Arizona Erin H Klug Arizona Department of Insurance Arizona Marketplace Landscape Since 1012013 27943 Marketplace Plans selected HHS Enrollment Report ID: 719952
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Slide1
A Federally Facilitated Marketplace
Arizona:
Erin H. Klug
,
Arizona Department of InsuranceSlide2
Arizona Marketplace Landscape
Since 10/1/2013
27,943
– Marketplace Plans
selected
(
HHS Enrollment Report
October
1, 2013 – December 28, 2013)
98,203
– Adults added to AHCCCS
(
1,369
in 100-133
%
FPL category;
AHCCCS Enrollment Update as of
1/10/14)
$
144 to $665 – Premium range
(
Marketplace
medical
plans, age 30, all counties, all
metal
levels
;
https
://www.healthcare.gov/shop-health-plan-information
/
)Slide3
FFM
certified insurance companies in AZ:
Medical (QHPs)
Dental (SADPs)
1. Aetna Life IC (PPO)
1. Delta
Dental of AZ
2. Blue Cross Blue Shield of AZ (PPO)
2. Cigna
Health & Life IC
3. Cigna Health & Life IC (PPO)
3. Dentegra
IC
4. Health Choice IC (HMO)
4. Humana
IC
5. Health Net of AZ (HMO)
5. Premier
Access IC
6. Health Net Life IC (PPO)
6. Renaissance
Life & Health IC of America
7. Humana Health Plan of AZ, Inc.
(
HMO)
7. United
Concordia IC
8. Meritus Health Partners (HMO)*
https://www.healthcare.gov/health-plan-information/
9. Meritus Mutual Health Partners (PPO)*
https://www.healthcare.gov/dental-plan-information/
10.The University of AZ Health Plan (HMO)
*CO-OPSlide4
Who does what in
Arizona?
CCIIO/CMS
Outreach/education:
Direct
advertising, consumer publications, funding others
Approve
and remove entities to operate on the exchange:
QHP issuers, agents, web-brokers, Navigators, CACs Management of the exchange website: Collect, correct and display insurer plan data Consumer AssistanceMarketplace appeals, special enrollment, APTC & CSR Premium Stabilization: Risk adjustment, reinsurance and risk corridors programs Links to Medicaid/AHCCCS for eligibility determination
State Insurance Department
Regulate contracts of insurance issued by health insurers
on- and off-exchange
: Review insurance contracts, rates, and advertising for compliance with state requirements and ACA
Consumer Assistance
Monitoring & Enforcement
Financial oversight of insurersSlide5
How do we coordinate?
CCIIO certification of QHP issuers requires DOI input on:Insurer licensure
Insurance
policies and rates filed/approvedHMO service areas
Enforcement activity
DOI may require data regarding insurer and agent exchange activity to perform
:
Complaint investigations
M
arket analysisFiscal monitoring Slide6
How we
assist consumers?
FFM assists consumers with:
Plan e
nrollment and eligibility
Special Enrollment
APTC eligibility
Marketplace appeals
ADOI assists consumers with:Problems with insurance plans Claim denials/delays, appealsAccess to careAgent misconductUnlicensed activity/insurance scamsSlide7
What’s next?
Plan networks
Mismatches
Decertification process
Producers (agents) on the exchange
FraudSlide8
Consumer Affairs Division
Arizona Department of Insurance
2910 N. 44
th
Street, Ste. 210
Phoenix, AZ 85018
www.azinsurance.gov
602.364.2499
Erin H. Klug -
eklug@azinsurance.gov