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Townhall meeting about the implications of ACA / Obamacare How the Affordable Care Act Affects You - ICC Milpitas Octobar 24, 2013 - Moderator: Aditya Ullal, Veterans Affairs Palo Alto Health Care System - Jason Andrew, CEO & Founder, Stone Meadow Benefits, Silicon Valley based insurance company
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Market Today
7+ SmallGroup
Carriers
Small Group Market
(2-50 employees)
1
Individual Health Insurance:
Individuals can be declined
Based on health
Guaranteed:No one can be
declined for health 7+ individualCarriers
Market > January 1, 2014
7+ SmallGroup
Carriers
SHOP Exchange
(Covered CA)
2
SmallGroup Market
13+ SmallGroup
Carriers
Non ExchangeMarket(similar
to today)
IndividualMarket
No one can be declinedIn ANY market for ANY
reason
10+IndividualCarriers
Income basedsubsidies
2014 Small business OptionsSmall Group
Non ExchangeMarket
(like today)
Small GroupSHOP Exchange
Market(New)
IndividualMarket
‘DefinedContribution’
IndividualExchange‘Subsidy’
04/08/2023
How rating will change in 2014Today
7 Age-bands, no ratio rules Family Tier Rating 7 rate areas Based on the employer zip code Risk Adjustment Factors (.90-
1.10)
2014 and Beyond
45 Age Bands, 3:1 max ratio Member Level Rating 19 rating areas Based on employee or employer
zip code - TBD No Risk Adjustment Factors
Groups with grandfathered plans will continue to be rated as we do today, in 2014
Groups with non-grandfathered plans will be rated in the 2014 and beyond methodology
Groups with grandfathered and non-grandfathered plans will be rated using both methodologies 4
5/8/2013 | © Kaiser Permanente2424 2013. All Rights Reserved.
Member Level Rating
Current Rates $30 Plan
Age EE EE + SP EE + CH FAM
<30 $303 $847 $833 $1,179
30-39 $335 $910 $856 $1,303
40-49 $432 $994 $821 $1,312
50-54 $563 $1,170 $928 $1,495
55-59 $711 $1,493 $1,063 $1,717
60-64 $877 $1,666 $1,173 $1,945
65+ $995 $2,150 $1,496 $2,363
Age Rate Age Rate
0-20 $196 43 $418 21 $308 44 $430 22 $308 45 $445 23 $308 46 $462 24 $308 47 $481 25 $309 48 $503 26 $315 49 $525 27 $323 50 $550 28 $335 51 $574 29 $345 52 $601 30 $350 53 $628 31 $357 54 $657 32 $364 55 $687 33 $369 56 $718 34 $374 57 $750 35 $376 58 $785 36 $379 59 $802 37 $381 60 $836 38 $384 61 $865 39 $389 62 $885 40 $394 63 $909 41 $401 64+ $924 42 $408
Illustrative ACA Compliant Rates
Compare and Contrast Rate Structure $30 Copay Plan at a 1.0Current Rates Structure Based on the subscriber age and family tierACA Compliant Rate Structure Based on each family member age
55/8/2013 | © Kaiser Permanente2424 2013. All Rights Reserved.
Example 1 of Member Level Rating Impact
Age EEEE + SP
EE + CH FAM
<30 $303 $847 $833 $1,179 30-39 $335 $910 $856 $1,303 40-49 $432 $994 $821 $1,312 50-54 $563 $1,170 $928 $1,495 55-59 $711 $1,493 $1,063 $1,717 60-64 $877 $1,666 $1,173 $1,945 65+ $995 $2,150 $1,496 $2,363
Current Rates ACA Compliant Member RatesAge Rate Age Rate Age Rate
0-20 $196 35 $376 50 $550 21 $308 36 $379 51 $574 22 $308 37 $381 52 $601 23 $308 38 $384 53 $628 24 $308 39 $389 54 $657 25 $309 40 $394 55 $687 26 $315 41 $401 56 $718 27 $323 42 $408 57 $750 28 $335 43 $418 58 $785 29 $345 44 $430 59 $802 30 $350 45 $445 60 $836 31 $357 46 $462 61 $865 32 $364 47 $481 62 $885 33 $369 48 $503 63 $909 34 $374 49 $525 64+ $924
Employee: Joe age 53 with spouse and 4 Children
Family Coverage Tier Premium:
$1,495Member Level Rating Family Premium:
AgeJoe 53Spouse 48Child 18Child 16Child 14Child 12
Rate$628$503$196$196$196
$0
$1,719
$1,495
5/8/2013 | © Kaiser Permanente2424 2013. All Rights Reserved.
6
Example 2 of Member Level Rating impact
Age EEEE + SP
EE + CH FAM
<30 $303 $847 $833 $1,179 30-39 $335 $910 $856 $1,303 40-49 $432 $994 $821 $1,312 50-54 $563 $1,170 $928 $1,495 55-59 $711 $1,493 $1,063 $1,717 60-64 $877 $1,666 $1,173 $1,945 65+ $995 $2,150 $1,496 $2,363
Current Rates ACA Compliant Member RatesAge Rate Age Rate Age Rate
0-20 $196 35 $376 50 $550 21 $308 36 $379 51 $574 22 $308 37 $381 52 $601 23 $308 38 $384 53 $628 24 $308 39 $389 54 $657 25 $309 40 $394 55 $687 26 $315 41 $401 56 $718 27 $323 42 $408 57 $750 28 $335 43 $418 58 $785 29 $345 44 $430 59 $802 30 $350 45 $445 60 $836 31 $357 46 $462 61 $865 32 $364 47 $481 62 $885 33 $369 48 $503 63 $909 34 $374 49 $525 64+ $924
Employee: Joe age 53 with spouse and 1 Child
Family Coverage Tier Premium:
$1,495Member Level Rating Family Premium:
AgeJoe 53Spouse 48Child 18
Rate$628$503$196
$1,327
$1,495
5/8/2013 | © Kaiser Permanente2424 2013. All Rights Reserved.
7
Survey of 2013/2014 Renewals
8
