SHOP Advisory Group August 2, 2012
8/2 Agenda • Welcome & Introductions 5 min 10 min • 7/26 Meeting Review • Individual & Health Plan AG updates 10 min • Policies – Broker Relationship & Compensation 60 min – Introduce Customer Service 15 min • Public Forum 10 min • Wrap-up 5 min 2
Broker Relationship & Compensation Essential Questions: − How will COHBE partner with brokers? − Will brokers be appointed and certified? Will brokers need to be appointed with all of the carriers on the Exchange? Should the Exchange try to develop a process to simplify becoming appointed with all carriers? − Will brokers be compensated and if so, how? Should all plans offer the same commission in the Exchange? 3
Broker Relationship & Compensation Goals of COHBE: Provide enhanced access to coverage Support SB 11 � 200 intent to increase access, affordability and choice for individuals and small employers purchasing health insurance in Colorado. Promote a level playing field for plans 4
Broker Relationship & Compensation 7/26 meeting takeaways − COHBE should partner with brokers. − In addition to current DOI licensing, brokers should be certified to sell through the Exchange, both initially and ongoing. − This certification process should enable brokers to sell all plans for all carriers in the Exchange. − Individuals should NOT be required to use a broker. 5
Broker Compensation Structure $$$ OR $ Rate set by carrier Rate set by exchange; e.g. different rates for Equal compensation different carriers, and across all carriers thus plans; (plans); 6
Customer Service Center July 23, 2012 What is the mission and scope of the COHBE customer service center? Goals/Objectives of COHBE: Fulfill the mission outlined in SB-200 to increase access, affordability and choice to individuals and small employers purchasing health insurance in Colorado Provide a best-in-class service experience to Coloradans utilizing the Exchange Comply with applicable state and federal laws Meet the Exchange implementation timeline Applicable law: Colorado SB11-200 “The ¡intent ¡of ¡the ¡Colorado ¡Health ¡Benefit ¡Exchange ¡is ¡to ¡increase ¡access, ¡affordability, ¡and ¡choice ¡for ¡individuals ¡and ¡ small ¡employers ¡purchasing ¡health ¡insurance ¡in ¡Colorado.” Federal §155.205 Consumer assistance tools and programs of an Exchange. (a) Call center. The Exchange must provide for operation of a toll-free call center that addresses the needs of consumers requesting assistance and meets the requirements outlined in paragraphs (c)(1), (c)(2)(i), and (c)(3) of this section. (b) Internet Web site. The Exchange must maintain an up-to-date Internet Web site that meets the requirements outlined in paragraph (c) of this section and: (3) Provides applicants with information about Navigators as described in §155.210 and other consumer assistance services, including the toll-free telephone number of the Exchange call center required in paragraph (a) of this section. (c) Accessibility. Information must be provided to applicants and enrollees in plain language and in a manner that is accessible and timely to — (1) Individuals living with disabilities including accessible Web sites and the provision of auxiliary aids and services at no cost to the individual in accordance with the Americans with Disabilities Act and section 504 of the Rehabilitation Act. (2) Individuals who are limited English proficient through the provision of language services at no cost to the individual, including (i) Oral interpretation; (ii) Written translations; and Introduction date: July 23, 2012 Target Decision date: August 27, 2012 1
(iii) Taglines in non-English languages indicating the availability of language services. (3) Inform individuals of the availability of the services described in paragraphs (c)(1)and (2) of this section and how to access such services. (d) Consumer assistance. The Exchange must have a consumer assistance function that meets the standards in paragraph (c) of this section, including the Navigator program described in §155.210, and must refer consumers to consumer assistance programs in the State when available and appropriate. Recommended Scope and Functionality: In an effort to build a best-in- class ¡service ¡experience ¡for ¡Coloradans ¡utilizing ¡the ¡Exchange, ¡COHBE’s ¡contact ¡center ¡will ¡ provide assistance to individuals and small employers through a wide range of services and maximize state of the art technology. At a high level, some expectations of the customer service center are to: Be responsible for assisting customers with enrollment across all channels (i.e. website, telephone, mail, etc.). Customer service representatives (CRs) will provide information on potential benefits such as advance premium tax credits and provide basic information on various aspects of health insurance such as deductibles, co- pays, benefits associated with levels of coverage (e.g. metal levels) and state medical programs. CRs will be trained to be objective and not advise on plan selection. They will also be trained to file formal complaints. Coordinate closely with the Medicaid/CHP+ contact center processe s ¡and ¡technologies ¡to ¡enable ¡a ¡“warm” ¡handoff ¡ for certain populations that require additional state customer support services. Offer real-time chat capabilities to consumers. With one click a consumer will be able to connect to a CR, the CR will be able to ¡view ¡the ¡customer’s ¡screen ¡and, ¡if ¡authorized, ¡take ¡control ¡of ¡their ¡screen ¡to ¡navigate ¡the ¡customer ¡ through the eligibility and enrollment process. Have the capability to monitor all CR customer interactions to ensure high quality service. All CR customer interactions will be monitored for adherence to COHBE policies and customer support scripts. COHBE has licensed a customer relationship management system that will track all customer inquiries and all documents submitted by the customer and outbound communications such as email, notifications sent via US mail. Support small employers and brokers through specially trained CRs. Premium billing and financial reconciliations for SHOP (employer and employee) financial transactions will NOT be handled by the customer service center. These services will be handled by back-office staff at COHBE. Track performance measures. Some performance measures include: maximum time to answer a call, abandonment rate, time to complete enrollments, and response times. Introduction date: July 23, 2012 Target Decision date: August 27, 2012 2
Wrap up Next meeting – Thursday, August 16 nd , 10a—noon 7
Back Up 8
Topic Summary & Board Target Decision Dates Standard Comparative Plan Information 6/25 Employer & Employee Choice Architecture 7/9 Display & Pricing of Supplemental Plans 7/23 Broker Relationship & Compensation 8/13 Customer Service Center TBD Consumer & Employer Rights & Responsibilities TBD Single Streamlined Application TBD Certification of Health Issuers & QHPs TBD 9
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