CA HBEX Standardized Plan Benefit Designs

[Dave020]

These are an approval item for the 12/18 meeting.

2 HSA plans, one Silver one Bronze

Lots of Silver plans with FPL levels addressed

http://www.healthexchange.ca.gov/St... HBEX Standardized Designs 11-09-12 draft.pdf

 

[taterpeeler]

reeks with mapd attributes

 

[Yagents]

Great info. I'm sure these are just guidelines, and more differences will come out once the insurance companies make up their own flavors that match similar AV values.

As usual, the HSA plans are the easiest to understand, but I wish they had a structure like the catastrophic plan with 0% coinsurance.

I found the 100-150% of FPL plans kind of interesting.....$3 dr visit copays, and $25 ER room copays........this displays the "cost sharing" subsidies in addition to the premium subsidies that will be available. I still don't see a deterrent to people flocking to the ER for a bloody nose.

But, we should all be glad they didn't eliminate HSA's, and you'll find them to be the best priced plans and best selling plans on all exchanges.

 

[taterpeeler]

Great info. I'm sure these are just guidelines, and more differences will come out once the insurance companies make up their own flavors that match similar AV values.

As usual, the HSA plans are the easiest to understand, but I wish they had a structure like the catastrophic plan with 0% coinsurance.

I found the 100-150% of FPL plans kind of interesting.....$3 dr visit copays, and $25 ER room copays........this displays the "cost sharing" subsidies in addition to the premium subsidies that will be available. I still don't see a deterrent to people flocking to the ER for a bloody nose.

But, we should all be glad they didn't eliminate HSA's, and you'll find them to be the best priced plans and best selling plans on all exchanges.

Those plans tied to the fpl look like the mapd plans with extra help and lis as well as snp plans... As we talked about today bill...mapd

 

[Ann H]

Great info, Dave. Thanks for sharing.

I have a question for you. Since the title says these are the Standardized Benefit Plan Designs for the CA HBEX, does that preclude any other creative plan designs, or are they saying that all carriers must offer these plan designs and are free to offer others?

Like the other posters, I found the 100-150% of FPL plans interesting, but I was shocked by the Bronze Copay plan. A $70 copay for Dr. visits?

There are other strange things, well, maybe strange for the AZ market. Perhaps these are normal in the CA market... The co-insurance plans have copays, and the copay plans have copays. I don't see much of a difference. Also, it says the deductible is waived for the first 2 office visits, and that appears to apply to copay plans as well as co-insurance plans. Do they mean that subsequent Dr. visits are subject to the deductible and then the copay applies again?

Since the copays and all cost sharing applies to the out-of-pocket max, I see that as being another item that will raise costs above the currently marketed plans.

I'm not trying to make any particular point, I'm just writing down interesting things that I noted from this spreadsheet. And, speaking of interesting things, YAgents hit the nail solidly on the head when he said that $25 for ER for 100-150% of FPL clients won't motivate them to stop using the ER for minor conditions.

And my last observation is this. Some say the exchange will be like using travelocity to buy an airline ticket. I've never seen an airline ticket be anywhere near this complicated. If these are the base plans, and consumers will be provided a spreadsheet similar to this, then it's clear that most people will want a broker to help them make their choice. There are actually only a handful of plans on this spreadsheet. They are just complicated by the differing cost-sharing for lower FPL limits. And, if more plans than these are allowed in the exchange, as well as outside the exchange, then the help of a broker is even more valuable. Most people won't know the qualification rules for subsidies. Most people don't know their MAGI. Most people won't know what a Bronze HSA is, much less the IRS rules for the accompanying savings account. Many 40 year olds might want to take the Catastrophic plan designed for the under-30 crowd. I doubt that a visit to the govt website or a call to your friendly exchange will guide them to proper answers.

 

[Dave020]

The 2 office visits is common on most CA IFP plans today. Any further visits are paid NFR under the deductible.

I expect that this is the "base" design and the each carrier will provide QHPs in some, but not necessarily all of the designs. It will be interesting if Carrier X does not have a certain Silver Plan and only Carrier Y offers it.

The meeting (live web cast will be available) on the 18th should clear up a lot of this. These are the basic plan designs and I am sure that there will be wiggle room and some changes.

I was interested to note that FPL plan all fall into Silver. I know that they said no Gold or Platinum options for anyone 250% or below.

Glad to see HSAs were preserved and expect every carrier approved will offer both Silver and Bronze HSA plans.

The last plan, Cat Bronze, is the odd ball plan. You have to be under 30 to buy it and have a participation waiver from HHS. Silver seems to rule the exchange.

Link info for the December meeting (standardized plans is an action item at this meeting)

http://www.healthexchange.ca.gov/Bo...012/HBEXDecember18_2012BoardMeetingAgenda.pdf

 

[Ann H]

Interesting. So, Dave, you said you expect that this is the base plan and each carrier will provide QHPs in some but not necessarily all of the designs. Do you feel there will be MORE designs than this, inside and outside the exchange, so long as they meet the EHB's and metal tier requirements? Or is CA restricting all sales to these designs?

 

[pahealthquotes]

wow, some of the benefits look very rich. Funny how all of the sickies will flock to the lower OOP plans and the healthier bunch will flock to the HSA's and the like. Bottom line this is gonna cost a damn fortune.

Have the carriers released any preliminay rates?

What will the offerings look like outside the exchange?

Things are about to heat up.

Joe

 

[Yagents]

Webinar is on NOW........

 

[Dave020]

Revised (and simplified) CA Exchange plan designs

http://www.healthexchange.ca.gov/St...rd Benefit Plan Designs webinar 12-11-12.pdf