Conditional Award of the 2021 Seal of Approval VOTE · 7/9/2020 · AllWays Health Partners Select, BMC HealthNet Plan, Fallon Health, Health New England, and Tufts ... finalized

Conditional Award of the 2021Seal of Approval (VOTE)

AUDREY MORSE GASTEIER

Chief of Policy & Strategy

MARIA JOY DAWLEY

Director of Plan Management & Product Strategy

SAMUEL ADAMS

Program Analyst, Health & Dental Plans

Board of Directors Meeting, July 9, 2020

2021 Conditional Seal of Approval

Today we ask the Board to allow further consideration of the proposed plans

we received in response to the Seal of Approval (SOA) Request for Responses

(RFR) issued in March.

▪ A vote today authorizing the Conditional SOA allows us to consider these plans for sale through the

Health Connector for the 2021 benefit year; it is not an indication of expected approval, but rather a

signal to the market of the types of plans we are considering for sale

▪ We will return to the Board in September seeking a final award of the 2021 SOA, after the Division of

Insurance (DOI) completes its form and rate filing review process and Health Connector staff

complete review of the value the plans offer to our Marketplace

2

Mar 2020 Apr May Jun Jul Aug Sept Oct Nov Dec 2020

3/20: Release Medical and Dental RFRs

5/22: RFR Responses Due

7/9: Conditional SOA – Board Meeting

9/10: Final SOA Awarded – Board Meeting

Review and Analysis of Responses

Review and Analysis of Rates

Analysis and Selection of ConnectorCare Plans

7/1: Rates Filed with DOI

2021 Product Goals and Strategies

The Health Connector designed its 2021 plan requirements with a focus on

improving affordability and predictability in standard plan designs while

maintaining a largely stable product shelf.

3

Goal Responsive Strategy

Affordability • Lowered deductibles, where needed, to align with an

indexed Minimum Creditable Coverage (MCC) deductible

• Continued carrier requirement to offer a low Gold plan, but

with new flexibility of design to promote competitive

offerings

• Member access to at least one of each major type of insulin

at a $30 copay (or lower) in all standard plans

Predictability • Standardized copay for ambulance transport

• Small group PPO from all relevant carriers, without exception

• Clarifications in online shopping experience

• Close review and monitoring of carrier changes impacting

the ConnectorCare program

Qualified Health Plan (QHP)Submissions

Qualified Health Plans:

Overview

Ten medical carriers responded to the 2021 Seal of Approval, submitting a total

of 63 non-group, and 77 small group, Qualified Health Plans (QHPs).

▪ As in Plan Years (PY) 2019 and 2020, carriers continue to be required to

offer standard platinum, high gold, high silver, low silver (small group only)

and bronze plans, and a PPO plan for small groups, as well as a low gold

plan newly non-standardized for PY 2021

• For PY 2021, the Health Connector no longer offered a standard plan

design for low gold but continues to require carriers offer a low gold

plan within the existing AV range requirement to encourage more

competition at this tier

▪ There is one new carrier entrant for PY 2021: AllWays Health Partners

Select

• Under the proposal, the current AllWays Health Partners carrier would

no longer participate in the ConnectorCare program beginning in PY

2021

• Instead, AllWays Health Partners Select, the smaller-network carrier,

submitted for consideration to participate in ConnectorCare in PY 2021

Platinum

High Gold

Low Gold

High Silver

Low Silver (SG)

Bronze

5

▪ There are no carrier departures for PY 2021

▪ As in PYs 2018, 2019, and 2020, ConnectorCare carriers will continue to “load” their silver tier non-group plans

with an additional percentage of premium to offset the loss of federal cost-sharing reductions


Overview (Non-Group)

The chart below outlines the 63 non-group QHPs proposed for the Health

Connector’s consideration for 2021, a net increase of seven plans from 2020.

6

Non-Group 2021*

Issuers Platinum Gold Silver Bronze Catastrophic* Total 2021Total 2020 for

Comparison

AllWays Health Partners Inc. 1 2 1 1 0 5 5

AllWays Health Partners Select 1 2 1 1 0 5 0

Blue Cross Blue Shield 1 2 1 1 1 6 6

BMC HealthNet Plan 1 2 1 1 0 5 5

Fallon Health 2 4 3 2 1 12 13

Health New England 1 2 1 2 1 7 5

Harvard Pilgrim Health Care 1 2 1 2 0 6 5

Tufts Health Plan - Direct 1 2 1 2 1 7 7

Tufts Health Plan - Premier 1 2 1 1 0 5 5

United 1 2 1 1 0 5 5

Total 2021 11 22 12 14 4 63

Total 2020 for Comparison 10 21 11 11 3 56

*Excludes Catastrophic plans requested for withdrawal – subject to review and Board approval.


Overview (Small Group)

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The chart below outlines the 77 small group QHPs proposed for the Health

Connector’s consideration for 2021, a net increase of eight plans from 2020.

Small Group 2021

Issuers Platinum Gold Silver Bronze Catastrophic Total 2021Total 2020 for

Comparison

AllWays Health Partners Inc. 1 2 3 1 N/A 7 7

AllWays Health Partners Select 1 2 2 1 N/A 6 0

Blue Cross Blue Shield 1 2 3 1 N/A 7 7

BMC HealthNet Plan 1 2 3 1 N/A 7 7

Fallon Health 2 4 6 2 N/A 14 15

Health New England 1 3 2 2 N/A 8 7

Harvard Pilgrim Health Care 1 3 2 2 N/A 8 7

Tufts Health Plan - Direct 1 2 2 2 N/A 7 7

Tufts Health Plan - Premier 1 2 3 1 N/A 7 6

United 1 2 2 1 N/A 6 6

Total 2021 11 24 28 14 N/A 77

Total 2020 for Comparison 10 23 25 11 N/A 69


New and Closing plansCarriers proposed nine new non-group plans, and ten new small group plans,

for consideration for 2021, and two plans will be closed.

Carrier# New

Non-GroupReason(s)

# New

Small GroupReason(s)

AllWays

Select5

New carrier, with one of each required

plan design6

New carrier, with one of each required

plan design

Fallon 1Low Gold design added on additional

network1

Low Gold design added on additional

network

HNE 2

One new non-standard bronze, and one

catastrophic (previously waived

catastrophic)

1 New non-standard bronze

HPHC 1 New non-standard bronze 1 New non-standard bronze

Tufts

PremierN/A N/A 1 New addition of PPO for PY 2021

TOTAL 9 10

8

▪ Health New England’s new offering of a catastrophic plan in 2021 would expand catastrophic plan

choice for members in the western portion of the Commonwealth

• Additionally, BCBS, Fallon, and Tufts Direct propose to continue offering catastrophic plans in 2021; the

remaining carriers submitted requests to waive their catastrophic plan offering

• Most members would have at least two catastrophic plan choices available

▪ Fallon intends to close two non-standard gold plans in 2021; the ~90 current members in these plans

would be mapped to Fallon gold plans with a similar plan design and same network

Affordability Initiatives: High-Value

MedicationsThe 2021 SOA requires low-cost access to insulin, in addition to the

continued requirement of zero cost-sharing opioid use disorder medication in

ConnectorCare.

▪ With clear data displaying cost barriers to care, and recent state-level initiatives aimed at limiting

enrollee cost-sharing for insulin, the Health Connector required carriers to include at least one of

each major type of insulin at a $30 copay (or lower) in all standard plans in their PY 2021 SOA

proposals

• All carriers’ SOA responses indicate this requirement will be met, and the Health Connector is

working with carriers to ensure proper display in formulary search tools

▪ Additionally, the Health Connector will continue to require ConnectorCare carriers to provide key

treatments for opioid use disorder at zero dollar cost sharing for ConnectorCare enrollees in PY 2021

9

Predictability Initiatives:

Standardization and TransparencyChanges for Plan Year 2021 also include standardization and transparency

initiatives to improve predictability in benefits and promote clarity in member plan

selection.

▪ The Health Connector newly required standardized ambulance cost-sharing for all standard plans, including

ConnectorCare plans, for PY 2021

• No member will see an increase in cost-sharing under this standardization compared to PY 2020, and

members in some carriers will see a decrease

• All carriers adhered to standardized ambulance cost-sharing in proposed 2021 plans

▪ Parity in small group PPO offerings

• Tufts Premier submitted a PPO for PY 2021, expanding small group PPO choice from all carriers offering

PPOs in the merged market

▪ Carrier clarifications in shopping experience

• Given ongoing member confusion between Tufts Direct and Tufts Premier, the carrier names in the online

shopping “filtering tool” will be updated for PY 2021 to clearly reflect “Direct” and “Premier”; plans are

currently grouped under one “Tufts Health Plan” filter

• AllWays Inc and AllWays Select will also clearly reflect two different entities in the filtering tool

• Additionally, Health Connector staff clarified the existing “network alert” language applied to plans with

smaller networks within the same carrier to promote member understanding of network differences

10

New Carrier:

AllWays Health Partners Select

AllWays Health Partners plans to operate under two different carrier licenses

for PY 2021: AllWays Health Partners Inc and a new narrower-network carrier,

AllWays Health Partners Select.

▪ Key differences between the two entities include:

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PY 2021

Carrier ProposalAllWays Health Partners Inc AllWays Health Partners Select

Populations Served Unsubsidized, APTC-only, and small groupUnsubsidized, APTC-only, ConnectorCare, and

small group

Plans OfferedOne of each required plan design, including small

group PPO

One of each required plan design, without small

group PPO (not required as not offered in wider

market)

NetworkBroad network covering nearly all acute care

hospitals in the Commonwealth

• Narrower network focused in eastern portion

of the Commonwealth

• Maintains Partners HealthCare hospital

coverage

• No coverage of Children’s Hospital and Dana-

Farber Cancer Institute, of particular concern

for the ConnectorCare program

Service Area

Statewide for PY 2021, compared to a PY 2020

service area covering Worcester county through

the Eastern portion of the state

• Eastern portion of state only

• Excludes Worcester County

• Continues to include Islands coverage

ConnectorCare Participation

2021 ConnectorCare Participation

The SOA submissions reflect one proposed ConnectorCare carrier

participation change, and several geographic coverage changes, for 2021.

▪ AllWays Health Partners Select, BMC HealthNet Plan, Fallon Health, Health New England, and Tufts

Direct have proposed to offer ConnectorCare coverage in PY 2021

▪ AllWays Inc would no longer participate in the ConnectorCare program under the carrier’s proposal

• If approved for ConnectorCare participation, AllWays Select would take its place but with a smaller

geographic footprint with the removal of Worcester County, and participation in some areas to be

finalized related to ConnectorCare network adequacy as described in subsequent slides

▪ HNE proposed a larger geographic coverage area in PY 2021, newly entering Worcester County

• HNE currently offers unsubsidized and APTC-only coverage in Worcester County and meets

ConnectorCare network adequacy standards

▪ Tufts Direct proposed a larger footprint in PY 2021, newly entering Franklin County

• Tufts Direct’s signing of a hospital contract in Franklin County allows them to meet ConnectorCare

network adequacy standards for hospital coverage in the county, and ConnectorCare adequacy of

specialist coverage is under review with Health Connector staff

▪ While Health Connector staff are pleased to see expected ConnectorCare geographic coverage mostly

maintained or expanded for PY 2021, some proposed provider network changes signal possible

concerns regarding the stability of ConnectorCare networks in future years

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AllWays Health Partners Select:

ConnectorCare ProposalHealth Connector staff are working with AllWays to determine whether the

AllWays Select provider network can sufficiently support ConnectorCare

membership in all geographic regions.

▪ Health Connector staff have expressed concerns about whether the initially proposed AllWays Select

provider network meets the Health Connector’s ConnectorCare-specific network adequacy standards,

and is currently working with the carrier to determine if those standards can be met in all proposed

ConnectorCare regions

▪ Hospital Coverage: The Health Connector allows a carrier to participate in the ConnectorCare program

in a given county only if the carrier contracts with at least one acute care hospital in the county and

that provides reasonable access to all county residents

• Health Connector staff identified areas of certain counties where access may not be reasonable

for all enrollees and therefore AllWays Select’s ConnectorCare participation in those areas remains

to be determined

• AllWays Select added two Massachusetts hospitals in response to Health Connector feedback, and

indicates it is continuing efforts to add to its hospital network in order to satisfy ConnectorCare

hospital standards in all proposed regions

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ConnectorCare Proposal (cont’d)The AllWays Select provider network, as initially proposed, represents a

smaller selection of primary care and specialty providers in comparison to the

AllWays Inc network.

▪ Primary Care Provider (PCP) and Specialist Coverage: The AllWays Select network is a narrower network

with a smaller portion of the PCPs and specialists available to members currently enrolled in AllWays Inc

plans, though the degree of provider attrition varies by region

• The Health Connector is reviewing AllWays Select PCP and specialist coverage with a focus on the

experience of current members accustomed to a wide array of available providers

▪ Based on preliminary data from AllWays, the difference in breadth between the two networks is more

acute in some counties than others

• For example, Health Connector staff are concerned about provider coverage in Bristol County, where

27% of PCPs, 40% of obstetricians/gynecologists, and 14% of cardiologists in the AllWays Inc network

are retained in the AllWays Select network

• Conversely, in Suffolk County, 65% of PCPs and cardiologists, and 79% of obstetricians/gynecologists,

remain in the Select network

▪ If the carrier is unable to sufficiently expand its network to ensure it can adequately serve ConnectorCare

members, Health Connector staff will return to the Board in September to recommend certain restrictions

on AllWays Select’s ConnectorCare participation, such as a smaller geographic coverage area

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Member ImpactIf the AllWays Select’s ConnectorCare submission proceeds as proposed,

ConnectorCare members would be impacted in several ways.

▪ While AllWays’ existing ~9,900 ConnectorCare members would maintain access to the Partners

hospital system under the proposed Select license, a portion would experience a disruption in

provider continuity if they enroll in the AllWays Select ConnectorCare plan

• Preliminary data from AllWays suggest approximately 23% of ConnectorCare members would

experience at least one disrupted relationship with a provider if they enroll in an AllWays Select

ConnectorCare plan in 2021*

▪ As with provider retention, the degree of provider disruption varies regionally with, for example, ~50%

of Bristol County ConnectorCare members experiencing at least one provider disruption, compared to

~18% in Suffolk County or ~13% in Essex County

▪ A ConnectorCare member would be able to select from BMCHP, Fallon, and Tufts Direct

ConnectorCare plans, depending on their region, if they did not wish to enroll in AllWays Select

• However, members may also experience provider disruption if they enroll in one of these other

carriers

• As AllWays is the only ConnectorCare carrier to offer coverage on the Islands, Islands residents

would need to remain with AllWays

• AllWays indicates there will be no change in Islands provider coverage under the Select license

16

*Data represent AllWays ConnectorCare members as of June 2020 who utilized at least one health service in 2019. As the data does

not include health services utilized in 2020 due to claims lag, the proportion of provider disruption is potentially an undercount.

Qualified Dental Plan (QDP)Submissions

Qualified Dental Plans:

Overview

The proposed 2021 dental shelf is unchanged from 2020.

▪ Two existing carriers proposed to offer plans to the non-group market: Altus Dental and Delta Dental

▪ Four existing carriers proposed to offer plans to the small group market: Altus Dental, Blue Cross Blue

Shield, Delta Dental and Guardian; however, BCBS and Guardian again requested to waive on-

exchange sale

▪ There are no new carriers exits or entrants

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Plan Year 21 (No change from PY 20)

Carriers Non-GroupSmall

Group

Intent to sell on

exchangeHigh Low Pedi Total

Altus Dental ✓ ✓ ✓ 1 1 1 3

Blue Cross Blue

Shield of MA✓ 1 1 2 4

Delta Dental of MA ✓ ✓ ✓ 2 3 4 9

Guardian ✓ 1 1 1 3

TOTAL 5 6 8 19

Next Steps and Vote

2021 Seal of Approval: Next Steps

The Conditional Seal of Approval is an important step in the process,

but more data and analysis, particularly regarding premiums, is

required before the 2021 product shelves are finalized.

▪ We will work closely with the Board throughout the summer to develop recommendations for final

award of the Seal of Approval

• Carriers must demonstrate compliance with all DOI requirements, including completion of

premium rate review

• Our final recommendation will be based on confirmation that all SOA plans offer good value to our

consumers, meet ConnectorCare network adequacy standards in all proposed coverage areas, and

carrier readiness to enter a contract with the Health Connector

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VOTE

The Health Connector recommends allowing the 2021 Conditional

Seal of Approval to enable consideration of all recommended

standardized and non-standardized QHPs and QDPs proposed by the

following carriers:

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• AllWays Health Partners Inc

• AllWays Health Partners Select

• Altus Dental

• Blue Cross Blue Shield of MA

• Boston Medical Center HealthNet Plan

• Delta Dental of MA

• Fallon Health

• Guardian

• Harvard Pilgrim Health Care

• Health New England

• Tufts Health Plan Direct

• Tufts Health Plan Premier

• UnitedHealthcare

Appendix 1: PY 2021 Standard Plan Designs

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2021 Standard Qualified Health Plan DesignsPlan Feature/ Service

Note: “Deductible then…” means the member must first meet the

plan’s deductible; then, the member pays only the copay as listed for

in-network services.

Platinum High Gold High SilverLow Silver

(HSA compatible,

Small Group Only)

Bronze #1 Bronze #2(HSA compatible)

Annual Deductible – Combined$0 $0 $2,000 $2,000 $2,700 $3,600

$0 $0 $4,000 $4,000 $5,400 $7,200

Annual Deductible – MedicalN/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

Annual Deductible – Prescription DrugsN/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

Annual Out-of-Pocket Maximum$3,000 $5,000 $8,550 $6,850 $8,550 $7,000

$6,000 $10,000 $17,100 $13,700 $17,100 $14,000

Primary Care Provider (PCP) Office Visits and

Mental/Behavioral Health Outpatient Services$20 $25 $25 Deductible then $30 Deductible then $40 Deductible then $100

Specialist Office Visits $40 $50 $50 Deductible then $60 Deductible then $90 Deductible then $150

Urgent Care $40 $50 $50 Deductible then $60 Deductible then $90 Deductible then $150

Emergency Room $150 $300 Deductible then $300 Deductible then $300 Deductible then $750 Deductible then $1,750

Emergency Transportation $0 $0 Deductible then $0 Deductible then $0 Deductible then $0 Deductible then $0

Inpatient Hospitalization $500 $750 Deductible then $1,000 Deductible then $750 Deductible then $1,200 Deductible then $2,000

Skilled Nursing Facility $500 $750 Deductible then $1,000 Deductible then $750 Deductible then $1,200 Deductible then $2,000

Durable Medical Equipment 20 percent 20 percentDeductible then 20

percent

Deductible then 20

percent

Deductible then 20

percent

Deductible then 20

percent

Rehabilitative Occupational and Rehabilitative Physical Therapy $40 $50 $50 Deductible then $60 Deductible then $90 Deductible then $150

Laboratory Outpatient and Professional Services $0 $50 Deductible then $50 Deductible then $60 Deductible then $75 Deductible then $55

X-rays and Diagnostic Imaging $0 $75 Deductible then $75 Deductible then $75 Deductible then $100 Deductible then $140

High-Cost Imaging $150 $400 Deductible then $400 Deductible then $500 Deductible then $1,000 Deductible then $1,000

Outpatient Surgery: Ambulatory Surgery Center $250 $500 Deductible then $500 Deductible then $500 Deductible then $500 Deductible then $500

Outpatient Surgery: Physician/Surgical Services $0 $0 Deductible then $0 Deductible then $0 Deductible then $0 Deductible then $0

Prescription Drug

Retail Tier 1 $10 $25 $25 Deductible then $30 $30 Deductible then $30

Retail Tier 2 $25 $50 $50 Deductible then $60 Deductible then $100 Deductible then $150

Retail Tier 3 $50 $75 Deductible then $75 Deductible then $105 Deductible then $150 Deductible then $225

Mail Tier 1 $20 $50 $50 Deductible then $60 $60 Deductible then $60

Mail Tier 2 $50 $100 $100 Deductible then $120 Deductible then $200 Deductible then $300

Mail Tier 3 $150 $225 Deductible then $225 Deductible then $315 Deductible then $450 Deductible then $675

Federal Actuarial Value Calculator 89.25 percent 81.40 percent 71.97 percent 69.10 percent 64.98 percent 64.98 percent

Bold indicates changes from 2020.

2021 Standard Qualified Dental Plan Designs

Plan Feature/ Service Family High Family Low Pediatric-only

Plan Year Deductible $50/$150 $50/$150 $50

Deductible Applies toMajor and Minor

Restorative

Major and Minor

Restorative

Major and Minor

Restorative

Plan Year Max (>=19 only) $1,250 $750 N/A

Plan Year MOOP <19 Only$350 (1 child)

$700 (2+ children)

$350 (1 child)

$700 (2+ children)$350 (1 child)

Preventive & Diagnostic Co-Insurance (In/out-of-

Network)0 percent/20 percent 0 percent/20 percent 0 percent/20 percent

Minor Restorative Co-Insurance (In/out-of-Network)25 percent/45

percent

25 percent/45

percent

25 percent/45

percent

Major Restorative Co-Insurance (In/out-of-Network)50 percent/70

percent

50 percent/70

percent

No Major Restorative

>=19

50 percent/70

percent

Medically Necessary Orthodontia, <19 only (In/out-of-

Network)

50 percent/70

percent

50 percent/70

percent

50 percent/70

percent

Non-Medically Necessary Orthodontia, <19 only (In/out-

of-Network)N/A N/A N/A

Note: Standard QDP designs are unchanged from 2020.

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Appendix 2: ConnectorCare Membership

ConnectorCare Membership Summary

26

Membership by Plan Type*

Plan Type AllWays BMCHP FCHP HNETufts

Direct

PT 1 (<100% FPL)

334 9,680 372 <50 8,778

PT 2 (100-200%

FPL)

4,309 41,232 3,622 1,842 59,113

PT 3 (200-300%

FPL)

5,245 27,406 3,465 1,912 56,888

Proportion of Carrier Membership by

Plan Type*

Plan Type AllWays BMCHP FCHP HNETufts

Direct

PT 1 (<100% FPL)

3% 12% 5% 1% 7%

PT 2 (100-200%

FPL)

44% 53% 49% 48% 47%

PT 3 (200-300%

FPL)

53% 35% 46% 50% 46%

*Data as of 7/2/2020.

Appendix 3: PY 2020 Reference Material


2020 Standardized Plan Designs

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Plan Feature/ Service

A check mark (✓) indicates this benefit

is subject to the annual deductible

Platinum High Gold Low Gold High Silver Low Silver (HSA) Bronze #1 Bronze #2 (HSA)

Annual Deductible – Combined$0 N/A N/A $2,000 $2,000 $2,900 $3,500

$0 N/A N/A $4,000 $4,000 $5,800 $7,000

Annual Deductible – MedicalN/A $1,000 $2,000 N/A N/A N/A N/A

N/A $2,000 $4,000 N/A N/A N/A N/A

Annual Deductible – Prescription DrugsN/A $0 $250 N/A N/A N/A N/A

N/A $0 $500 N/A N/A N/A N/A

Annual Out-of-Pocket Maximum$3,000 $5,000 $5,600 $8,150 $6,850 $8,150 $6,850

$6,000 $10,000 $11,200 $16,300 $13,700 $16,300 $13,700

Primary Care Provider (PCP) Office Visits $20 $25 $30 $30 $30 $30 $45

Specialist Office Visits $40 $45 $55 $60 $60 $60 $75

Emergency Room $150 $150 $350 $350 $300 $350 $300

Urgent Care $40 $45 $55 $60 $60 $60 $75

Inpatient Hospitalization $500 $500 $750 $1,000 $750 $750 $750

Skilled Nursing Facility $500 $500 $750 $1,000 $750 $750 $750

Durable Medical Equipment 20 percent 20 percent 20 percent 20 percent 20 percent 20 percent 20 percent

Rehabilitative Occupational and

Rehabilitative Physical Therapy$40 $45 $55 $60 $60 $60 $75

Laboratory Outpatient and Professional

Services$0 $25 $50 $60 $60 $60 $60

X-rays and Diagnostic Imaging $0 $25 $75 $75 $75 $75 $75

High-Cost Imaging $150 $200 $300 $500 $500 $500 $500

Outpatient Surgery: Ambulatory Surgery

Center$250 $250 $500 $500 $500 $500 $500

Outpatient Surgery: Physician/Surgical

Services$0 $0 $0 $0 $0 $0 $0

Prescription Drug

Retail Tier 1 $10 $20 $25 $30 $30 $30 $35

Retail Tier 2 $25 $40 $50 $60 $60 $60 $75

Retail Tier 3 $50 $60 $125 $100 $105 $125 $150

Mail Tier 1 $20 $40 $50 $60 $60 $60 $70

Mail Tier 2 $50 $80 $100 $120 $120 $120 $150

Mail Tier 3 $150 $180 $375 $300 $315 $375 $450

Federal Actuarial Value Calculator 89.38 percent 81.30 percent 76.04 percent 71.94 percent 69.42 percent 64.96 percent 64.95 percent

Bold indicates changes from PY2019.

2020 ConnectorCare Enrollee Contributions

Region A1

Enrollee Premium Contribution By Plan Type

1<100

percentFPL

2A100-150

percent FPL

2B150-200

percent FPL

3A200-250

percent FPL

3B250-300

percent FPL

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3 HNE $104 $107 $156 $199 $246

4AllWays Health

Partners$155 $156 $206 $250 $299

Region A2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3 HNE $104 $107 $156 $199 $246


1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 HNE $37 $74 $130 $199 $246


1 2A 2B 3A 3B

1 HNE $0 $0 $45 $87 $130

Region B1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 Fallon $0 $0 $45 $87 $130

3 BMC $0 $0 $45 $87 $130

4AllWays Health

Partners$147 $145 $194 $237 $282

Region C1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3AllWays Health

Partners$191 $193 $243 $286 $331

Region D1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3AllWays Health

Partners$161 $171 $221 $263 $307

Region E1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3AllWays Health

Partners$217 $226 $276 $318 $360

Region F1Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3AllWays Health

Partners$206 $211 $263 $305 $352

Region

F2

Enrollee Premium Contribution By

Plan Type

1 2A 2B 3A 3B

1AllWays Health

Partners$0 $0 $45 $87 $130

Region

G1

Enrollee Premium Contribution By

Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $12 $50 $105 $151 $194

Region G2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1AllWays Health

Partners$0 $0 $45 $87 $130

Region C2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3 Fallon $0 $0 $45 $87 $130

4AllWays Health

Partners$191 $193 $243 $286 $331

Region G3Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $12 $50 $105 $151 $194

3AllWays Health

Partners$221 $266 $327 $375 $422

Region D2Enrollee Premium Contribution By Plan Type

1 2A 2B 3A 3B

1 Tufts-Direct $0 $0 $45 $87 $130

2 BMC $0 $0 $45 $87 $130

3AllWays Health

Partners$166 $172 $221 $263 $305

4 Fallon $216 $221 $271 $313 $355

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Documents

Conditional Award of the 2021 Seal of Approval VOTE · 7/9/2020 · AllWays Health Partners Select, BMC HealthNet Plan, Fallon Health, Health New England, and Tufts ... finalized