Presentation by Tia Cintron, Project Director, Insurance Exchange ...

▐ Planning Connecticut’s Health Insurance Exchange
Overview
November 14, 2011
Tia Cintron, Project Director
Insurance Exchange Planning

Planning Connecticut’s Health Insurance Exchange
Rationale
▐ Millions Uninsured and Underinsured
▐ 377,000 Connecticut
▐ Skyrocketing health care costs
Premise
▐ Reform is making changes to the insurance market
▐ Guarantee Issue
▐ Requirement that most US citizens and legal residents get
insurance or face financial penalty.
Intent
▐ Creation of new competitive health insurance markets
designed to give individuals and small businesses access to
affordable health care coverage at competitive prices
▐ Improve quality, contain costs, simplify processes, drive change

Planning Connecticut’s Health Insurance Exchange
Opportunity
▐ Serve a number of purposes: Create larger individual and small
employer insurance pools which create advantages:
▐ Lower costs
▐ Lower premiums
▐ More policy choices
▐ Provide individuals and small employers with access to the new
policies written using national rules which are consumer focused
▐ The Exchange/SHOP will provide one-stop shop for researching,
comparing, purchasing coverage which simplifies and increases
efficiencies
COB Exchange Estimates by 2017:
• 24 million purchased coverage
• 5 million purchased through employer
• 16 million previously uninsured
• 81% will receive financial assistance

Planning Connecticut’s Health Insurance Exchange
Purchasing
Power
▐ Individuals, self employed and small businesses will buy policies from
private insurance companies underwritten and rated using the new
set of consumer protective federal rules—Exchanges and Small
Business Health Option Programs (SHOP)
▐ Individuals and small businesses can also choose to continue any
insurance coverage they have
SHOP
▐ Better Information: Will improve employer access to information
about plan benefits, quality and premiums
▐ Tax Credits: Small employer that purchase employer-sponsored
health coverage through SHOP may also qualify to receive tax credit
up to 50% of the employer’s premium
▐ More Choices, Less Hassle: Will benefit from reduced administrative
burden and facilitated choice of qualified health plans

Exchange Functions
Flexibility to
Design and
Implement
▐ Certify qualified health plans
▐ Administer premium tax credits and cost sharing reductions
▐ Provide customer assistance
▐ Provide an easy-to-use website
▐ Coordinate eligibility and enrollment
Federal
Guidance in
Core Areas
▐ Basic Exchange Functions
▐ Open Enrollment Periods
▐ Minimum Benefit standards for Exchange Products
▐ Requirement that Exchanges need to be self sustaining 2015
▐ Requirement that the Exchange consult with Stakeholders

Exchange Funding
1
2011
2012
2013 2014
Planning Grant
$1M
State
Certification
Open Enrollment
2
Systems Testing
Level One Establishment Grant: $6.7M
Administrative Structure – Business Ops – Customer Assistance
3
Level Two
Grant
Application
Level One Establishment Grant
Operations and IT Development – Systems Testing – Program Implementation

Planning Grant Research Areas
Assessment
of
Uninsured
Analysis of
Insurance
Market
Analysis of
Small Employer
Market
Analysis of
Economic and
Actuarial
Models
Analysis of
Large Group
Market after
2017
Impact of other
Health System
Initiatives on the
Exchange
Develop Financial
Model for
Sustainable
Exchange
Accounting and
Financial System
Function Assessment
IT Gap Analysis
Impact Study on
Medicaid
Program
Analysis of HIX
Implementation
Options
▐ Flexibility to design and Implement
▐ Compliance with minimum federal requirements

Primary Project Areas
1
2011
Planning
Grant
2012
2013 2014
2
Level One Establishment Grant
Administrative
Structure
CEO Recruitment
Leadership Staffing
State
Certification
Systems Testing
Open Enrollment
RFP Process
Business
Operations and
IT Systems
Work Period
Customer
Assistance
Development
Work Period
Consumer
Outreach
Research
Marketing - Communications Strategy Development - Implementation
3
Level Two
Grant
Application
Level Two Establishment Grant
Operations and IT Development – Systems Testing – Program Implementation

Contact Information
Tia Cintron, MHA
Project Director, Insurance Exchange Planning
Tia.cintron@ct.gov
860-418-6407
▐
Office of Healthcare Reform and Innovation (See: Insurance Exchange tab)
www.healthreform.ct.gov