Access Health ConnecticutAHCT Broker WebinarDecember 12, 2019

Agenda

• Recap: Individual Market Changes for 2020 Certification Requirements

• Moving Forward: 2021 Plan Year Information Collection: Potential Exhibits

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Recap: Individual Market Changes for 2020

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2020 QHP Offerings –Summary

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Topic “On-Exchange” Individual Market “On-Exchange” Small Group MarketCarrier

ParticipationAnthem Health Plans Inc. (Anthem)

ConnectiCare Benefits Inc. (CBI)Anthem Health Plans Inc. (Anthem)

ConnectiCare Benefits Inc. (CBI)CID 2019 Rate

Filing DecisionsAnthem: -7.3 to +16.7%

CBI: -3.1 to +8.7%Anthem: +7.4 to +27.6%

CBI: -10.0 to +9.7%Plans to be

Offered via AHCTAnthem: 9

CBI: 8Anthem: 9

CBI: 5New Plans (#) Yes (4) No

Plan Crosswalk13 of the 2019 plans are renewing;

2 Silver plans per carrier not renewing (enrollees mapped to carrier’s remaining Silver plan)

All 14 of the 2019 plans are renewing

Common Cost Share Changes

(# of Plans)

MOOP (11); Emergency Room (7); Outpatient Facility (7); Rx Tier 1 (6); Deductible (6); Rx Tier 3 (6)

• Additional flexibility on copay maximums

MOOP (11); Urgent Care (8); Specialist (7); Deductible (6); Rx Tier 1 (5)

• Additional flexibility on copay maximums

Noteworthy Items

• CBI adding Adult Dental Preventive Benefit (Non-EHB) to non-standard Catastrophic, Bronze & Gold plans

• CBI new Gold non-standard plan includes $0 PCP copay at Sanitas Center (design similar to terminated Silver plan)

• ConnectiCare Inc (CCI) “Off-Exchange” Silver plan is lower in premium than any “On-Exchange” Silver plan (ranges by county

from -8.8% to -11.9%)• Anthem “On-Exchange” Gold non-standard plan is lower in

premium than any “On-Exchange” Silver plan (ranges by county from -0.1% to -11.8%)

• Plans (as of final filing to CID) by Metal Level

10 licensed insurance companies “On/Off”

Metal LevelOff- Exchange

ONLYOn-Exchange Total

Bronze 23 5 28Silver 62 5 67Gold 49 3 52

Platinum 16 1 17Grand Total 150 14 164

2020 QHPs: Plans Offered thru AHCT

*Catastrophic plans:• generally available only to those who are under 30 years old at the time of enrollment;• do not qualify for Premium Tax Credits 5

Individual Market

“On-Exchange” Permitted Number of Plans per Carrier “On-Exchange” Submitted Plans

Metal Level Standardized (Required)

Non-Standard(Optional)

Anthem Health Plans

ConnectiCare Benefits, Inc. Total

Catastrophic* N/A 1 1 1 2

Bronze 2 3 4 4 8

Silver 1 0 1 1 2

Gold 1 3 3 2 5

Platinum N/A 2 0 0 0

Total 4 Up to 9 9 8 17

2020 QHPs: What Changed from 2019?• Plan Benefits & Cost

Sharing– Cost sharing changes

for some covered services in mostrenewing plans

– Anthem Tiered-Network Plans Renewed (Gold & Bronze Non-Standard Plans)

– CBI Adult Preventive Dental Benefit (Catastrophic, Bronze & Gold Non-Standard Plans)

Individual Market Submitted Plans

Metal Level (Nbr) Anthem Health Plans ConnectiCare Benefits, Inc.

Catastrophic (2) 1 plan renewed 1 plan renewed

Bronze (8) 3 plans renewed;1 new plan

3 plans renewed;1 new plan

Silver (2) 1 plan renewed;2 plans terminated

1 plan renewed; 2 plans terminated

Gold (5) 2 plans renewed, 1 new plan

1 plan renewed;1 new plan

Net Change vs 2019: • 2 more Bronze plans• 4 fewer Silver plans• 2 more Gold plans

Current enrollees are notified by their insurance company about specific plan changes, including any resulting from assignment to an alternative from a terminated plan.

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2020 QHPs: Individual Market Silver Plans*

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2019 Anthem Blue Cross Blue Shield ConnectiCare Benefits, Inc. (CBI)Per Carrier:

2 standard Silver plans required with option to submit 1 non-standard

Silver plan

Silver PPO Pathway X

Tiered

Silver PPO Standard

Coinsurance Pathway X

Silver PPO Standard

Pathway X

Choice Silver Alternative

POS

Choice Silver Standard

Coinsurance POS

Choice Silver Standard

POS

2020 Anthem Blue Cross Blue Shield* ConnectiCare Benefits, Inc. (CBI)*Per Carrier:

1 standard Silver plan required (non-standard plans not permitted)

Silver PPO Standard Pathway X Choice Silver Standard POS

*Silver ‘On-Exchange’ plans filed with Connecticut Insurance Department (CID) for 2020 plan year

Comparison: On & Off-Exchange Plans

Bronze• In every county, at least two

Bronze plans offered via AHCT are lower in premium than any of the other 12 Bronze plans filed for Plan Year 2020 in the Individual Market

Silver• In all counties, one Silver “Off-

Exchange” plan filed by CCI is lower in premium than any of the other 9 Silver plans filed for Plan Year 2020

• Premium difference vs lowest “On-Exchange” Silver plan ranges by county from -8.8% to -11.9%

Gold• In every county, one Gold plan

offered via AHCT is lower in premium than any of the other 6 Gold plans filed for Plan Year 2020

• In all counties, this Gold plan is lower in premium than the lowest premium “On-Exchange” Silver plan (premium difference ranges from -0.1% to -11.8%)

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Individual Market Plans Filed for 2020

Wakely Consulting: Rate Review and Rate Impact Analysis Report*

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*Excerpts of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf

**Full report begins on page 71

Wakely Consulting: Rate Review and Rate Impact Analysis Report*

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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf

**Full report begins on page 71

Enrollees eligible for auto-renewal who

were enrolled in one of the 4 Silver plans

available in 2019 that will not be offered

for 2020 will be cross-walked to their carrier’s remaining

Silver plan

Wakely Consulting: Rate Review and Rate Impact Analysis Report*

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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf

**Full report begins on page 71

Enrollees eligible for auto-renewal can

shop for a different plan that may be

better suited to their needs for the 2020

plan year

Each carrier will be offering a new Gold

plan and a new Bronze plan for 2020

Each carrier will continue to offer a Catastrophic plan

Wakely Consulting: Rate Review and Rate Impact Analysis Report*

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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf

**Full report begins on page 71

Sample household scenario illustrates the net change in

premium for an enrollee in the lowest cost Silver plan in each county for 2019 when auto-

enrolled to their carrier’s remaining Silver plan for 2020

In every county except Litchfield, the enrollee will

remain in the lowest premium Silver plan after auto-

enrollment

Enrollee can also shop for an alternate plan

Wakely Consulting: Rate Review and Rate Impact Analysis Report*

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*Excerpt of October 17, 2019 presentation to AHCT Board of Directors – complete presentation available at: https://agency.accesshealthct.com/wp-content/uploads/2019/10/October-2019-BOD-Presentation.pdf

**Full report begins on page 71

Sample household scenario illustrates the net change in

premium for an enrollee in the lowest cost Bronze plan in each

county for 2019 when auto-enrolled to the same Bronze

plan for 2020

In every county, the enrollee will remain in the lowest

premium Bronze plan after auto-enrollment

Enrollee can also shop for an alternate plan

Moving Forward: 2021 Plan Year

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Plan Management Certification Life Cycle

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Regulations & Guidance

Develop AHCT Certification

Requirements

QHP Solicitation

PMP System Annual

Upgrades

QHP Application

QHP Application Submission

& Data Review

PMP Data Testing/

Uploads/ Issuer Preview

QHP/SADP Certification/

Data Publication

Open Enrollment November -

April

December -April

February -April

February -August

April -May

July -September

July -October

October

November - December

Each plan year, the cycle begins with the release of regulations and guidance, including the Actuarial Value Calculator (AVC) tool used to develop standardized plans, and ends once

Open Enrollment commences

Certification requirements for carriers, including development of standardized plans

takes place during this time period

Note: timeframes subject to change

AHCT Agency Website: Health Plan Benefits & Qualifications Advisory Committee

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https://agency.accesshealthct.com/

AHCT Agency Website: Health Plan Information

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https://agency.accesshealthct.com/

Appendix

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AHCT Individual Market Gold Plan

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PLAN FEATURE 2019 Standard Gold 2020 Standard Gold

Deductible: Individual (medical) $1,300 $1,300

Deductible: Individual (prescription) $50 $50

Out-of-Pocket Maximum: Individual $5,000 $5,250

Provider Office Visits

Provider Office Visits (Primary Care, Mental & Behavioral Health, Substance Abuse) $20 copayment per visit $20 copayment per visit

Specialist Office Visits $40 copayment per visit $40 copayment per visit

Prescription Drugs – Retail (up to 30-day supply/script)

Tier 1 $5 copayment per script $5 copayment per script

Tier 2 $25 copayment per script $35 copayment per script

Tier 3 $50 copayment per script $60 copayment per script

Tier 4 20% coinsurance up to a maximum of $100 per script after INET Rx deductible

20% coinsurance up to a maximum of $100 per script after INET Rx deductible

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020

AHCT Individual Market Gold Plan

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PLAN FEATURE 2019 Standard Gold 2020 Standard GoldOther Services

Outpatient Services (in a hospital or ambulatory facility)

$500 copayment per visit after INET plan deductible

$500 copayment per visit after INET plan deductible (OP Hosp) or

$300 copayment per visit after INET plan deductible (Freestanding Facility)

Hospital Services

Inpatient Hospital $500 copayment per day to a maximum of $1,000 per admission after INET plan

deductible

$500 copayment per day to a maximum of $1,000 per admission after INET plan

deductibleEmergency and Urgent Care

Emergency Room $200 copayment per visit after INET medical deductible

$400 copayment per visit after INET medical deductible

Urgent Care Center or Facility $50 copayment per visit $50 copayment per visit

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020

AHCT Individual Market Silver Plans

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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver 70% AV Level (>250% FPL) 73% AV Level (>200% to ≤250% FPL)

Deductible: Individual (medical) $4,300 $4,300 $3,900 $3,950

Deductible: Individual (prescription) $250 $250 $250 $250

Out-of-Pocket Maximum: Individual $7,900 $8,150 $6,300 $6,500

Provider Office VisitsProvider Office Visits (Primary

Care, Mental & Behavioral Health, Substance Abuse)

$40 copayment per visit $40 copayment per visit $40 copayment per visit $40 copayment per visit

Specialist Office Visits $50 copayment per visit $60 copayment per visit $50 copayment per visit $60 copayment per visit

Prescription Drugs – Retail (up to 30-day supply/script)

Tier 1 $5 copayment per script $10 copayment per script $5 copayment per script $10 copayment per script

Tier 2 $35 copayment per script after INET Rx deductible

$45 copayment per script after INET Rx deductible

$35 copayment per script after INET Rx deductible

$45 copayment per script after INET Rx deductible

Tier 3 $60 copayment per script after INET Rx deductible

$70 copayment per scriptafter INET Rx deductible

$60 copayment per script after INET Rx deductible

$70 copayment per script after INET Rx deductible

Tier 420% coinsurance up to a

maximum of $200 per script after INET Rx deductible

20% coinsurance up to a maximum of $200 per script

after INET Rx deductible

20% coinsurance up to a maximum of $100 per script

after INET Rx deductible

20% coinsurance up to a maximum of $100 per script

after INET Rx deductibleAV = Actuarial ValueFPL = Federal Poverty Level

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020

AHCT Individual Market Silver Plans

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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver

70% AV Level (>250% FPL) 73% AV Level (>200% to ≤250% FPL)Other Services

Outpatient Services (in a hospital or ambulatory facility)

$500 copayment per visit after INET plan deductible

$500 copayment per visit after INET plan deductible (OP

Hosp) or $300 copayment per visit after INET plan deductible

(Freestanding Facility)

$500 copayment per visit after INET plan deductible

$500 copayment per visit after INET plan deductible (OP

Hosp) or $300 copayment per visit after INET plan deductible

(Freestanding Facility)Hospital Services

Inpatient Hospital $500 copayment per day to a

maximum of $2,000 per admission after INET plan

deductible

$500 copayment per day to a maximum of $2,000 per

admission after INET plan deductible

$500 copayment per day to a maximum of $2,000 per

admission after INET plan deductible

$500 copayment per day to a maximum of $2,000 per

admission after INET plan deductible

Emergency and Urgent Care

Emergency Room $200 copayment per visit after INET medical deductible

$450 copayment per visit after INET medical deductible

$200 copayment per visit after INET medical deductible

$450 copayment per visit after INET medical deductible

Urgent Care Center or Facility $75 copayment per visit $75 copayment per visit $75 copayment per visit $75 copayment per visit

AV = Actuarial ValueFPL = Federal Poverty Level

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020

AHCT Individual Market Silver Plans

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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver 87% AV Level (>150% to ≤200% FPL) 94% AV Level (>138% to ≤150% FPL)

Deductible: Individual (medical) $600 $650 $0 $0

Deductible: Individual (prescription) $50 $50 $0 $0

Out-of-Pocket Maximum: Individual $2,300 $2,500 $900 $900

Provider Office VisitsProvider Office Visits (Primary

Care, Mental & Behavioral Health, Substance Abuse)

$20 copayment per visit $20 copayment per visit $10 copayment per visit $10 copayment per visit

Specialist Office Visits $35 copayment per visit $45 copayment per visit $30 copayment per visit $30 copayment per visit

Prescription Drugs – Retail (up to 30-day supply/script)

Tier 1 $5 copayment per script $10 copayment per script $5 copayment per script $5 copayment per script

Tier 2 $20 copayment per script $25 copayment per script $10 copayment per script $10 copayment per script

Tier 3 $35 copayment per script after INET Rx deductible

$40 copayment per script after INET Rx deductible $30 copayment per script $30 copayment per script

Tier 420% coinsurance up to a

maximum of $60 per script after INET Rx deductible

20% coinsurance up to a maximum of $60 per script after INET Rx deductible

20% coinsurance up to a maximum of $60 per script

20% coinsurance up to a maximum of $60 per script

AV = Actuarial ValueFPL = Federal Poverty Level

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020

AHCT Individual Market Silver Plans

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PLAN FEATURE 2019 Standard Silver 2020 Standard Silver 2019 Standard Silver 2020 Standard Silver 87% AV Level (>150% to ≤200% FPL) 94% AV Level (>138% to ≤150% FPL)

Other Services

Outpatient Services (in a hospital or ambulatory facility)

$100 copayment per visit after INET plan deductible

$100 copayment per visit after INET plan deductible (OP Hosp) or $60 copayment per visit after

INET plan deductible (Freestanding Facility)

$75 copayment per visit$75 copayment per visit (OP Hosp) or $45 copayment per visit (Freestanding Facility)

Hospital Services

Inpatient Hospital $100 copayment per day to a maximum of $400 per admission

after INET plan deductible

$100 copayment per day to a maximum of $400 per admission

after INET plan deductible

$75 copayment per day to a maximum of $300 per

admission

$75 copayment per day toa maximum of $300 per

admissionEmergency and Urgent Care

Emergency Room $75 copayment per visit after INET medical deductible

$150 copayment per visit after INET medical deductible $50 copayment per visit $50 copayment per visit

Urgent Care Center or Facility $35 copayment per visit $35 copayment per visit $25 copayment per visit $25 copayment per visit

AV = Actuarial ValueFPL = Federal Poverty Level

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020

AHCT Individual Market Bronze Plans

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PLAN FEATURE 2019 Standard Bronze 2020 Standard Bronze 2019 Standard Bronze HSA 2020 Standard Bronze HSA

Deductible: Individual (medical) $6,000 $6,200 $5,685 $5,685

Deductible: Individual (prescription) Included in Medical Included in Medical Included in Medical Included in Medical

Out-of-Pocket Maximum: Individual $7,900 $8,150 $6,550 $6,550

Provider Office VisitsProvider Office Visits (Primary

Care, Mental & Behavioral Health, Substance Abuse)

$40 copayment per visit $40 copayment per visit 10% coinsurance per visitafter INET plan deductible

10% coinsurance per visitafter INET plan deductible

Specialist Office Visits $50 copayment per visit after INET plan deductible

$60 copayment per visit after INET plan deductible

10% coinsurance per visitafter INET plan deductible

10% coinsurance per visitafter INET plan deductible

Prescription Drugs – Retail (up to 30-day supply/script)

Tier 1 $5 copayment per script $10 copayment per script 10% coinsurance per scriptafter INET plan deductible

10% coinsurance per scriptafter INET plan deductible

Tier 2 50% coinsurance per scriptafter INET plan deductible

50% coinsurance per scriptafter INET plan deductible

15% coinsurance per scriptafter INET plan deductible

15% coinsurance per scriptafter INET plan deductible

Tier 3 50% coinsurance per scriptafter INET plan deductible

50% coinsurance per scriptafter INET plan deductible

25% coinsurance per scriptafter INET plan deductible

25% coinsurance per scriptafter INET plan deductible

Tier 450% coinsurance up to a

maximum of $500 per script after INET plan deductible

50% coinsurance up to a maximum of $500 per script after INET plan deductible

30% coinsurance up to a maximum of $500 per script after INET plan deductible

30% coinsurance up to a maximum of $500 per script after INET plan deductible

HSA = Health Savings Account

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020

AHCT Individual Market Bronze Plans

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PLAN FEATURE 2019 Standard Bronze 2020 Standard Bronze HSAOther Services

Outpatient Services (in a hospital or ambulatory facility)

$500 copayment per visit after INET plan deductible

$500 copayment per visit after INET plan deductible (OP Hosp)

or $300 copayment per visit after INET plan deductible

(Freestanding Facility)

10% coinsurance per visitafter INET plan deductible

10% coinsurance per visitafter INET plan deductible

Hospital Services

Inpatient Hospital $500 copayment per day to a

maximum of $1,000 per admission after INET plan

deductible

$500 copayment per day to a maximum of $1,000 per

admission after INET plan deductible

10% coinsurance per admissionafter INET plan deductible

10% coinsurance per admissionafter INET plan deductible

Emergency and Urgent Care

Emergency Room $200 copayment per visit after INET plan deductible

$450 copayment per visit after INET plan deductible

10% coinsurance per visitafter INET plan deductible

10% coinsurance per visitafter INET plan deductible

Urgent Care Center or Facility $75 copayment per visit $75 copayment per visit 10% coinsurance per visitafter INET plan deductible

10% coinsurance per visitafter INET plan deductible

HSA = Health Savings Account

High Level In-Network (INET) Member Cost Sharing: 2019 vs 2020