Final Award of 2017 Seal of Approval (VOTE) ASHLEY HAGUE Deputy - PowerPoint PPT Presentation

Final Award of 2017 Seal of Approval (VOTE) ASHLEY HAGUE Deputy Executive Director, Strategy and External Affairs BRIAN SCHUETZ Director of Program and Product Strategy HEATHER CLORAN Associate Director of Program and Product Strategy EDITH BOUCHER CALVAO, FSA, MAAA Chief Actuary Board of Directors Meeting, September 8, 2016

2017 Seal of Approval Overview The 2017 Qualified Health and Dental Plan shelves will offer a range of plan designs, carriers and premiums.  Rising premium costs, for certain medical carriers and plans, means many members will experience high renewal increases  Many unsubsidized and APTC-only enrollees, particularly those enrolled in Harvard Pilgrim HealthCare and Neighborhood Health Plan, will see large premium increases for their renewal plans  Rising premium costs will also impact ConnectorCare members enrolled in higher cost carriers. These members will experience large increases in the contributions for their renewal plans  Despite these increases, almost all of our enrollees facing steep increases can find similar (or identical) plan options with lower costs from other carriers  All of our carriers offer networks with high quality providers  Many enrollees who shop will find plans with lower costs than their renewal plan and their current plan  The Health Connector will strongly encourage all members to comparison shop in order find a 2017 plan that meets their needs – including cost 2

2017 Seal of Approval Timeline  Today we share our recommendation for the award of the Final Seal of Approval (SOA) for Qualified Health and Dental Plans to be offered for sale through the Health Connector for coverage starting January 1, 2017  We will also be detailing our recommendation for the 2017 ConnectorCare program Mar Dec Apr May Jun Jul Aug Sept Oct Nov 2016 2016 3/10: SOA Kickoff – Board Meeting 3/18: Release Medical and Dental RFRs 5/13: RFR Responses Due 7/14: Conditional SOA – Board Meeting 9/8: Final SOA – Board Meeting (TODAY) 11/1: Open Enrollment Begins 3

2017 Seal of Approval Requirements Affordable Care Act (ACA) & Massachusetts Health Connector SOA Requirements Standards • Propose one Standardized plan on each metallic tier on broadest commercial network Licensure and accreditation • – Option to propose one alternative network variation for each • Network adequacy metallic tier • Service Area • Option to propose up to three Non-standardized plans in total • May request to withdraw Standardized Bronze plan if Health • Essential Health Benefit (EHB), Connector receives a sufficient number of Bronze options cost-sharing limits and actuarial • Propose a Catastrophic plan; may request to withdraw Catastrophic QHPs value (AV) requirements plan if Health Connector receives a sufficient number of • Premium review Catastrophic options Fair marketing practice • • Propose a ConnectorCare-compatible Silver plan for the • Transparency of coverage ConnectorCare program that complies with the Health Connector’s network adequacy requirements for this population • Quality Improvement Strategy – Plans may be offered on an any network type, including a (QIS), Quality Reporting narrower network, or a network that is broader than their Standards (QRS) and QHP standard commercial network Enrollee Satisfaction Survey • Must offer one plan for each Standardized plan design: Family High, • All other requirements necessary Family Low and Pediatric-only for Division of Insurance (DOI) QDPs – Option to propose one alternative network variation for each approval design Option to propose up to three Non-standardized plans in total • 4

2017 Seal of Approval Approach Through the 2017 SOA, the Health Connector has worked to further simplify the consumer shopping experience by streamlining our product offerings and bolstering the ability to conduct “apples-to-apples” comparison shopping.  As part of the 2017 SOA, we made several key changes to the Qualified Health Plan (QHP) and Qualified Dental Plan (QDP) product shelves aimed at achieving these goals  We eliminated the second standardized Gold plan design, standardized the Bronze tier and standardized additional cost sharing categories  Overall, we focused the number of allowable plan offerings on our QHP product shelf and instituted a cap on the number of allowable offerings on our QDP shelf  We also leveraged this year’s SOA to begin influencing the product design of plans in our marketplace to address the health needs of our members, through pediatric dental coverage and opioid use disorder therapy; for future years, we also plan to address chronic disease management through value-based insurance design (VBID) 5

Summary of Seal of Approval Results For 2017, Unsubsidized and APTC-only ( i.e., 300-400% of the federal poverty level) members will see significant premium increases, while the ConnectorCare program continues to generate competition on the Silver tier. However, there is significant variation between the premium trends among carriers, with notable outliers. Changes in Premium: 2016 to 2017 Unsubsidized & ConnectorCare 2 Dental 3 Merged Market APTC-only 1 (Division of Insurance) 50,790 members 4 173,495 members 60,323 members 7.3% 6.7% 19.0% 6.2% Excluding HPHC & NHP Excluding NHP 28,153 members 130,992 members 6.6% 0.7% 1 Enrollment-weighted premium change (2016 actuals to 2017 calculated) w/ member aging (~2%), assumes mapping to 2017 renewal plan 2 Enrollment-weighted premium change from 2016 ConnectorCare selected Silver plan to 2017 selected Silver plan (2016 actuals to 2017 calculated) w/ member aging (~2%), not directly reflected in member contributions 3 Enrollment-weighted non-group average premiums for Family High and Family Low based on age 20 and over premium value; Pediatric-only based on age less than 20 premium value 6 4 Enrollment data as of August 2016

Qualified Dental Plan (QDP) Recommendation

Qualified Dental Plans Update As noted in the Conditional Seal of Approval presentation in July, we received a late request from Guardian to consider their products for our shelf, and are now recommending to accept Guardian for the 2017 Seal of Approval.  As in 2016, Guardian only submitted QDPs for the small group shelf  Guardian submitted the required three standardized plan designs: Family High, Family Low and Pediatric-only  Guardian did not submit any non-standardized plans for 2017  Additionally, Guardian submitted all other required materials, has received approval from the Division of Insurance and has met the requirements described in the Seal of Approval  Health Connector staff have reviewed the submission and recommend that Guardian be approved for the 2017 Seal of Approval 8

Qualified Dental Plans: Product Shelf  All four carriers have submitted at least one offering for each of the required three standardized plan designs: Family High, Family Low and Pediatric-only  Four non-standardized plan designs have been proposed by two carriers  Delta Dental proposed three non-standardized plans and Blue Cross Blue Shield of MA proposed one non-standardized plan, all previously offered in 2016 Standardized Plans Non-Standardized Plans Non- Small Carriers All Plans Group Group High Low Pedi Total High Low Pedi Total Altus Dental   1 1 1 3 - - - 0 3 Blue Cross Blue Shield  1 1 1 3 - - 1 1 4 of MA Delta Dental of MA 2 2 2 6 - 1 2 3 9   Guardian  1 1 1 3 - - - 0 3 Standardized Plans Non-Standardized Plans All Plans Non-Group 9 3 12 Small Group 15 4 19 9

Qualified Dental Plans: Non-group Premiums Overall, non-group members enrolled in QDPs will see an average decrease in premiums of 7.3%, with those enrolled in Family Low and Pediatric-only products experiencing larger decreases. 1 Non-group Dental Average Changes in Premium by Tier: 2016 to 2017 1 Family High Family Low Pediatric-only 16,912 members 2 43,783 members 629 members 12.2% 25.0% 5.3% Non-group Dental Average Changes in Premium by Carrier: 2016 to 2017 Membership Share 2 Premium Change 1 Carriers Altus Dental 16% 12.0% Delta Dental of MA 84% -10.8% OVERALL -7.3% 1 Enrollment-weighted non-group average premiums for Family High and Family Low based on age 20 and over premium value; Pediatric-only based on age less than 20 premium value 10 2 Enrollment as of August 8, 2016

Qualified Dental Plans: Renewal Approach More than 99% of dental members will be renewed into the same plan as 2016, with a majority of members seeing a decrease in their premiums for 2017.  For the very limited enrollment in the one closing QDP, members will be mapped to the lowest cost plan from the same carrier in the Pediatric-only tier QDP Renewal Status for 2017 (Members) 1 Plan Closing (Market-wide) 0.10% Renew into Same Plan 99.90% 11 1 Enrollment as of August 8, 2016

Qualified Health Plan (QHP) Recommendation