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ACA Townhall - Options for small business, Jason Andrew ICC prez
- 1. Market Today Small Group Market (2-50 employees) Individual Health Insurance: Individuals can be declined Based on health Guaranteed: No one can be declined for health 1 7+ Small Group Carriers 7+ individual Carriers
- 2. Market > January 1, 2014 No one can be declined In ANY market for ANY reason Small Group Market Non Exchange Market (similar to today) 7+ Small Group Carriers 2 SHOP Exchange (Covered CA) 13+ Small Group Carriers Individual Market Income based subsidies 10+ Individual Carriers
- 3. 2014 Small business Options Small Group Non Exchange Market (like today) Small Group SHOP Exchange Market (New) Individual Market ‘Defined Contribution’ Individual Exchange ‘Subsidy’ 10/27/2013
- 4. How rating will change in 2014 Today 7 Age-bands, no ratio rules Family Tier Rating 7 rate areas Based on the employer zip code Risk Adjustment Factors (.901.10) 2014 and Beyond 45 Age Bands, 3:1 max ratio Member Level Rating 19 rating areas Based on employee or employer zip code - TBD No Risk Adjustment Factors Groups with grandfathered plans will continue to be rated as we do today, in 2014 Groups with non-grandfathered plans will be rated in the 2014 and beyond methodology Groups with grandfathered and non-grandfathered plans will be rated using 5/8/2013 | © Kaiser Permanente2424 4 both methodologies 2013. All Rights Reserved.
- 5. Member Level Rating Compare and Contrast Rate Structure $30 Copay Plan at a 1.0 Current Rates Structure Based on the subscriber age and family tier ACA Compliant Rate Structure Based on each family member age Current Rates $30 Plan Age <30 $303 $847 $833 $1,179 30-39 $335 $910 $856 $1,303 40-49 $432 $994 $821 $1,312 50-54 $563 $1,170 $928 $1,495 55-59 $711 $1,493 $1,063 $1,717 60-64 $877 $1,666 $1,173 $1,945 65+ 5 EE EE + SP EE + CH FAM $995 $2,150 $1,496 $2,363 Illustrative ACA Compliant Rates Age 0-20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 5/8/2013 | © Kaiser Permanente2424 2013. All Rights Reserved. Rate $196 $308 $308 $308 $308 $309 $315 $323 $335 $345 $350 $357 $364 $369 $374 $376 $379 $381 $384 $389 $394 $401 $408 Age 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64+ Rate $418 $430 $445 $462 $481 $503 $525 $550 $574 $601 $628 $657 $687 $718 $750 $785 $802 $836 $865 $885 $909 $924
- 6. Example 1 of Member Level Rating Impact Current Rates EE + EE + Age EE SP CH FAM <30 $303 $847 $833 $1,179 30-39 $335 $910 $856 $1,303 40-49 $432 $994 $821 $1,312 50-54 $563 $1,170 Family Premium: Member Level Rating $928 $1,495 55-59 $711 $1,493 $1,063 $1,717 60-64 Age $877 $1,666 $1,173 $1,945 Rate 65+ 53$995 $2,150 $1,496 $2,363 Joe $628 Spouse 48 $503 Child 18 $196 $1,719 Child 16 $196 Child 14 $196 Child 12 $0 6 ACA Compliant Member Employee: Joe age 53 with spouse and 4 Children Age Rate Age Rate Age Rate Rates 0-20 $196 35 $376 50 $550 Family Coverage Tier $379 51 $1,495 Premium: $574 21 $308 36 22 $308 37 $381 52 $601 23 $308 38 $384 53 $628 24 $308 39 $389 54 $657 25 $309 40 $394 55 $687 26 $315 41 $401 56 $718 27 $323 42 $408 57 $750 28 $335 43 $418 58 $785 29 $345 44 $430 59 $802 30 $350 45 $445 60 $836 31 $357 46 $462 61 $865 32 $364 47 $481 62 $885 33 $369 48 $503 63 $909 34 $374 49 $525 64+ $924 5/8/2013 | © Kaiser Permanente2424 2013. All Rights Reserved.
- 7. Example 2 of Member Level Rating impact Current Rates EE + EE + Age EE SP CH FAM <30 $303 $847 $833 $1,179 30-39 $335 $910 $856 $1,303 40-49 $432 $994 $821 $1,312 50-54 $563 $1,170 $928 $1,495 55-59 Member$711 Rating Family Premium: Level $1,493 $1,063 $1,717 60-64 $877 $1,666 $1,173 $1,945 Rate 65+ Age$995 $2,150 $1,496 $2,363 $628 Joe 53 $503 $1,327 Spouse 48 $196 Child 18 7 ACA Compliant Member Employee: Joe age 53 with spouse and 1 ChildRate Age Rate Age Rate Age Rates 0-20 $196 35 $376 50 $550 Family Coverage Tier $379 51 $1,495 Premium: $574 21 $308 36 22 $308 37 $381 52 $601 23 $308 38 $384 53 $628 24 $308 39 $389 54 $657 25 $309 40 $394 55 $687 26 $315 41 $401 56 $718 27 $323 42 $408 57 $750 28 $335 43 $418 58 $785 29 $345 44 $430 59 $802 30 $350 45 $445 60 $836 31 $357 46 $462 61 $865 32 $364 47 $481 62 $885 33 $369 48 $503 63 $909 34 $374 49 $525 64+ $924 5/8/2013 | © Kaiser Permanente2424 2013. All Rights Reserved.
- 8. Survey of 2013/2014 Renewals 8
Notas del editor
- There may not be different rates for each rate area but there will be 19 rate areas. Market standardization same geo ratings, member level rating, 3:1 ratio that each carrier is mandated to include. 3:1 applies to the 21-63 age band.*Employee/employer zip code is still in question. KP advocating for employee zip.
- These rates are only illustrative only. These are not the actual rates.Lets look at an example of the difference in rate structures between how we apply rates under AB1672 and the new ACA provisions. Under the current structure, there are 7 age bands and for tiers. Employee, Employee and Spouse, Employee and Child(ren) and Family. Under then new ACA provisions, rates are applied based on the number of members within a family and the actual age of each member. There is a cap on the number of under age 20 children to a maximum of three (3). Furthermore, for dependent children under 20, if there are more then three, you must rate for the three oldest children. Today, when an employee age changes the employee rate tier, we apply the new rate the first of the month following the birthdate. Under the new provisions, we can not apply the new rate until the next renewal. We will apply this consistently for both grandfathered and non-grandfathered groups.
- Lets look at an example of an employee and their Family. Under the current rate structure, the rate for this family would be $1,495.00 per month. Under the new rate structure, the rate for this family would be $1,719.00. Since the rate is determined based on the actual number of members in the family, this family rate would be higher under the new Member Level Rating structure.
- Now, lets take a look at another example of and employee with the same age and the same family composition. In this example, the employee only has one child under 20. In this example, the employee actually pays less then the current rate structure.