Presentation #2 - Arkansas Business Events

Key Aspects for Employers
 2015
 Will Arkansas be operating as a State Partnership
Marketplace or will Arkansas become a StateBased Marketplace?
 Implications for the Small Group Market and
Small Employer Health Options Program (SHOP):
 Employer or employee choice model
 Active purchaser or market based
Known Changes to the Market
beyond 2015
 New definition of Small Group moves to 100 employees
in 2016
 Rating rules apply to 50-100 groups
 Essential Health Benefits (EHB) package applies to 50-100
 New way rates are built for 50-100 groups
 HHS has reserved the right to define “Essential Health
Benefits” Package for 2016
 May result in a standardized EHB in all 50 States
 State waiver for private option ends in 2016
New Rating Methodology for 50100 in 2016
 Gender rating removed
 Industry rating removed
 Common geographic rating established by regulators
 Tobacco load nationally 50% (Arkansas 20%)
 Health status and pre-existing conditions no longer considered
 Age rating reduced from 6:1 ratio oldest to youngest to 3:1
Essential Health Benefits
Non-grandfathered small group health plans – offered on or off the SHOP, must provide these
government-mandated essential health benefits
Essential health benefits include services in the following 10 categories:
Ambulatory patient services
Prescription drugs
Emergency services
Rehabilitative and “habilitative”
services and devices
Maternity and newborn care
Laboratory services
Preventive and wellness services
and chronic disease management
Pediatric services, including dental
and vision care
Mental health and substance
use disorder services,
including behavioral health
Premium Rate Calculation
 Unique rate calculation for every member
 Member-level, rather than employee-level, census
required to comply
 Every member on an employee contract has a
unique rate
 Rates developed for up to 3 minor children
 4th minor child (and any additional) is free
 Children age 21+ must be rated as adults
2017 Marketplace
 Marketplace can allow
large groups (100+) to
purchase through online
marketplaces similar to
SHOP for small employer
 Implications
“Large Group” Purchasing
on Marketplace
 Essential Health Benefits Package
 Employee Choice Model
 Employer Open Enrollment Period
Employer Strategies to Stay
“Outside Marketplace”
 Self-Funding
 Grandfathering
 Defined contribution
through private
ACA Impact on Employer Group
Coverage Cost
Employer Strategies to
Control Costs
 Employee/Incentives to drive engagement
(Wellness and Health Management
 Medical Home Models
 Health Improvement Tools
Employer Strategies to Stay
“Off Exchange” and Control Costs
 Management of “pre-crisis” chronic conditions –
new models of Case Management
 Focused Provider Panels
 Home Monitoring, Electronic Health
 Reference-based pricing
 Onsite health care
 New payment mechanism

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