Kentucky Health Benefit Exchange

April 18, 2013

Carrie Banahan, Executive DirectorOffice of the Kentucky Health Benefit Exchange

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COMMONWEALTH OF KENTUCKYCABINET FOR HEALTH AND FAMILY SERVICES

Health Insurance Reforms that are Affecting You Now

• Temporary High Risk Pool (PCIP)• New coverage options for young adults• No lifetime limits on health benefits• Coverage for children with pre-existing conditions

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Health Insurance Reforms that are Affecting You Now

• Preventive services with no deductible or co-pay• Rate Review and MLR Rebates• Rescissions• Uniform Explanation of Coverage and Standard

definitions• Appeals

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Kentucky Health BenefitExchange

Executive Order (2012- 587) signed by Governor Beshear July 17, 2012 created the Exchange and administrative structure:•Organized Office of KHBE under CHFS with 4 divisions and (with up to 30 employees); •Established an Advisory Board; and •Authorized Board to create sub-committees.

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Kentucky Health Benefit Exchange Advisory Board

• First meeting held September 27, 2012• Six subcommittees formed:

– Behavioral Health– Dental and Vision– Education and Outreach– Navigator/Agent– Qualified Health Plans– Small Employer Health Options Program (SHOP)

• Navigator/Agent, Qualified Health Plans, and SHOP subcommittees have met.

• Meeting schedules and materials posted on the KHBE website (healthbenefitexchange.ky.gov).

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A health benefit exchange is an organized marketplace for individuals and employees of small businesses to shop for health insurance offered by insurers (insurance companies, CO-OPs, and Office of Personnel Management (OPM)) based on price and quality. Individuals will also be able to apply for Medicaid coverage through the Exchange.

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When must the Exchange be operational?

Open Enrollment - October 1, 2013 – March 31, 2014

Fully Operational - January 1, 2014

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Why is Kentucky pursuing a State-Based Exchange instead of a

Federal Exchange?• Support from interested stakeholders;• Prevent Federal government from controlling the

Exchange;• Concerns with dual regulation of health insurance

market;• Allows Kentucky to determine the benefits that will be

provided in Kentucky’s Exchange;• Allow Kentucky to have flexibility, including

determinations of Medicaid eligibility; and• Consider Kentucky’s unique regional and economics

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Overview of Essential Health Benefits

ACA requires health insurance plans sold to individuals and small employers to provide a minimum package of services in 10 categories called “Essential Health Benefits” (EHBs).

EHBs are the minimum standards to be applied both inside and outside the Exchange. They include items and services within the following categories:

Ambulatory Patient Services;Emergency Services;Hospitalization;Maternity and Newborn Care;Mental Health and Substance Abuse Disorder Services;Prescription Drugs;Rehabilitative and Habilitative Services and Devices;Laboratory Services;Preventive/Wellness Services/Chronic Disease Management; andPediatric Services, including Oral and Vision Care.

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Navigator ProgramNavigators - Individuals or Entities that:

May include: Community/consumer-focused nonprofit groups, Chambers of commerce, resource partners of Small Business Administration, Health Care Providers, etc.

Maintain expertise in eligibility, enrollment and programs;

Provide information/services in fair, accurate, impartial way;

Facilitate selection of Qualified Health Plans (QHPs); and

Provide referrals to any applicable office, health insurance consumer assistance or ombudsman, or State agency for grievances, complaints, or questions about health plan.

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Who will qualify for Premium Assistance and Tax Credits?

Premium Assistance:

Individuals with a household income (for the taxable year) between 133% and up to 400% of the federal poverty level (FPL); and

Small Businesses may qualify for tax credits if:

The Employer has fewer than 25 full-time equivalent employees for the taxable year;

The average annual wage of Employees in group is less than $50,000; and

The Employer pays at least 50% of the premium for each employee.

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Income Level Individual Family of Four100% FPL $11,490 $23,500133% FPL $15,281.70 $31,255150% FPL $17,235 $35,250200% FPL $22,980 $47,000250% FPL $28,725 $58,750300% FPL $34,470 $70,500400% FPL $45,960 $94,000

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 Income level

 Individual Income Amount

 Percent of Income

 Premium Limit as a percent of

Income Individual

   Family of Four Income Amount

 Percent of

Income

 Premium Limit as a percent of Income for Family of Four

 

      Minimum

Maximum     Minimum Maximum

100-133% FPL

$11,490 - $15,281.7

0

2% $229.80($19.15/ Month)

$305.63($25.47/Month)

$23,500 - $31,255

2% $470.00($39.17/ Month)

$625.10($52.09/ Month)

133– 150% FPL

$15,281.70 -

$17,235

3-4 % $458.45($38.20/Month)

$689.40($57.45/ Month)

$31,255 - 35,250

3-4 % $937.65($78.14/ Month)

$1,410.00($117.50/ Month)

150-200% FPL $17,235 -

$22,980

4-6.3% $689.40($57.45/ Month)

$1,447.74($120.65/ Month)

$32,250 - $47,000

4-6.3% $1,410.00($117.50/ Month

$2,961.00($246.75/Month)

200-250% FPL

$22,980 - $28,725

6.3-8.05%

$1447.74 ($120.65/Month)

$2,312.36($192.70/ Month) $47,000 -

$58,750

6.3-8.05% $2,961.00($246.75/Month)

$4,729.38($394.11/Month)

250-300% FPL

$28,725 - $34,470

8.05-9.5%

$2,312.36($192.70/Month)

$3,274.65($272.89/ Month) $58,750 -

$70,500

8.05-9.5% $4,729.38($394.11/ Month)

$6,697.50($558.13/Month)

300-400% FPL

$34,470 - $45,960

9.5% $3,274.65($272.89/Month)

$4,366.20($363.85/ Month) $70,500 -

$94,000

9.5% $6,697.50($558.13/Month)

$8,930.00($744.17/ Month)

Premium Contribution Amounts for plan year 2014(Based on 2013 Poverty Guidelines)

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