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Spring Broker Meeting

May 2015

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Meeting Agenda

I. Welcome & Introductions

II. Legislative Update

III. Group ACA Updates

IV. Innovations

V. Additional Items & Questions

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Today’s presenters

• Terrie Havis, Director of Broker Relations

• Mike Reynoldson, Director of Government Affairs

• Adam Caldwell, Broker Relations

• Lisa Wilson, Broker Relations

• Kathy McGuire, Director of Sales Operations

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Legislative update Mike Reynoldson, Director of Government Affairs

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The life of a lobbyist…

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My contact information

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Today’s legislative landscape

• Governor Otter was elected to a third consecutive term

• Hard fought primary and general election campaigns

• New faces in the legislature and executive offices

• Five new state senators (of 35)

• Fifteen new state representatives (of 70)

• New Secretary of State and Superintendent of Public Instruction

• Same leadership in the House and Senate

• President Pro Tempore Brent Hill (R-Rexburg)

• Speaker of the House Scott Bedke (R-Oakley)

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In December 2014, the pundits predicted…

Education funding

Road funding and ongoing infrastructure investment

Medicaid redesign

Tax relief

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But what actually happened…

• The Giant Salamander

• Add the Words

• Idaho Education Network

• Historic horse racing and instant horse racing

• 1-800 Contacts vs. Johnson & Johnson

• Conceal-carry requirements

• Licensing of naturopaths

• Child support system

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Health insurance legislative update

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H46: Stand-alone dental products on the exchange

Law

• Sponsor: Delta Dental

• Law defines ‘stand-alone dental plan’

• Authorizes product to be sold on the state exchange

• However, the term is not defined in state code

• Proposal provides necessary clarification of the term

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H189: Telemedicine Act

Law

• Sponsors: Idaho Telemedicine Council; Representative John Rusche (D-Lewiston)

• Law provides definitions and uses of telemedicine; does not require payment by health plans

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H107: Immunization Assessment Act

Law

• Sponsor: Department of Insurance

• New law extends the sunset of the Vaccines for Children/Immunization Assessment program for two years

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H108: Dispensing of Opioid Antagonists

Law

• Sponsors: Idaho Office of Drug Policy

• Law allows for the prescription and possession of opioid antagonists, which are used to reverse the effects of an opioid overdose

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H182a: Guaranty Funds for ACA Consumer Operated & Oriented Health

Law

• Sponsor: Guaranty Association Board

• Law excludes health insurance cooperatives from assessment and coverage by the Idaho Life & Health Guaranty Association

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S1062a: Direct Primary Care Agreements

Law

• Sponsors: Rep. Lynn Luker (R-Boise) and Sen. Steve Thayn (R-Emmett)

• Allows family physicians, internists, pediatricians and dentists to enter into direct care agreements for medical services over a specified period of time for direct fee

• Prohibits providers and patients from billing an insurer for services

• States these arrangements are not insurance

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S1121: Immunization Registry

Law

• Sponsor: Idaho Association of Health Plans

• Permits the registry to share immunization data with the Idaho Health Data Exchange

• The Idaho Health Data Exchange is monitored by the Idaho Health Quality Planning Commission

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If you think healthcare is expensive now, wait until you see what it cost when it’s free!

P.J. O’Rourke

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S1146: Cannabidiol Oil

Vetoed

• Sponsor: Sen. Curt McKenzie (R-Boise)

• Legislation provided a limited affirmative defense for the possession of cannabidiol (CBD) oil

• CBD is a type of hemp oil containing trace amounts of THC, the principal psychoactive constituent of marijuana

• Used to reduce the number and duration of seizures in children and adults with epilepsy

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H151: Transparency on Exchange Products

Held

• Sponsor: Rep. Christy Perry (R-Nampa); Pharmaceutical companies

• Proposal would require carriers to make formulary, out-of-pocket, out-of-network providers, appeal rights and other information available and as deemed pertinent by the exchange

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H180: ACA Grace Period

Held

• Sponsor: Idaho Medical Association

• Legislation reiterated the ACA requirement that health plans selling on the exchange must provide information to providers that a member has paid his/her premium, and the date through which he/she paid the premium

• Required reimbursement to a provider if the health plan stated the member paid the premium

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H188: Pharmacy Audits/Pharmacy Benefit Managers

Held

• Sponsors: Idaho Pharmacy Association; Idaho Association of Retailers

• Proposal would establish minimum and uniform standards and criteria for the audit of pharmacy records by insurance companies and other entities

• Establish a Pharmacy Benefit Manager Transparency Act that includes a registration and disclosure of requirements

• Establish the use of maximum allowable cost (MAC pricing) list by PBMs; require PBMs to establish an appeal process

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S1060: Prescribing Privileges for Psychologists

Held

• Sponsor: Idaho Psychology Association

• Provide for additional educational requirements for this class of providers

• Provide psychologists with the authority to prescribe patients a certain class of drugs for “psychiatric, mental, cognitive, nervous, emotional or behavioral disorders”

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Fact: Prescription drug spending increased

The AP reported that U.S. spending on prescription drugs increased last year, “driven by costly breakthroughs in medicines, manufacturer price hikes and a surge from the millions of people newly insured” under the ACA

Source: Johnson, Linda A. “IMS: US Prescription Drug Spending Jumped 13 Pct. In 2014.” Associated Press. 14 April 2015.

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Growth over 12 months

Source: Center for Sustainable Health Spending. “Insights from Monthly National Health Expenditures Estimates Through February 2014.” 8 April 2015.

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H175: Biosimilar Medication Notification

Held

• Sponsors: Rep. Christy Perry (R-Nampa); Pharmaceutical companies

• Require a dispensing pharmacist to communicate to the prescriber the specific product dispensed to the patient, including the name of the product and the manufacturer

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H235: Oral Cancer Drugs

Held

• Sponsors: Rep. Melissa Wintrow (D-Boise); Pharmaceutical companies

• Would cap copayments at $150 for oral cancer drugs

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Copayments and coinsurance for prescription drugs

No action

• Sponsor: Pharmaceutical companies

• Would require any copayment not exceed $150 per prescription per month

• All copayments and coinsurance (annual total) not exceed 50 percent of the out-of-pocket maximum allowed by federal law for QHPs

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Medicaid redesign – What happened?

• Gov. Otter and House/Senate leadership did not push to redesign Medicaid this session

• Health plans and providers agreed on principles (ideas?) that should be included in a new Medicaid plan

• Unsure at this point if this issue will come up in the 2016 session

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Need more information

• Visit legislature.idaho.gov to read full bill text, fiscal impacts and how your senator or representative voted

• Write or call your legislator at legislature.idaho.gov/howtocontactlegislators.htm

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Thank you! Any questions?

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2016 Group ACA updates

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All groups: Grandmothered plans

• Individual, small and medium group with October through December renewals move to a QHP beginning with their 2016 renewal

• We will not be able to change renewal dates

• Individual, small and medium group with January through September renewals move to a QHP at 2017 renewal

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MOOP – Effective in 2015

Medium/large group, non-grandfathered

business only

Individual: Annual maximum

out-of-pocket is $6,600

Family: Annual maximum out-of-pocket is

$13,200

Pharmacy copays, coinsurance and

deductibles are subject to total maximum out-

of-pocket

The ACA allows for separate out-of-pocket expenses (medical and pharmacy) as long as

the sum of both do not exceed the total

maximum out-of-pocket

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Blue Cross of Idaho changes to MOOP

• Blue Cross of Idaho chose to keep separate medical and pharmacy out-of-pocket limits for the majority of our non-grandfathered medium/large group business.

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What’s the Cadillac Tax?

• This is a new excise tax on high-cost health plans that takes effect in 2018

• The tax targets health plans that provide employees with a rich benefit structure

• These plans are usually paid by employers, have low (or no) deductibles and very low little cost-sharing

Sources for slides 36 & 37: • Health Affairs. Health Policy Briefs. September 12, 2013 • Falner, Brian. ‘Cadillac tax’ the Next Big Obamacare Battle. Politico. 6 April 2015 • Millman, Jason. How Businesses Are Planning for Obamacare’s Cadillac Tax. Washington Post. 20 November 2014

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How does the Cadillac Tax impact groups and employers?

• In 2018, the Federal government will assess a 40 percent tax on health plans with annual benefits that exceed a certain annual limit

• Individual: $10,200

• Family: $27,500

• Groups at risk of paying the Cadillac tax need to start looking at their benefits now

• Example: A family has benefits worth $30,000; tax applies to the $2,500 that’s over the limit

• Health insurers and groups of self-funded plans must pay the 40 percent tax of any dollar amount beyond the caps

• This is considered “excess” health spending

• It’s a great idea to contact your account representative about the Cadillac tax soon

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Need more information?

• Blue Cross of Idaho can help you learn more about the Cadillac tax, and upon request we can provide you a report to determine if a group is subject to the Cadillac tax. Please contact your Account Representative for more information.

• However, we encourage you to direct specific tax questions to a certified public accountant or tax professional

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Small Group Updates

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Small group – Tax reporting

• The ACA includes Section 6055 that requires small employers (fewer than 50 FTEs) to report the health insurance provided to employees

• Reporting to the IRS was voluntary in 2014, but mandatory in 2015

• Most Blue Cross of Idaho small groups are fully insured, so we report to the IRS on their behalf

• We encourage any individual employer in multi-employer groups to consult a tax advisor to prepare for the 2015 reporting

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What actions does a small employer need to take?

• No action for fully insured small employers

• We are required to file 1094-B and 1095-B forms to the IRS on behalf of most small employers

• 1095-B: reports information about each employee

• 1094-B reports summary information on the employer and determines employee eligibility for premium tax credits

• We will provide a copy of this information to employees in 2016.

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Further information on tax reporting

• Questions and answers on Section 6055 reporting

• irs.gov/affordable-care-act/questions-and-answers-on-information-reporting-by-health-coverage-providers-section-6055

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Medium Group Update

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Medium group updates

• Current group sizes

• Small group: 2-49

• Medium group: 50-99

• Large group: 100 and above

• Group sizes at 2016 renewal

• Small group: 2-100

• Large group: 101 and above

• As you can see, groups between 50 and 100 move into the small group category

• This means there will be two group categories:

• We’re hearing this proposal may be delayed until 2017

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Large Group Updates

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Large group tax reporting

• The ACA includes two sections requiring large employers to report the health insurance provided to employees:

• Section 6055: enforces the individual mandate

• Section 6056: enforces the employer mandate

• Both sections were voluntary in 2014

• No action is needed for the 2014 plan year, unless a group voluntarily complied with the rule

• Mandated reporting starts for the 2015 calendar year

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My large group wants to report this year. What are the steps?

• The deadline passed to voluntarily file

• However, these are the two forms your large employer group will use to report to the IRS:

• Form 1094-C: reports summary information for the employees

• Form 1095-C: reports information about each employee and determines eligibility for tax credits

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Where can I go for more information?

• We do encourage you and/or your groups to contact a tax consultant with specific questions

• Blue Cross of Idaho will provide data on the healthcare plan for the employer

• Instruction for forms 1094-C and 1095-C is at irs.gov/pub/irs-dft/i109495c--dft.pdf

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Innovations bcidaho.com/innovation

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CostAdvisor

• Our new CostAdvisor is an online transparency platform that provides your clients with cost estimates for healthcare services and procedures

• All Blue Cross of Idaho individual members have CostAdvisor as a value-added feature at no cost

• Cost look up – Your client can search costs prior to accessing care

• Ways to Save – Your client can view new ways to save on services they already use, like physical therapy.

• ASC’s must buy-up Ways to Save at $2 pmpy

• https://www.youtube.com/watch?v=nA2edNu-hbg

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Where does it get its data?

• Blue Cross of Idaho provides the CostAdvisor with a rolling 12-months of claims through our data warehouse

• CostAdvisor uses this data to create a database of information about specific healthcare costs, providing the most up-to-date estimated cost results

• MA members get access to the CostAdvisor at the end of the 2nd quarter

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Need your knee repaired in the Treasure Valley?

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Cost of a colonoscopy screening in Idaho Falls

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Rotator cuff surgery in Coeur d’Alene

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ACL repair in Twin Falls

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Cost of a colonoscopy screening in Lewiston

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Lower spine surgery in Pocatello

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Increasing our reach

• If you have a client who hasn’t registered at bcidaho.com, encourage him/her to sign up

• Benefits of registering on our website:

• CostAdvisor

• Wellness portal

• Electronic EOB’s

• Much more!

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Mobile App

• The Blue Cross of Idaho mobile app is a smartphone-friendly tool which gives your clients immediate access to the most vital parts of their health insurance benefits

• Provides personalized health insurance information wherever, whenever

• Gives members a snapshot of their healthcare finances

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How does it work?

We designed the app to help your clients have greater control over their healthcare finances by giving them the freedom of having key health coverage information the palms of their hands.

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Easily find a doctor from your smart phone

• Members can search by the name of the provider or the type of care

• Advanced search options include limiting the gender of the provider

• Max distance limits the travel distance

• In- and out-of-network warnings to verify network status are always located at the bottom of the page and pop as a warning, too

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Get a quick overview of benefits

• Members must be logged in to see any benefits information

• Summary view gives general information

• Use the options at the bottom of the page to see more

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Find out more detailed benefit information

• Toggle between in- and out-of-network benefits using the bar at the top of the page

• Benefits gives specific information on what is covered, co-pays and more

• There are more benefit options at the bottom of the screen

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Need to know your deductible? No problem!

• Toggle between in- and out-of-network benefits using the bar at the top of the page

• Deductibles shows individual, family and combined in- and out-of-network deductibles for the year

• Information comes from the same source as the website and will be just as up-to-date

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Member ID cards always in your pocket

• Members must be logged in to access member ID cards

• Enrollees can see their card, as well as the cards of any dependents

• Members will only see their own cards

• Icons below each card allow users to:

• Fax an ID card

• Email an ID card

• Contact the Customer Service Department

• Flip the card over to see the back

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Fax your ID card to a provider

• To fax an ID card, users must enter the desired phone number unless the card is accessed from the Find a Doctor and More search results details page, which will automatically fill in the information if it is on file.

• Users are warned to independently verify the number is correct before sending the card.

• The card is sent by Clarity and will include a cover sheet.

• When fax is sent, they will receive a success message.

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Or, email your ID card to your provider

• To email an ID card, members must enter the desired email address unless the card is accessed from the Find a Doctor and More search results details page, which will automatically fill in the information if it is on file.

• Members receive a warning to verify the address is correct before sending

• The card is sent by Clarity at sysadmin@claritydeliver.com and includes a message

• A message will appear when the card is successfully sent

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Download it

It’s free!

It’s available for iPhones and Android devices

Search “Blue Cross of Idaho”

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Group Wellness Suite – What is it?

Prospective groups

now have a choice of

wellness programs

that meet their needs,

no matter where they

are on the wellness

path.

Fits Your Needs

Businesses with

wellness programs see

improved employee

performance, recruit

talent and see a

financial impact from

improved productivity.

Benefits to Business

Three programs

include health

coaching and

incentives to help

employees achieve

health goals.

Achieve Goals; Foster

Change

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New program levels & benefits for groups

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How do these programs help you?

• These three levels fit groups of any size, and meet a business where they are in terms of wellness

• For example, the Peak suite is perfect for a small business like an auto mechanic or small professional office

• Summit suite, on the other hand, is the most robust program, and ideal for a group with an imbedded culture of wellness

• Your groups can purchase a la carte add-ons for any program

• For more information, please contact Karri Ryan at 208-331-7317

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Your individual clients & wellness

• Blue Cross of Idaho offers individual members access to our WellConnected portal

• They have access to:

• Health assessment

• Nutrition tips

• Health library

• Wellness workshops

• Exercise tracking

• Health coaching

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Online Learning Center

• This is a platform designed to inform and train Blue Cross of Idaho’s four major constituent groups:

• Brokers

• Vendors

• Providers

• Group Administrators

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Key features

• 24/7 access to the learning center

• You have exclusive access to educate and train related to the ACA and our products

• Cloud based

• You can access the center when you need it and on your terms… no need for classrooms, scheduling or travel

• Flexible learning

• Need the latest information? No problem… the center serves as a reference tool

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Easy access, anytime, anywhere

• Complete your courses on Blue Cross of Idaho products and ACA training – bcidaho.com/brokers

• You can RSVP for events using the Online Learning Center

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Coming soon: Medical Savings Accounts

• Blue Cross of Idaho has partnered with HealthEquity®, a leading financial account administrator, to deliver a fully integrated approach to consumer-driven healthcare

• Combines health savings and reimbursements accounts with benefit plan design

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Online enrollment for groups

• Blue Cross of Idaho provides groups with an online enrollment center to enter ongoing eligibility changes in real-time

• Adding new employees

• Deleting former employees

• Changing status due to a qualifying life event

• Open enrollment is also available for new and existing group renewals

• Transitioning groups to online enrollment starting in 2015

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How does the online enrollment center help you?

Real-time access to all demographic

and enrollment changes

Qualified life events online

More broker revenue for less work; manage

clients by tasks & exceptions

Communication and education for

members

Members have self-care tools

Secure data

Electronic document upload

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Coming Soon – Private Health Exchange

• National research shows by 2017, about 1 in 5 Americans will purchase benefits on a health exchange system – but people are not familiar with an exchange

• A private exchange allows employees to shop for benefits

• An employer provides a ‘defined contribution’ employee uses that money to purchase a plan that best fits his/her needs

• This offers greater choice for employers and employees

Source: Accenture: Insight Driven Health

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Individual Process Changes

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Individual premium due dates

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Idaho residency verification

• Idaho residency is required to purchase an individual plan from Blue Cross of Idaho

• We’ve had several cases where out-of-state residents incurred high-claim cases

• It’s considered fraud when someone does not live in Idaho, but claims residency

• This fraudulent action increases rates for Idaho residents

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How will we verify residency?

• Blue Cross of Idaho will strengthen the language regarding residency requirements for all off-exchange applications

• Your Health Idaho is responsible for verifying residency for on-exchange applications

• However, Blue Cross of Idaho will investigate any questionable situations

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2015 Healthy Smiles sales competition

• You can win an iPad® for selling Healthy Smiles dental coverage

• If you sell 10 Healthy Smiles plans per month, you earn one entry into a drawing for an iPad

• The more Healthy Smiles plans you sell, the more entries you earn

• Winners are selected around the 20th each month

• Please call 800-365-2345 if you have questions

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Thank you! Any questions?