how to enroll in health insurance on the connect for health colorado marketplace

How to Enroll in Health Insurance on the

Connect for Health Colorado Marketplace

Small Business Majority

Emily Dewey

Health Coverage Guide

Connect for Health Colorado

Jim Sugden

Small Business Marketplace Manager

Agenda

• The new marketplace (Connect for Health Colorado)

• Health insurance definitions

• Enrollment preparation

• Applying on ConnectforHealthCO.com

• Small business tax credit

About Small Business Majority

• Small business advocacy organization – founded and run by small business owners

• National – offices in Washington, D.C., Ohio, Colorado, Missouri, Virginia, Washington State, New York and California

• Research and advocacy on issues of top importance to small businesses (<100 employees) and the self-employed, including healthcare, access to credit and clean energy

• Very focused on outreach to and education of small business owners across the country

What is Connect for Health Colorado?

• Competitive marketplace for private health insurance

• Makes comparing and purchasing commercial health insurance plans more convenient and competitive

• Provides broad array of choices in one place

• Helps you make an informed decision by creating transparency about your options

• Only place to check eligibility for new tax credits and apply them right away to reduce your costs

• Offers you statewide network of trained professionals to help you access the new financial help and find the health plan that is right for you and your family

• A new service operated by a non-profit with the mission to help Coloradans

92 Health Plans for Small Employers

Competing for Your Business:

• Anthem Blue Cross and Blue Shield / HMO Colorado

• Colorado Choice Health Plans

• Colorado HealthOP

• Kaiser Permanente

• Rocky Mountain Health Plans

• SeeChange Health

– Premium: The monthly amount that you must pay for your health / dental insurance (coverage)

– Deductible: You need to pay this amount before your plans starts helping you pay for most covered services through coinsurance.

– Annual Out of Pocket Max: This is the most you’ll pay for care during a policy period (usually a year) before your plan starts paying 100 percent for most covered services.

– Copay: A fixed amount (for example, $15) you pay for a medical visit or for medication that is covered under your health plan, usually when you receive the service. This is considered part of your out-of-pocket costs, separate from premiums and deductibles.

– Coinsurance: After reaching your deductible, you may start paying a percentage of the total cost for certain services. Coinsurance usually reflects the percentage of medical expenses that you are responsible to cover, for dental expenses the percentage reflects what the dental plan will cover.

Health Insurance 101

Source: Cliff Craig, Connect for Health

– HMO: A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. (No Out of Network Coverage)

– PPO: A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals and providers outside of the network for an additional cost. (Out of Network Coverage but at higher cost-sharing)

– EPO: A more restrictive type of preferred provider organization plan under which employees must use providers from the specified network of physicians and hospitals to receive coverage; there is no coverage for care received from a non-network provider except in an emergency situation. (No Out of Network Coverage)

Health Insurance 101

Source: Cliff Craig, Connect for Health

The Enrollment Process

• Gathering information

• Employer account creation

• Creating enrollment

• Employee responsibilities

Info You’ll Need to Enroll

• For all employees:

– Date of hire

– Email address

– Date of birth

– Social Security Number

– Home address

– Salary

– Hours worked per week

• For all dependents:

• Date of birth

• Social Security Number

Enrollment Process - Employer

• Create account

• Create roster (list of all employees)

• Attest to small business status (2-50 employees)

• Create census (list of employees offered coverage)

• Create enrollment– Define enrollment period

– Select census

– Define plan selection options

– Define contribution

– Browse/select plans

– Complete enrollment

Enrollment Process – Employer, cont.

• Send welcome message to employees

• Check participation rate – At least 70% of employees must accept or decline

coverage

• When enrollment period closes, submit application– Send payment to Connect for Health

Ongoing:

• Manage enrollment– Change roster

– Manage employee life change events

– Pay monthly premium

Enrollment Process – Employees

• Receive welcome message with participation code

• Create account on employee portal

• Enter participation code to associate with

employer account

• Shop and select plan during open enrollment

period

• Submit application

Creating an Account

• Go to www.connectforhealthco.com

Creating an Account, cont.

Creating an Account, cont.

Adding Employees

Adding Employees

Adding Employees

Adding Dependents

Click ‘Save & Continue’

Create Your Census

1

2

3

Create an Enrollment

Creating an Enrollment

Select Census

Define Plan Selection Options

Define Contribution

Filter Plans

Filters:

• Employer contribution

• Employee contribution

• Annual deductible

• Carrier

• Metal level

Review Enrollment

Send Welcome Message

• Despite not being subject to employer shared responsibility provisions, the Marketplace may help make healthcare more affordable for small employers

o How will it be different?

o Small business tax credit

o Greater employer choice- shop by price, plan, service, level of coverage

o Pooling together of small businesses

o How will it be similar?

o Private insurance competing for business

o Option for small employers, insurance still sold outside

Small Business Marketplace

Small business tax credits

• Available to businesses with employees

• Took effect immediately (tax year 2010)

• Which businesses are eligible?

Fewer than 25 full-time employees

Average annual wages <$50,000

Employer pays at least 50% of the premium cost

Small business tax credits

• Tax credits on a sliding scale:

o Up to 35% of premium expenses for 2010–13

o Up to 50% of premium expenses for any two years beginning 2014

• Tax credits do not cover premium expenses of owners or their families

• Tax credits can not be claimed by the self-employed

• Still as an amendment to your 2010 taxes, or can be carried back to tax year 2010.

Contact Connect for Health Colorado:

www.connectforhealthco.comCall center: 855-PLANS-4-YOU (855-752-6749)

For More Information: www.smallbusinessmajority.org

healthcoverageguide.org/states/colorado/

Resources

Emily DeweyHealth Coverage GuideSmall Business Majority

edewey@smallbusinessmajority.org

Jim SugdenSHOP Marketplace ManagerConnect for Health Colorado

jsugden@connectforhealthco.com

Join Our Network

• Emma Hollister, Network Coordinator

• Email: ehollister@smallbusinessmajority.org

• Direct: (202) 535-3229

Connect with us!

@SmlBizMajority

Small Business Majority

Ways to Get Involved:

Contact

• Receive a monthly newsletter

• Share your story for media requests

• Letters to the editor/Op-eds

• State events/Roundtables

• Fly-ins

• Webinars for business organizations