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2015 Individual and Small Employer Markets
Utah Insurance Department
9/18/2014 Health Reform Task Force
Disclaimer
• 2015 rate review has not been finalized and rates are sJll subject to change
• The Utah Insurance Department is recommending individual plans for cerJficaJon to the U.S. Department of Health and Human Service’s Federally Facilitated Marketplace (FFM), Healthcare.gov, and small employer plans to Avenue H (SHOP).
• The FFM and Avenue H (exchanges) have final say for cerJficaJon • Insurers may withdraw plans before final cerJficaJon, or the
exchanges may choose to reject plans. • The FFM and Avenue H are expected to finalize cerJficaJon and
have QHP contracts signed by the first week in November
Market ParJcipants Individual Dental
On and Off Exchange • 7 insurers’ plans recommended to the FFM
• 2 insurers offering exclusively off exchange
• 2 new insurers • 1 insurer exiJng
*New to the market in 2015. **SelectHealth embedded pediatric dental benefits into their medical plans.
Company 2015ACE Property and Casualty OffAlpha Dental of Utah On/OffBEST Life and Health Insurance On/OffDelta Dental Insurance On/OffDentegra Insurance* On/OffEducators Health Plans On/OffHumana Insurance Company On/OffPremier Access Insurance On/OffRenaissance Life* OffSelectHealth**
Individual
Market ParJcipants Small Employer Dental On and Off Exchange
• 8 insurers’ plans recommended for Avenue H
• 7 insurers exclusively off exchange
• 7 new insurers; 1 on and off exchange, 6 off exchange only
• 1 insurer exiJng
*New to market in 2015. **SelectHealth embedded pediatric dental benefits into their medical plans
Company 2015ACE Property and Casualty On/OffAlpha Dental of Utah On/OffAmeritas Life Insurance* OffBEST Life and Health Insurance On/OffCompanion Life Insurance* OffDelta Dental Insurance On/OffDentegra Insurance* On/OffEducators Health Plans On/OffKansas City Life* OffPremier Access Insurance On/OffReliance Standard Life* OffRenaissance Life* OffSelectHealth**Standard Insurance* OffThe Guardian Life Insurance On/OffThe Lincoln National Life Insurance Off
Small Employer Group
Market Plans Dental
• One insurer pared down their dental plan offerings from approximately 50 plans in 2014 to 15 plans in 2015.
• UID recommends plans for cerJficaJon, but the FFM and Avenue H have final cerJficaJon determinaJon.
Individual 2014 2015On Exchange 28 26Off Exchange 20 12Total 48 38
Small Group 2014 2015On Exchange 45 53Off Exchange 49 33Total 94 86
2014 2015Grand Total 142 124
Market ParJcipants Individual Medical
• 6 insurers’ plans recommended to the FFM
• 6 insurers exclusively off exchange
• 3 new entrants off exchange only
Company 2015Altius On/OffArches On/OffBridgeSpan On/OffFreedom* OffHumana Ins Co OffHumana of Utah On/OffMolina On/OffNatl Foundation Life* OffRegence BCBS of Utah OffSelectHealth On/OffTime OffUHC Life* Off
Individual
* New to the market in 2015.
Market ParJcipants Small Employer Medical
• 3 insurers’ plans recommended to Avenue H
• 7 insurers exclusively off exchange
• 1 new entrant (only markeJng to out-‐of-‐state employees of in-‐ state employers)
Company 2015Aetna* OffAltius OffArches On/OffHumana Ins Co OffRegence BCBS of Utah OffSelectHealth On/OffSterling Life OffUHC Ins OffUHC of Utah On/OffWMI Off
Small Employer Group
* New to the market in 2015.
Market Plans Medical • All plans offered on
exchange are also required to be available off exchange
• StarJng in 2015, all riders are required to be integrated into plans, or offered as a stand alone product
• FFM and Avenue H have final determinaJon for on exchange QHP cerJficaJon
Individual 2014 2015On Exchange 96 108Off Exchange 54 148Total 150 256
Small Group 2014 2015On Exchange 70 75Off Exchange 188 576Total 258 651
2014 2015Grand Total 408 907
Individual Medical Rates On and Off Exchange Salt Lake County
$0.00
$50.00
$100.00
$150.00
$200.00
$250.00
$300.00
$350.00
$400.00
$450.00
$500.00
1 7 13
19
25
31
37
43
49
55
61
67
73
79
85
91
97
103
109
115
121
127
133
139
145
151
157
163
169
175
181
187
193
199
205
211
217
223
229
235
241
Mon
thly Premium
Count of Plans Available
Comparison of individual age 21 non-‐tobacco on and off exchange rates for 2014 and 2015 in Salt Lake County
2015 Plans 2014 Plans
Individual Medical Rates On and Off Exchange Salt Lake County
Increase is based on straight average of plans (not enrollment weighted). Only plans that were available first quarter of both 2014 and 2015 are shown.
Age 21 Non-‐Tobacco Rate
Individual Medical Rates On Exchange
Salt Lake County
$50.00
$70.00
$90.00
$110.00
$130.00
$150.00
$170.00
$190.00
$210.00
$230.00
$250.00
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100 103
Mon
thly Premium
Count of Plans Available
Comparison of individual age 21 non-‐tobacco on exchange rates for 2014 and 2015 in Salt Lake County
2015 Plans 2014 Plans
Individual Medical Rates On and Off Exchange
Salt Lake County Silver Plan
Increase is based on straight average of plans (not enrollment weighted). Only plans that were available first quarter of both 2014 and 2015 are shown.
Age 21 Non-‐Tobacco Rate
Individual Medical Rates 2015 On Exchange
Salt Lake County Silver Plan
Individual Medical Rates 2nd Lowest Silver
• Individual On Exchange Medical – Second lowest premium silver plan that is available to an individual for purchase
– Establishes benchmark off of which premium subsidies are based (reduced premium costs)
– A person must purchase a Silver plan to get the addiJonal cost sharing reducJon (reduced copay / coinsurance / deducJbles)
Individual Medical Rates 2nd Lowest Silver
• Example – John is eligible for a premium credit of $3,552 based on an expected contribuJon of 6.3% of his income. The silver benchmark plan (2nd lowest cost silver plan) for John costs $5,000 per year. There is also a bronze plan available that would cost $3,500 per year and the cheapest silver plan that costs $4,500.
hfp://www.cbpp.org/files/QA-‐on-‐Premium-‐Credits.pdf
Individual Medical Rates 2nd Lowest Silver
hfp://www.cbpp.org/files/QA-‐on-‐Premium-‐Credits.pdf
Plan PremiumPremium Credit
John's Premium
Cost Sharing Reduction
Bronze 3,500$ 3,552$ -‐$ NoLowest Silver 4,500$ 3,552$ 948$ Yes
Benchmark Silver 5,000$ 3,552$ 1,448$ Yes
Individual Medical Rates 2nd Lowest Silver
• People who chose a plan last year to opJmize their premium and cost sharing could be auto enrolled into a plan in 2015 that will no longer be opJmal.
• It is in the best interest of each individual market parJcipant to shop for coverage during open enrollment for the plan that best meets their financial and medical needs.
Small Employer Medical Rates On and Off Exchange Salt Lake County
$120.00
$170.00
$220.00
$270.00
$320.00
$370.00
$420.00
1 16
31
46
61
76
91
106
121
136
151
166
181
196
211
226
241
256
271
286
301
316
331
346
361
376
391
406
421
436
451
466
481
496
511
526
541
556
571
586
601
616
631
646
Mon
thly Premium
Count of Plans Available
Comparison of small group age 21 non-‐tobacco on and off exchange rates for 2014 and 2015 in Salt Lake County
2015 Plans 2014 Plans
Small Employer Medical Rates On Exchange
Salt Lake County
$120.00
$140.00
$160.00
$180.00
$200.00
$220.00
$240.00
$260.00
$280.00
$300.00
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75
Mon
thly Premium
Count of Plans Available
Comparison of small group age 21 non-‐tobacco on exchange rates for 2014 and 2015 in Salt Lake County
2015 Plans 2014 Plans
Small Employer Medical Rates On and Off Exchange Salt Lake County
Increase is based on straight average of plans (not enrollment weighted). Only plans that were available first quarter of both 2014 and 2015 are shown.
Age 21 Non-‐Tobacco Rate
Individual & Small Employer 2015 Medical Rates
On Exchange – Salt Lake County
$50.00
$100.00
$150.00
$200.00
$250.00
$300.00
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100 103
Mon
thly Premium
Count of Plans Available
Comparison of on exchange age 21 non-‐tobacco rates for individual and small group in Salt Lake County in 2015
Individual Small Group
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