20. 20. Assume:• Second cheapest silver plan inLas Vegas is $800 per month forthe same family of four.• The family, in Las Vegas, wants topurchase a gold plan that costs$900.The Advance Premium Tax Credit isbased on the second cheapest silverplan. The family must pay (or save)the difference.20$247.28$752.72*Tax Implications Individual SubsidyPremium illustration for family of 4 with an annual income of $47,100 (200% FPL)$900.00* Illustrativecosts$247.28$800.00$552.72*APTC isadjustedFamilyshare isfixed$347.28$552.72
  21. 21. Tax Implications Individual Penalty21Family Size 100% FPL 138% FPL 200% FPL 300% FPL 400% FPL1 adult $115 $159 $230 $345 $4601 adult / 1 child $155 $214 $310 $465 $6202 adults $195 $270 $391 $586 $7811 adult / 2 children $236 $325 $471 $707 $9422 adults / 1 child $276 $380 $551 $827 $1,1032 adult / 2 children $316 $436 $632 $948 $1,264For each additional personadd$40 $55 $80 $121 $161Estimated Calendar Year 2014 Annual Tax Penalty(1.0%; $95; based on the FPL for 2013)
  22. 22. Tax Implications Individual Penalty22Family Size 100% FPL 138% FPL 200% FPL 300% FPL 400% FPL1 adult $695 $695 $695 $862 $1,1491 adult / 1 child $1,043 $1,043 $1,043 $1,163 $1,5512 adults $1,390 $1,390 $1,390 $1,465 $1,9531 adult / 2 children $1,390 $1,390 $1,390 $1,766 $2,3552 adults / 1 child $1,738 $1,738 $1,738 $2,068 $2,7572 adult / 2 children $2,085 $2,085 $2,085 $2,369 $3,159For each additionalperson add$101 after 13 $139after 8$201after 3$302 $402Estimated Calendar Year 2016 Annual Tax Penalty(2.5%; $695; based on the FPL for 2012)
  23. 23. Impact on Business Tax Credit• Fewer than 25 full time equivalent employees• Cover at least 50% of the cost of employee coverage (notfamily)• Average wages less than $50,000/year• Available now, goes up in 2014- Must be on SHOP Exchange• Contact your tax preparer- Form 8941- Line 44f of Form 990-T (for Exempt Orgs)23
  24. 24. Impact on Business Tax Penalty• No tax penalty for small business• For companies with more than 50 full time equivalentemployees (FTE) and at least one employee receives anindividual tax credit:- No coverage offered: $2,000 x ( FTE – 30 ) per year- Coverage offered but not affordable (9.5% income) orminimum essential coverage (bronze plan), lesser ofabove or: $3,000 x FTEs that receive a premium credit24
  25. 25. Nevada Health LinkOperated by the Silver State Health InsuranceExchange2310 South Carson Street, Suite 2Carson City, NV 89701(775) 687-9939contact@exchange.nv.govwww.exchange.nv.gov

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