As Glen Shor put it, the Connector is moving full steam ahead with Affordable Care Act (ACA) implementation. Today, the Connector Board discussed possibilities for updating the Connector’s health plan offerings to meet ACA requirements and offer products with “market appeal.” Materials from the meeting are here.
Before diving into proposed strategies for offering new insurance products, Glen Shor updated the Board with enrollment numbers for Connector programs. As of November 1st, CommCare had 195,853 enrollees, a significant increase from October. CommChoice had 43,734 subscribers, which is relatively flat enrollment.
Shor also acknowledged Stephanie Chrobak, the Connector’s Director of Programs, who is leaving the Connector at the end of this week. On behalf of Health Care For All, I want to thank Stephanie for her commitment to ensuring the viability and accessibility of the CommCare program, even under difficult fiscal constraints, and for her leadership in effectively integrating the CommCare and CommChoice teams in preparation for ACA implementation.
With that, Connector staff dove into a presentation about the proposed 2014 Seal of Approval (SoA) product development strategy, focusing on metallic tiers, actuarial value, stand-alone dental plans, and employee choice offerings.
Medical Insurance Products
Under the ACA, all small and non-group plans both inside and outside the Exchange (our Exchange is the Connector) must fit into metallic tiers based on actuarial value. Actuarial value (AV) is the percentage of total average costs for covered benefits a plan covers.
The Connector used the AV model in the early years of CommChoice. However, in response to feedback from consumer focus groups, the Connector began offering only standardized products in 2009. Currently, the Connector offers 4 tiers of standardized plans in CommChoice (Gold, Silver, Bronze, Young Adult) based on cost-sharing parameters. The Connector intends to continue offering standardized plans as well as non-standardized plans to expand choice and respond to feedback from small businesses.
The Connector is developing decision support tools to help consumers navigate their health insurance options. They added a “plan helper” to their website, which provides information on key health insurance concepts (e.g. deductible) and allows consumers to search for plans based on their cost-sharing and provider preferences. Additional decision support tools will be available as part of the Health Insurance Exchange-Integrated Eligibility System (HIX-IES) project.
Dental Insurance Products
The ACA requires that pediatric dental coverage be included in the Essential Health Benefits (EHB) package. However, a medical insurance plan that does not cover dental may still be certified as a Qualified Health Plan (QHP) as long as the Exchange also offers stand-alone dental plans that include required pediatric benefits.
This summer, the Connector received legislative authorization to sell stand-alone dental plans. Most medical plans in the Massachusetts market do not offer extensive dental coverage. In fact, according to the Division of Insurance (DOI), more than 90% of dental coverage in the Commonwealth is sold through stand-alone carriers.
The Connector hopes offering stand-alone dental plans will increase the dental coverage take-up rate and address important health care needs. That said, purchasing dental coverage is voluntary and new Advanced Premium Tax Credits (APTCs) will apply to pediatric dental benefits but not adult dental benefits. As adult stand-alone dental plans will remain unsubsidized, the Connector is considering strategies to address affordability.
The ACA requires Employee Choice products to be offered in each state’s Small Business Health Options Programs (SHOP) Exchange. Employee Choice allows employers to select a metallic tier of coverage and employees to choose from all QHPs within the chosen tier. The Connector plans to use their Contributory Plan (CP) model, a pilot which ran during 2009, as a basis for the ACA-mandated Employee Choice program.
Here’s how the CP model works:
• The employer chooses a benchmark plan within a metallic tier.
• Employees who choose the benchmark plan all pay the same premium and the employer contribution varies by employee.
• Employees who choose alternative plans within the same tier will have different premiums depending on the plan they choose, as the employer premium contribution is fixed based on the benchmark plan.
In addition to updating and refining the CP, the Connector plans to continue offering Business Express (sole-source model) and employee choice within a single carrier. Overall, the Connector expects to continually learn from experience and refine their strategy as they moved toward full implementation of the ACA and beyond.
The next Connector Board meeting is scheduled for Thursday, December 13th from 9-12 at 1 Ashburton Place, 21st floor.