Corporate Training

What is the Marketplace/FF-SHOP?

Marketplace/FF-SHOP Mandates

Essential Health Benefits (EHB)

Who’s Eligible? Enrollment Periods

• Enrollment Chart Metal Tier Details

Small Group Options • KEEP OLD Plans• Renew before 1/1/15• New Enrollment in ACA in 2015

Types of Plan Networks Resource to Plan

Benefits Repository Web Tool for Small

Groups Summary Contact Information

The Marketplace/Federally –facilitated Small

Business Health Options Program (FF-SHOP), is

a set of government-regulated qualified health plans

available to small groups with 2-50 employees.

The Marketplace/FF-SHOP creates a new mechanism for purchasing insurance coverage plans which:

Creates a more competitive market by offering a choice of health plans

Establishes common rules regarding how insurance is offered and priced (tax credits available to employers)

Provides information to help employers better understand the options available to them

Plans must include the following in 2015: • Coverage of Essential Health Benefits • No Annual Limits• No Pre-existing limits• No Discrimination on Health Status

Note: For more details regarding Marketplace/FF-SHOP mandates, go to http://www.hhs.gov/healthcare/facts/timeline/timeline-text.htmlNote: For more details regarding Marketplace/FF-SHOP mandates, go to http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html

Essential health benefits means plans must include benefits for the following services: Ambulatory Patient Services Emergency Services Hospitalization Maternity and Newborn Care Mental Health and Substance Abuse Disorder Services Prescription Drugs Rehabilitative & Habilitative (Services and Devices) Lab Services Preventive and Wellness Services & Chronic Disease

Management Pediatric Services (including Oral and Vision Care)*

Applies to non-grandfathered Fully Insured plans.Applies to non-grandfathered Fully Insured plans.

All plans offered through Regional Health Care Provider Co. follow the ACA Guidelines for fully insured plans:• Comprehensive prescription drug coverage

• Coverage of adult dependents up to age 26 (Federal law) and 28 (Ohio law)

• Coverage of certain preventive services at 100 percent, including mammograms, immunizations, well-child visits and women’s preventive services

• Health and wellness services for employers staff to stay healthy

• Access to thousands of providers and top hospitals that are part of your Regional Health Care Provider Co. network

Effective 01/01/2015, only qualified employer small groups (2-50 employees) will be eligible to purchase healthcare insurance through the marketplace.

Based on the number of full-time equivalent employees working for the small group.• A full-time employee generally works at least 30 hours

per week on average.

Initial open enrollment for small group begins on 11/15/2014.

The effective date for groups who enroll during the open enrollment period in 2014 is 01/01/2015.

For groups who enroll in 2014- 2015:• Effective the first of the next month if enrolling

days 1-15• Effective the first of the following month if

enrolling day 16 and up

Enrollment Date Effective Date

November 15 – December 15 January 1, 2015

December 16 – January 15 February 1, 2015

January 16 – February 15 March 1, 2015

February 16 – March 15 April 1, 2015

March 16 – April 15 May 1, 2015

April 16 – May 15 June 1, 2015

May 16 – June 15 July 1, 2015

June 16 – July 14 August 1, 2015

July 16 – August 15 September 1, 2015

August 16 – September 15 October 1, 2015

September 16 - October 15 November 1, 2015

October 16 – November 15 December 1, 2015

IMPORTANT: Marketplace /FF-SHOP must enroll online.IMPORTANT: Marketplace /FF-SHOP must enroll online.

Plans offered on and off the Marketplace/FF- SHOP fall into categories called ‘metal tiers’:

1. Gold – higher level of coverage 2. Silver – lower level of coverage 3. Bronze – lowest level of coverage

Please design for the different tier level : 1. Gold – lower OOP Max, In Network: 20% individual and

Out-Network: 50% family coinsurance 2. Silver – comparable OOP Max to the Bronze, In Network:

20% individual, and Out-Network: 50% family coinsurance3. Bronze – comparable OOP Max to the Silver, In Network:

20% individual and Out-Network: 50% family coinsurance

Note: A 2015 Final Group (On/Off) SHOP Plans cheat-sheet is available in the Course Repository.Note: A 2015 Final Group (On/Off) SHOP Plans cheat-sheet is available in the Course Repository.

Renew before 1/1/15 to remain on non-ACA SC Premier will only be available to groups that ‘keep

their old plan’ and renew 12/1/14 Groups that renew on old plan without ACA will keep

PHCS wrap network nationwide Group plans with “A” currently follow the older

Schedule of Benefits (SOB’s) and Certificate of Insurance.• Example: 5520A

Do not carry the Essential Health Benefits or RX built into the OOP

IMPORTANT: Under the small group offering, an employer group can select an ACA group plan at the time of their Annual Renewal.

IMPORTANT: Under the small group offering, an employer group can select an ACA group plan at the time of their Annual Renewal.

Groups that renew into ACA will carry a metal tier name with a - 15 after their name, i.e.: Regional Health Care Provider Silver 2005-15

Will have a narrower network, with urgent and emergency coverage outside of Ohio only. Groups that renew can chose Regional Health Care network

• A new network with a four (4) county service area• Groups must be located “domiciled” in one of RHConnect counties• ACO (Accountable Care Organization) PPO plan is offered• Significant discounted premiums

Groups that go with an ACA Compliant plan in 2015 will no longer be able use the Premier Network.• However, can purchase a new 2015 ACA online with the Marketplace-FF SHOP or through their broker.

IMPORTANT: SC Premier will no longer be available to new or renewal groups in 2015.IMPORTANT: SC Premier will no longer be available to new or renewal groups in 2015.

Available to New ACA small groups that want to offer FF-SHOP plan beginning on of after January 1, 2015.

Groups that go with an ACA plan in 2015 will have a narrower network, with urgent and emergency coverage outside of Ohio only.

These 2015 plans will be sold to new ACA small groups on or off the exchange for an effective date of 1-1-15.

Can purchase a new 2015 ACA plan from Marketplace-FF SHOP, via a broker or through insurance carrier.

1st Time, Qualified Employer Groups may purchase online with the FF-SHOP (Federally-facilitated Small Group Health Options Program)• Must enroll online to possibly receive Small Business Health

Care Tax Credit to help small groups save on premiums• The FF-SHOP website and phone number:

https://www.healthcare.gov/small-businesses/ Call Center at 1-800-706-7893

Prescription costs count toward the medical OOP maximum for all ACA plans.

All commercial plans, whether they are ACA plans or not, or purchased on or off the FF-SHOP, are PPO plans.

PPO plans offer both in-network and out-of-network benefits.• Services rendered In-Network

Less out-of-pocket cost to the member

• Services rendered Out-of-Network More out-of-pocket cost to the member

SMALL GROUP PLANS -2014 SMALL GROUP PLANS -2015 Regional Health Bronze 4000 Regional Health Gold 1000 Regional Health Gold 1500 Regional Health Care Provider Co. Gold

2000 Regional Health Care Provider Co.

2000Q Regional Health Care Provider Co. Gold

500 Regional Health Care Provider Co.

Platinum 250 Regional Health Care Provider Co.

Silver 2000

Offered On/Off FF-SHOPRegional Health Care Provider Co. Bronze 4000Q-15Regional Health Care Provider Co. Bronze 5000-15Regional Health Care Provider Co. Silver 2500-15Regional Health Care Provider Co. Gold 2000-15

Offered Off FF-SHOP onlyRegional Health Care Provider Co. Silver 1500-15Regional Health Care Provider Co. Silver 5000-15Regional Health Care Provider Co. Gold 1000-15

Regional Health Care Provider Co. is offering seven plan options for Small Groups in 2015:• Regional Health Care Provider Co. Bronze 4000Q-15

(HSA)• Regional Health Care Provider Co. Bronze 5000-15• Regional Health Care Provider Co. Silver 2500-15• Regional Health Care Provider Co. Gold 2000-15• Regional Health Care Provider Co. Silver 1500-15*• Regional Health Care Provider Co. Silver 5000-15*• Regional Health Care Provider Co. Gold 1000 -15*

*Note: Offered Off the FF-SHOP only.*Note: Offered Off the FF-SHOP only.

RHC Service Area network• 20 county service area• Includes Summa

Health System (SHS) Network of hospitals

• Excludes Cleveland Clinic

• PHCS/Multiplan available to groups seeking services outside Service Area

Provider Networks (primary and wrap networks, network benefit level or OON benefit level)• Primary Network – Regional Health Care

Select (20 counties)• Wrap Networks –PHCS

Regional Health Care Connect Service Area network• 4 county service area:

Medina Portage Stark Summit

• Business group must be located “domiciled” in this service area

• Includes Summa Health System (SHS) Network of hospitals

• ACO PPO Plan• NO Wrap Networks• Out of Network level benefits

Regional Health Care Connect is a new network to SHOP Groups.

ACO (Accountable Care Organization) PPO plan is offered

A new network with a four (4) county service area Groups must be located “domiciled” in one of

Regional Health Care Connect counties ACO (Accountable Care Organization) PPO plan is

offered Significant discounted premiums No WRAP network available

All new Commercial Small Group ACA compliant both on and off the F-SHOP in 2015 can use one two networks based on what is purchased:• Regional Health Care Select (20-county service area)• Regional Health Care Connect (ACO)

Wrap Networks –PHCS not available for ACA Compliant Plans

Available to Small Groups that chose a AjaxSelect network

Not available to Small Groups that chose a AjaxConnect

However . . .• Services rendered outside the 20-county area

will only be covered in-network when using the PHCS PPO network.

Regional Health Care Provider Co.’s website tool is available to help small groups find insurance on or off the FF SHOP in 2015.

www.myregionalhealthcareplan.com or www.regionalhealthcare.com

1. Complete an online form, which initiates a contact from a Sales Representative

2. Request a quote3. Get an Estimated Annual Tax Credit

Allows Small Groups to Request a Quote and much More.

Small groups can obtain their Estimated Annual Tax Credit

No Annual Limits No Pre-existing limits No discrimination on Health Status May receive a Tax Credit Can “Keep their Old Plans” Prescription costs count toward the

medical OOP maximum for all ACA plans.

Note: To learn more about ACA plans go to http://www.cms.gov/CCIIO/resources/fact-sheets-and-faqs/index.html, for frequentlyasked questions.

Note: To learn more about ACA plans go to http://www.cms.gov/CCIIO/resources/fact-sheets-and-faqs/index.html, for frequentlyasked questions.

For detailed plan benefit information, please refer to the documents posted on the Benefit Information SharePoint site via . . . • Shared Documents\ PPO\2015

Training resource material to reference and utilize for future use: PPO Service Area ‘Map’ for Group Plans 2015 Small Group Plans In-Network Benefit

Overview 2015 Final group (on/Off SHOP Plans) Health Insurance Marketplace/FF-SHOP Group

PowerPoint slides

Small Groups that renew with old plan without ACA will keep PHCS wrap network nationwide.

Under the small group offering, an employer group can select an ACA group plan at the time of their Annual Renewal.

RHPremier will no longer be available to new or renewal groups in 2015.

New ACA small groups plans for the 2015 plan year beginning on of after January 1, 2015 will be identified with a -15 after their name;• i.e. Regional Health Care Provider Co. Silver 2500-15

Small Group have four (4) plans offered on/off exchange.

Small Group have three (3) plans offered off exchange

Small groups have different Networks based on where their business is located “domiclied”.

Small Groups that go with ACA plan in 2015 will have narrower network, only urgent and emergent care services coverage outside Ohio.

Wrap Networks –PHCS not available for ACA Compliant Plans

•If you have a specific question about Regional Health Care Provider Co.’s Health Insurance Marketplace/ FF- SHOP:

Commercial Retention, Coworker One, Manager, Service & Support, at ext.: 68942

Commercial Sales, Coworker Two, Director, Sales & Broker Relations, at ext.: 6-8950

This concludes the Health Insurance Marketplace – FF SHOP course.

Please click the FINISHED BUTTON in the

upper right hand corner to move onto Objective Two to complete the course quiz.

Thank you.