John Barela Health Plan Advisory Committee Initial Meeting

Agenda Welcome and Introductions Expectations and standard operating procedures Topic Timeline Administration of the APTC 2

Recognized Roles Co-chairs – Marc Reese – Harriet Hall Staff Liason – John Barela 3

Expectations and Standard Operating Procedures 90 minute meetings every two weeks Tentative schedule first and third Tuesday of the month from 1:30 – 3:00 Meeting summary created Goal is for materials to be posted 48 hours before the meeting Recommendations will follow the current COHBE staff template COHBE staff are investigating Advisory Group collaboration tools 4

Tasks for Committee Employer and Employee Choice Architecture Certification of QHP and QHP Issuers Supplemental Plans Administering Premium Credits & Cost Sharing Assistance Other Tasks Assigned by the Board 5

Employer and Employee Choice What are the choices that an employer should have in choosing plans for employees? – Must allow for employers to choose any plan in tier – Current practice is for a single plan to be selected by employer – Current practice is for some carriers to allow plans of a certain size to choose multiple plans from the same carrier – Allow employers to choose a selection of plans from different carriers 6

Certification of QHPs and QHP Issuers Overall approach is contractual Responsibilities split between DOI and Exchange High level guidelines for

Certification Activities AccreditationMarketing Requirements Complaint DataMLR requirements Claim Payment DisclosuresNetwork Adequacy Discriminatory Benefit Design ReviewOut-of-Network Disclosure Requirements Essential Benefit ValidationQHP Quality Measures Essential Community Health ProvidersParticipation Requirements Financial DisclosuresProvider Directory Formulary RequirementsSolvency Requirement Licensure Requirements 8

Supplemental Plans Pricing of supplemental plans Bundling of benefits Supplemental plan requirements Comparison of supplemental plans 9

Administration of Premium Credits and Cost Sharing Assistance Plans sold off the exchange are not eligible for premium tax credits or cost sharing subsidies Members qualify at enrollment – Exchange calculates potential tax credit – Can select what portion of the tax credit to take in advance – Need to file a tax return the year after the tax credit, e.g. need to file taxes in 2015 if receive 2014 tax credits – Some “claw back” provisions are in place 10

Exchange Carrier Premium Tax Credit Requirements The Exchange is the system of record for premium tax credits The Exchange and carriers must reconcile enrollment no less than monthly The Exchange and carriers must coordinate to ensure the advance premium tax credits are in sync 11

Exchange Carrier Cost Sharing Subsidy Carriers must provide additional plan design variations for each Silver plan for individuals meeting the eligibility criteria Each carrier will receive a prepayment for the cost sharing reductions which is reconciled with the IRS at the end of the year The Exchange/DOI must review the prepayments for reasonableness as well as ensure certain regulations are met 12