update: small business marketplace

September, 2013

UPDATE:Small Business Marketplace

• What is the NY State of Health• Eligibility and Enrollment• Consumer Assistance• Qualified Health Plans• Small Business Marketplace

– Policy changes to the existing market– Value of the Marketplace for the employer– Small Business Tax Credit

• Financial Assistance for Individuals• Broker Engagement• Resources• Next Steps for Small Businesses

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Agenda

What is NY State of Health?• Organized marketplace

– One-stop shopping for subsidized and unsubsidized coverage– Easily compare health plan options – The only place to check eligibility and apply for financial

assistance– Enroll in qualified health plans

• Two programs – Individual Marketplace (individuals and families, sole proprietors)– Small Business Marketplace (businesses with 50 or fewer

employees)

Who is Eligible?You will be eligible to purchase a health plan

through the Marketplace if you:• Live in New York• Are a citizen or lawfully present immigrant

(different immigration rules may apply if you are eligible for Child Health Plus or Medicaid)

• Own or work for a small business with 50 or fewer eligible employees

Individual Marketplace (58%)

Small Business Marketplace (42%)

Who Will Enroll In NY State Of Health?Health Plan Marketplace enrollment is estimated to be

1.1 million New Yorkers

450,000 615,000

NY State of Health Enrollment• Open Enrollment begins on October 1, 2013• Coverage Starts on January 1, 2014• Individuals

– May enroll in health plans during open enrollment: October 1, 2013 - March 31, 2014 (or with a qualifying event)

– Individuals who qualify for Medicaid/CHP may enroll any month of the year

• Small employers – May choose open enrollment dates for their employees any

month of the year

• Online– Through the Exchange portal for new applications and administrative

renewals– Webchat for assistance

• In Person– In Person Assistors and Navigators– Agents and Brokers– Informal Assistors– Assistance available in many languages

• Phone– Leverage current public program call center– Assistance available in most languages

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Consumer Assistance

Online Enrollment• One portal will process applications for:

– Medicaid– Child Health Plus– Individual Marketplace– Small Business Marketplace

• System in rigorous testing for October 1 open enrollment

Customer Service Call Center• Assistance available in over 170 languages

– Many staff will be bilingual and oral interpretation will be available for remaining languages.

• Will take applications over the phone starting in October

• Can refer to in-person assistors

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3 Types of In-Person AssistorsIPA/

Navigators• Complete Applications• Compensation from DOH grant program• Training and certification required• Serve Individuals and Small Business Marketplace

Certified Application Counselors

• Complete Applications• No compensation from Marketplace• Training and certification required

Insurance Brokers/Agents

• Complete Applications• Commission-based compensation• Training and certification required• Choose to certify in Small Business Marketplace,

Individual, or both

• 50 Navigator organizations throughout the state Hundreds of trained individuals that speak 48 different

languages Site schedules will be publicly available 5 day training and certification coursehttp://www.healthbenefitexchange.ny.gov/IPANavigatorMap

• Insurance Brokers More than 2,000 brokers have already completed continuing

education for the Marketplace

• Certified Application Counselors Hospitals, healthcare providers, health plans, others

3 Types of In-Person Assistors

http://www.nystateofhealth.ny.gov/PlansMap

http://www.nystateofhealth.ny.gov/PlansMap

Qualified Health Plans

Bronze Silver Gold Platinum0%

10%20%30%40%50%60%70%80%90%

100%

60%70%

80%90%

Actuarial Values for Levels of Coverage

Required Ten Essential Health Benefits1. Ambulatory patient services2. Emergency room services3. Hospitalization4. Maternity and newborn care5. Mental health and substance abuse disorders6. Prescription drugs7. Rehabilitation and habilitation services and devices8. Laboratory services9. Preventive and wellness services and chronic disease

management10. Pediatric services, including oral and vision

Key Policy Decisions Related to the Small Business Marketplace

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• Small Group Market Size− 50 or fewer eligible employees in 2014 (will raise to 100 full time

equivalent employees by 2016)• Market Merger

− NY will leave the individual and small group markets separate − Staring on January 1, 2014 Sole Proprietors will access coverage through

the Individual Marketplace• Standard Plan Selection

− All carriers have to offer a standard product in each metal level− Premium rates will be the same both inside and outside of the exchange

for the same product• No Minimum Participation or Minimum Contribution

− NYS will not require a minimum number of employees be enrolled in a QHP nor require an employer to contribute an amount towards premium

Small Business Marketplace:Value for Small Employers

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Choice• Employers and employees regard expanded choice as a key advantage to using

the Marketplace.

Administrative Simplicity• The Marketplace provides monthly billing to employers along with other

administrative simplifications.

Tax Credits• The Marketplace will be the exclusive place to access small business tax credits in

2014.

Contribution Options• 76% of respondents believe this feature helps predict costs.

Employer Coverage Options

Employer Contribution Options

1) Select among QHPs offered by a specific carrier

2) Select specific QHPs offered by multiple carriers

3) Select a metal tier of coverage

4) Allow employees to select any Marketplace QHP

1) Uncapped percentage (e.g., employer pays 55% of premium)

2) Capped percentage (e.g., employer pays 55% of premium, up to $300)

3) Defined dollar amount (e.g., employer pays $300/month)

Employer Coverage and Contribution Options

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• Internal Revenue Code - 45R• A tax credit of up to 35% (25% for tax-exempt) is available now to

small businesses that offer insurance coverage to employees:– Must have fewer than 25 employees with an average annual salary of $50k or

less– Employer must contribute at least 50% of premium

• In 2014, the tax credit will increase:– Up to 50% of employer contribution (35% for tax-exempt)– The maximum tax credit of 50% may be claimed by businesses that have 10 or

fewer employees with an average annual salary of $25k or less– As the number of employees and average salary increases, the credit decreases

• Exchange will be the only place to access the tax credit after 2013 • Exchange will provide real-time estimate of credit at time of

application for those who qualify• Advised to work with tax advisor for tax information

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Small Business Health Care Tax Credit

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Financial Assistance for Individuals• Many individuals and families will be eligible for financial

assistance to reduce the cost of coverage

• Financial assistance is available in 2 forms– Tax credits will reduce the cost of premiums for most single adults

earning less than $45,960 and for families of 4 earning less than $94,200

– Cost-sharing reductions will lower co-payments and deductibles for those earning less than $28,725 for single adults and families of 4 earning $58,875

• Tax credits and cost sharing reductions are estimated at the time of application and applied immediately

Broker Engagement• Brokers will be a primary distribution channel for small group enrollment in

the Small Business Marketplace− 88% of NYS small group coverage currently sold through brokers

• Brokers must be certified to sell products in the Marketplace

• Brokers will have the support of a dedicated online portal to facilitate applications and renewals

− Broker can also serve as employer proxy in employer portal

• Marketplace will support brokers with a full customer service center

• Commissions will be paid directly from carriers– Commissions must be the same inside and outside the Marketplace

Broker Certification• The Department of Financial Services (DFS) has approved the

certification course for the Small Business Marketplace.– A certification course to sell insurance through the Individual

Marketplace is forthcoming.– Small Business Marketplace certification is a prerequisite to

Individual Marketplace certification.• Course training schedule and list of approved vendors:

– http://www.dfs.ny.gov/insurance/agbrok/ab_shop.htm• Agents/Brokers completing these courses will earn continuing

education credits toward the renewal of their insurance licenses.• These are the only approved courses for certification to sell

insurance through the Marketplace.

Available Resources

• Website (Now)• Fact Sheets & Newsletter templates• Navigator Map• Health Plan Map• Financial Assistance Calculator

• Materials (Oct.)• Rack cards and Fact Sheets• Posters

• Customer Service Center Phone Line (Sept 16 opens to answer questions)

• In-person Assistance–Local Navigators (Oct.)

Next Steps for Small Businesses• Talk with your insurance broker about how they can

help you make the best choices for employees. • Ask your tax advisor if your business may qualify

for the Small Business Health Care Tax Credit • Visit the Exchange website for latest information for

small business• Sign up for email updates

– http://www.nystateofhealth.ny.gov/

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NY Health Plan Marketplace ContactsHeather Rankin

Small Business Marketplacehpr01@health.state.ny.us

Get regular updates at: www.nystateofhealth.ny.gov