Kentucky Health Benefit Exchange April 18, 2013 Carrie Banahan, Executive Director Office of the Kentucky Health Benefit Exchange 1 COMMONWEALTH OF KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES

Health Insurance Reforms that are Affecting You Now Temporary High Risk Pool (PCIP) New coverage options for young adults No lifetime limits on health benefits Coverage for children with pre-existing conditions 2

Health Insurance Reforms that are Affecting You Now Preventive services with no deductible or co-pay Rate Review and MLR Rebates Rescissions Uniform Explanation of Coverage and Standard definitions Appeals 3

Kentucky Health Benefit Exchange Executive Order ( ) signed by Governor Beshear July 17, 2012 created the Exchange and administrative structure: Organized Office of KHBE under CHFS with 4 divisions and (with up to 30 employees); Established an Advisory Board; and Authorized Board to create sub-committees. 4

Kentucky Health Benefit Exchange Advisory Board First meeting held September 27, 2012 Six subcommittees formed: – Behavioral Health – Dental and Vision – Education and Outreach – Navigator/Agent – Qualified Health Plans – Small Employer Health Options Program (SHOP) Navigator/Agent, Qualified Health Plans, and SHOP subcommittees have met. Meeting schedules and materials posted on the KHBE website (healthbenefitexchange.ky.gov). 5

A health benefit exchange is an organized marketplace for individuals and employees of small businesses to shop for health insurance offered by insurers (insurance companies, CO-OPs, and Office of Personnel Management (OPM)) based on price and quality. Individuals will also be able to apply for Medicaid coverage through the Exchange. 6

When must the Exchange be operational? Open Enrollment - October 1, 2013 – March 31, 2014 Fully Operational - January 1,

Why is Kentucky pursuing a State-Based Exchange instead of a Federal Exchange? Support from interested stakeholders; Prevent Federal government from controlling the Exchange; Concerns with dual regulation of health insurance market; Allows Kentucky to determine the benefits that will be provided in Kentucky’s Exchange; Allow Kentucky to have flexibility, including determinations of Medicaid eligibility; and Consider Kentucky’s unique regional and economics needs. 8

Overview of Essential Health Benefits ACA requires health insurance plans sold to individuals and small employers to provide a minimum package of services in 10 categories called “Essential Health Benefits” (EHBs). EHBs are the minimum standards to be applied both inside and outside the Exchange. They include items and services within the following categories: Ambulatory Patient Services; Emergency Services; Hospitalization; Maternity and Newborn Care; Mental Health and Substance Abuse Disorder Services; Prescription Drugs; Rehabilitative and Habilitative Services and Devices; Laboratory Services; Preventive/Wellness Services/Chronic Disease Management; and Pediatric Services, including Oral and Vision Care. 9

Navigator Program Navigators - Individuals or Entities that: May include: Community/consumer-focused nonprofit groups, Chambers of commerce, resource partners of Small Business Administration, Health Care Providers, etc. Maintain expertise in eligibility, enrollment and programs; Provide information/services in fair, accurate, impartial way; Facilitate selection of Qualified Health Plans (QHPs); and Provide referrals to any applicable office, health insurance consumer assistance or ombudsman, or State agency for grievances, complaints, or questions about health plan. 10

Who will qualify for Premium Assistance and Tax Credits? Premium Assistance: Individuals with a household income (for the taxable year) between 133% and up to 400% of the federal poverty level (FPL); and Small Businesses may qualify for tax credits if:  The Employer has fewer than 25 full-time equivalent employees for the taxable year;  The average annual wage of Employees in group is less than $50,000; and  The Employer pays at least 50% of the premium for each employee. 11

Income LevelIndividualFamily of Four 100% FPL $11,490$23, % FPL $15,281.70$31, % FPL $17,235$35, % FPL $22,980$47, % FPL $28,725$58, % FPL $34,470$70, % FPL $45,960$94, Income level Individual Income Amount Percent of Income Premium Limit as a percent of Income Individual Family of Four Income Amount Percent of Income Premium Limit as a percent of Income for Family of Four MinimumMaximum MinimumMaximum % FPL $11,490 - $15, %$ ($19.15/ Month) $ ($25.47/M onth) $23,500 - $31,255 2%$ ($39.17/ Month) $ ($52.09/ Month) 133– 150% FPL $15, $17, %$ ($38.20/ Month) $ ($57.45/ Month) $31, , %$ ($78.14/ Month) $1, ($117.50/ Month) % FPL $17,235 - $22, %$ ($57.45/ Month) $1, ($120.65/ Month) $32,250 - $47, %$1, ($117.50/ Month $2, ($246.75/M onth) % FPL $22,980 - $28, % $ ($120.65/ Month) $2, ($192.70/ Month) $47,000 - $58, %$2, ($246.75/ Month) $4, ($394.11/M onth) % FPL $28,725 - $34, % $2, ($192.70/ Month) $3, ($272.89/ Month) $58,750 - $70, %$4, ($394.11/ Month) $6, ($558.13/M onth) % FPL $34,470 - $45, %$3, ($272.89/ Month) $4, ($363.85/ Month) $70,500 - $94, %$6, ($558.13/ Month) $8, ($744.17/ Month) Premium Contribution Amounts for plan year 2014 (Based on 2013 Poverty Guidelines )

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