1. Health Exchanges that Work for Business IOWA ISCEBS September 2011
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2. Healthcare Reform Heightens the Need for Accurate and Efficient Ben Admin and requires each State to have its own health exchange by 2014
I’ll close this portion of the presentation today by tying back to the data Lisa presented on the biggest concerns employers have around benefits. If you re-call, the cost of providing sufficient health and welfare benefits and Healthcare Reform top the list. With the passage of the Patient Protection and Affordable Care Act these two concerns will come even closer together. Take for example the requirement to provide benefits to dependents up to the age of 26. What will that cost your firm? It should be easier to administer any way , right? Well, maybe not when you consider the questions that are yet unanswered about dependents that are employed and offered health benefits and who is responsible to cover the dependents of those dependents? Not to mention how state specific laws will “trump or not trump” the federal law such as Nebraska’s requirement to cover dependents to age 30!! In the next 3 to 5 years as this legislation gets sorted out we can expect non-stop change and even more complexity. For many companies, this is an ideal time to wring out inefficiencies in benefit activities. Companies that are interested in learning where they lack automation and what that is costing them are invited to take the 30 minute version of our survey. We’ll provide you with contact information shortly.
The Senate Health Care Bill Printed
11/17/2018

3. The world of employee benefits is complex and rapidly changing

4. How does an exchange work?
bswift
Admin Portal
HR Portal
EE Portal
Carrier A
Carrier B
Carrier C
Carrier D
Etc.

5. Guiding Principle #1 Provides consumers with real choices by:
Allowing carriers to sell small group product outside the exchange
Placing no artificial restrictions on the number and/or types of product options available inside or outside the exchange
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6. Guiding Principle #2
Maximizes competition between health insurance carriers by:
Encouraging small group insurance carriers to offer product in Iowa (and all States) both inside and/or outside of the exchange
Allowing any carrier to participate in the exchange
Utilizing an open and transparent process so that there is confidence in the choices presented by the exchange
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7. Guiding Principle #3 Controlling costs to the consumers by:
Eliminating benefit mandates inside and/or outside the exchange
Encouraging the availability of innovative plan designs, such as high deductible plans to address the need to attract the “young invincibles”
Protecting the pre-tax benefits of buying insurance through an employer
Supporting 2 separate exchanges, one designed specifically for the small employer and one for the individual market, operated by the appropriate governing structures
Including health care cost and quality transparency requirements
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8. Guiding Principle #4
Uses qualified and licensed agents/brokers to assist employers interested in using the exchange by:
Establishing adequate compensation levels to licensed agents/brokers that assist small employers and individuals in purchasing health insurance through the exchange
Allowing any qualified and licensed broker/agent to sell products through the exchange
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9. Guiding Principle #5
Does not increase the size and cost of State Government by:
Utilizing the oversight capabilities which the OCI is already equipped and designed to provide
Not creating an additional governmental agency or quasi-governmental agency to “run/operate” the exchange
Utilizing technology and/or services that already exist in the private sector
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10. The Utah Health Exchange
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11. Advantages of the Utah Health Exchange
EMPLOYERS
Simplified Benefits Management
Predictable costs
Expanded Coverage Choices
Preserve Tax Benefits
EMPLOYEES
Individual Control and Choice
Pay with Pre-tax dollars
Plan Portability
Premium Aggregation
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12. Similarities: Massachusetts and Utah
State-based solution designed to be responsive to state-specific issues, customs, business practices, etc.
Consumer-centered approach
Achieved broad, bipartisan consensus supporting the basic reform elements
Utah
State-based solution designed to be responsive to state-specific issues, customs, business practices, etc.
Consumer-centered approach
Achieved broad, bipartisan consensus supporting the basic reform elements
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13. Differences: Massachusetts and Utah
Individual mandate
Employer mandate
Government role is contracting agent
Established Massachusetts Connector Authority with broad regulatory responsibilities
Acted first on public sector reforms; now rolling out private insurance market reforms
Utah
No individual mandate
No employer mandate
Government role is market facilitator
Regulatory authority strictly limited to establishment of electronic data standards
Began by implementing private market reforms first; public sector reforms to follow
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14. Differences: Massachusetts and Utah
No risk adjustment mechanism included
Upfront appropriation of $25 million; ongoing funding through retention of a portion of premium
Staff of approximately 45 employees
Utah
Risk adjustment mechanism established to deal with adverse selection issues
Upfront appropriation of $600,000; ongoing funding through annual appropriation and technology fees
Staff of 2 employees
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15. How does the Exchange work?
Step 1 – Employer signs up
Step 2 – Employee enters information
Step 3 – Premiums are generated
Step 4 – Employee comparison shopping and open enrollment period
Step 5 – Finalize enrollment
Step 6 – Plans go into effect on designated date
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17. Employees use the Exchange to begin the health plan selection process
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18. The Utah Health Exchange offers an employer-funded (Defined Contribution), consumer-centric solution for the purchase of health insurance
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19. HDHP’s/HSA-eligibility
Consumers shop from 4 carriers and 100+ plans, with the ability to search for the optimal plan based on:
carrier
provider
HDHP’s/HSA-eligibility
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20. bswift’s Best Fit tool empowers consumers to find the optimal plan, given the health status of the employee/family and likely health needs and expenses.
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21. Plans can be sorted based on Premium Cost, Estimated OOP Costs, and Total Costs
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22. Consumers then compare plans in more detail to make the best selection
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23. Dependents are then enrolled or waived, as desired
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24. If the employee selects a qualified HDHP, an HSA option is presented.
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25. Upon viewing the plan selections, coverage and costs, the employee confirms the purchase
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26. For more information contact:
Ray Seaver Joe Thomas
Executive Vice President Regional VP of Sales bswift (312 )
(414) ( 952)
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