2016 & beyond rhonda fossitt senior deputy director july 17, 2015

2016 & Beyond

Rhonda FossittSenior Deputy DirectorJuly 17, 2015

ACA: 2016 Highlights – Year 3

• Number of Issuers & Plans by Market

• Employee Choice on the SHOP

Small GroupOn/Off Market

7 Issuers337 Plans

Small GroupOff Market15 Issuers434 Plans

IndividualOn/Off Market

15 Issuers227 Plans

IndividualOff Market6 Issuers29 Plans

2016 Number of Issuers &Plans by Market

IndividualOn/Off Market

15 Issuers227 Plans

2016 Individual – On/Off Market

IndividualOn/Off Market

1 Issuer 11 Plans

Change Since 2015

IndividualOff Market6 Issuers29 Plans

2016 Individual – Off Market

IndividualOff Market 1 Issuer

125 Plans

Change Since 2015

2016 Small Group – On/Off Market

Small GroupOn/Off Market

7 Issuers337 Plans

Change Since 2015

Small GroupOn/Off Market 4 Issuers 53 Plans

2016 Small Group – Off Market

Small GroupOff Market15 Issuers434 Plans

Change Since 2015

Small GroupOff Market

No Change In Issuers 292 Plans

2016 Employee Choice for the SHOP

• Originally scheduled for 2015• Michigan opted to delay• Employee Choice

- Employers may allow employees: to choose any health plan at metal level

selected by employer

ACA: 2016 Timeline RemindersActivity Dates

Company-wide Participation in Plan PreviewContact DIFS if Errors Found (NEW!)

7/17/2015to 8/5/2015

Date to Review & Contact DIFS on Plan Preview (NEW!) 8/5/2015

CMS Notifies DIFS/Issuers of Necessary Correctionsto QHP Data

8/13/2015to 8/14/2015

Final Deadline for Issuers to Resubmit Data to DIFS 8/20/2015

Begin Marketing or Pre-EnrollmentOn or Off Marketplace

*Date QHP Agreements are Finalized with CMS

(Approx. 10/9/2015)

*Applies even if you are not required to sign QHP Agreement

ACA: 2016 Significant Issues – Year 3

• Expansion of Small Group• Large Group Transitional Policy

Expansion of Small Group MarketUnder ACA

• Effective January 1, 2016• Definition of “small employer” will change

- Employers with 100 of few FTE employees- Previously 50 or fewer

Expansion of Small GroupMarket Under ACA

According to American Academy of Actuaries:• Number of employees covered under small group

market may increase by 30%• Groups sized 51-100 will have more restrictive rating

rules• Groups sized 51-100 will have more benefit and

cost-sharing requirements• Could result in more self-insurance

Keep Current Definition ofSmall Group

• Legislation introduced in Congress to keep current definition of small group

• With King v Burwell behind us, legislation may move forward

• Legislation supported by many groups• If law is enacted, timing will be important

Large Group Transitional Policy

Michigan has adapted the Large Group Transitional Policy• Allows small employers (51-100)• Renewing prior to 10/1/2016• To delay adapting the small group definition• Transitional policies may not remain in effect

beyond 10/1/2017

ACA: DIFS Selected a BenchmarkPlan for 2017

As per HHS guidance, DIFS compared 10 plans in-force 3/31/2014:• 3 Largest Small Group Plans• 3 Largest State Employee Plans• 3 Largest Federal Employee Plans• Largest HMO Plan

ACA: DIFS Selected a BenchmarkPlan for 2017

DIFS:• Prepared comparison chart of 10 plans, along

with Benchmark Plan for Dental and Vision• Posted for public comment – May 15 to June 5• Reviewed public comment

Priority Health HMO Selected as Michigan Benchmark Plan

Selection Based on:• Mitigating rate increases for Michigan consumers• Ensuring all EHB requirements are met• Substantially similar to the current EHB benchmark

plan

The 2017 Essential Health Benefits Benchmark Plan Executive Report is posted on the DIFS website. This report outlines the process and selection of the plan.

Michigan Benchmark Plan – Final Steps

CMS will:• Post for public comment in late summer• Post the approved version in the Fall of 2015