A Federally Facilitated Marketplace - PowerPoint Presentation

A Federally Facilitated Marketplace
A Federally Facilitated Marketplace

A Federally Facilitated Marketplace - Description


Arizona Erin H Klug Arizona Department of Insurance Arizona Marketplace Landscape Since 1012013 27943 Marketplace Plans selected HHS Enrollment Report ID: 719952 Download Presentation

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insurance health exchange plan health insurance plan exchange gov life ppo amp hmo arizona marketplace consumer enrollment www consumers ahcccs dental information

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Presentation on theme: "A Federally Facilitated Marketplace"— Presentation transcript


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

Shom More....