Delaware’s Health Insurance Marketplace: Update on Activity Delaware Health Care Commission, December 16, 2013 Secretary Rita Landgraf, Department of Health and Social Services

Agenda Updates since last Health Care Commission meeting Enrollment activity Marketing and website update Marketplace Guide update Stories from the ground 2

Recent National Updates Healthcare.gov reports improvements since Nov. 30 th More detailed “window shopping” “Remove” function added; some users can remove problem applications Increased capacity More completed enrollments HHS announced a change in the last date to enroll for coverage to begin Jan. 1, 2014 – individuals must be enrolled by Dec. 23, 2013 It is advised that the first month’s premium also be paid by this date to ensure coverage Jan. 1 3

Extension of PCIP Update On December 12 th, President Obama announced a one-month extension of the Pre-Existing Condition Insurance Plan (PCIP) Individuals currently enrolled can remain in PCIP until January 31, 2014, if they have not yet secured other health coverage to ensure they do not experience a lapse in coverage Delaware has almost 300 people in this program 4

“834” File Transmission Update There have been problems with so-called “834” enrollment files that provide detailed information from HealthCare.gov to insurance companies about new subscribers While improvements have been made, many insurance companies are still seeing problems with the 834 transmissions. Some of the remaining problems include: Files with duplicative information Files that include missing or inaccurate information Files that fail to transfer from Federally Facilitated Marketplace (FFM) to the insurance company CMS and insurance companies report that they are working daily to resolve the technical problems and address the back-log of outstanding cases 5

Discontinued Policies Update On November 14 th, President Obama announced he would allow states to decide whether insurance companies could offer renewals of plans that did not meet the requirements of the ACA. On November 25 th, Delaware’s Insurance Commissioner announced that the DOI had reached an agreement with the health insurance companies to offer early renewals for current policies whose term of coverage was to end on or before March 31,  Consumers that are affected by this agreement and take advantage of this option must renew their policy on or before December 31,  All policies with an effective date after January 1, 2014, must be in compliance with Delaware law.  The insurance companies have indicated that individuals with questions regarding their policies should direct those questions to their agent or broker. 6

SHOP Update On November 27 th, CMS announced a yearlong delay of online enrollment for small business through the SHOP portal Small employers can enroll in a SHOP QHP directly with the insurance company or through an agent/broker and do not need to wait for an eligibility determination from the SHOP in order to enroll in a QHP. Employers who have already sent in a paper application do not have to wait to receive an eligibility determination before contacting an insurance company or agent/broker to enroll. If an employer is later determined to be ineligible for the SHOP but the group is already enrolled, the insurance company is not required to terminate coverage. However, that employer will not be able to claim the Small Business Health Care Tax Credit if they are ineligible. Enhanced Federally Facilitated SHOP Tools for Small Employers New Premium Estimation tool Expanded Plan Compare tool expected in December 7

Marketplace Enrollment Update Number of Delawareans that have selected a Marketplace QHP as of November 30 th reported by the U.S. Dept. of Health and Human Services: 431 Delaware enrollments through the HealthCare.gov as reported by the QHP issuers as of December 12 th : 793 This number represents consumers who have both selected a QHP only as well as those who have paid the first month's premium to the Issuers in order to fully effectuate enrollment in the health plan.) 8

Medicaid Update Number of individuals assessed eligible for Medicaid/CHIP by the Marketplace by the U.S. Dept. of HHS = 2,950 Some individuals have been flagged by the federal Marketplace as being potentially eligible for Medicaid when their household income is above the threshold. When the FFM sends these individuals to the State, the file does not contain all the information necessary to complete an eligibility determination. Eligibility workers will contact individuals to complete this process. If individuals are eligible for Medicaid, coverage is effective the 1 st day of the month in which the application was submitted. If individuals are not eligible for Medicaid, they will be directed back to the Marketplace. Advanced Resolution Center is available for cases needing additional assistance.

ChooseHealthDE.com (English version): As of Dec. 11, 2013, there have been 127,512 visits Visitors are staying an average of 2 minutes, 22 seconds

Health-Care/Espanol ChooseHealthDE.com (Spanish version): As of Dec. 11, 2013, there have been 8,525 visits. Visitors are staying an average of 2 minutes, 48 seconds.

HEALTHCARE.GOV Traffic from ChooseHealthDE.com to HealthCare.gov: As of Dec. 11, 2013, ChooseHealthDE.com has directed 24,706 visits to HealthCare.gov. 12

Marketing Updates ChooseHealthDE.com updates and enhancements Robust calendar of events where Marketplace Guides are available In The News section includes up to date notices for consumers Currently planning 2014 marketing activities Increased focus on targeted populations including year olds, Hispanic citizens, Sussex County

Marketplace Guide Activities to Date As of December 12, 2013: There are 73 fully certified Marketplace Guides and Navigators There are 105 total positions (both part- and full-time), which make up 68 FTEs 710 outreach activities conducted 25,362 total consumers reached 14

Outreach and Education During the first two months of open enrollment, Marketplace Guides have geared their activity primarily toward: Making consumers aware of the Marketplace and the various ways to enroll Answering questions about eligibility, available assistance and coverage options Talking consumers through their individual circumstances, including looking at specific plan information, to prepare them to apply and enroll Referring consumers to Medicaid as appropriate 15

Enrollment Support Now that significant improvements have been made to HealthCare.gov, the Guides have shifted their efforts to focus on assisting consumers to apply and enroll Guide organizations are holding special enrollment events throughout the state this week to help consumers meet the Dec. 23 deadline for coverage that begins Jan.1: Schools across the state Westside Family Healthcare sites Wilmington Hospital Dr. Joann Fields’ Office, Felton Full schedule is available on 16

Other Considerations Many consumers that seek assistance from a Guide prefer to complete the enrollment on their own at a later time (e.g. after taking time to shop and compare) and Guides are actively following up in these cases to ensure that the consumer gets connected to coverage The Federal government is still advising against the use of paper applications due to expected delays in processing these and a less seamless enrollment process Insurance companies are now offering direct enrollment through their sites, but consumers still need to complete an application at HealthCare.gov to qualify for financial assistance For consumers with more difficult cases, the Federal government has established an advanced resolution center. Consumers can reach this through the Federal Contact Center at

Plan Enrollment Verification Insurance companies require payment of the first month’s premium before the consumer is considered fully enrolled in a plan and prior to the start of benefit coverage. To ensure that coverage is able to begin Jan. 1, 2014, CMS recommends that consumers select, enroll and pay the first premium by Dec. 23, For those who select and enroll through the Marketplace: Contact the insurance company directly two days after selection of QHP through the Marketplace, to verify that enrollment information has been properly received Consumers are encouraged to have the following information ready when verifying enrollment with the insurance company: Name of plan enrollee, Marketplace Account ID, full Plan Name, names of anyone included on the Plan, date the enrollee completed transaction through the Marketplace If the insurance company is unable to confirm the enrollment, consumers are urged to contact the Federal Contact Center immediately to determine if there are any issues regarding their selection/enrollment transaction. 18

Get help from the QHP Insurance Companies The table below provides links to each of the Delaware QHP Issuer Customer Service Centers. Insurance CompanyCustomer Service WeblinkCustomer Service Phone Coventry Health and Life Insurance Company Coventry Health Care of Delaware Highmark Blue Cross Blue Shield of Delaware p/contactus.do?oid= &submitbutton=custserv Delta Dental Insurance Companyhttp:// ontactUs_midatl.html Dentegra Insurance Companyhttps:// TTY: 711 Dominion Dental Services, Inc

Stories from the Ground With the help of a Marketplace Guide from Brandywine Women’s Health Associates, a Newark woman was able to enroll. “This insurance is a blessing to me,” said the woman who lost her job 3 years ago, was on COBRA for 18 months and was without insurance the last 18 months. A Wilmington woman will save more than $500 a month with her Marketplace policy.

Stories from the Ground After initially applying Oct. 8, a Glasgow man was able to enroll Dec. 3 – with assistance from an MPG – by “removing” his application and starting over. His new application flowed right through. A Dover man, whose application was flagged by the Marketplace as being potentially eligible for Medicaid even though his income is above the threshold, is working with Sen. Coons’ office to fix the error.

Stories from the Ground Before enrolling in a gold plan, a 37-year-old Wilmington woman was able to learn that her prescriptions are in the plan’s formulary and her doctor is in the provider network. A woman from Bear with cancer, who is finishing her enrollment, is eligible for a tax credit. A Marketplace Guide assisted a woman who is legally blind with her enrollment. The woman’s employer doesn’t offer insurance – and with the subsidies she is eligible for – she will pay $43 per month for her medical coverage.

Stories from the Ground Westside Guides Adrian and Kristen talked with young people at the Delaware Sports League’s Flag Football Tournament. A Rehoboth Beach man, whose application had been stuck, received help from the Call Center and now just needs to decide on a plan before Dec. 23. A 53-year-old Wilmington man, who hasn’t had insurance in 5 years, signed up for medical and dental coverage.

Significant Dates December 23, 2013 – Last day to enroll for coverage beginning on January 1, 2014 March 31, 2014 – Must be enrolled in minimum essential coverage by this date to avoid penalty 24