HEALTH REPUBLIC INSURANCE OF
NEW JERSEY
Providing a New Choice in Health Care
Roy Frank, MBA, PAHM
Member Engagement & Outreach Manager
Introductory Video
Get Ready for the Affordable Care Act
http://kff.org/health-reform/video/youtoons-obamacare-video/
2
Health in Bergen County
● Total uninsured: 80,167 (estimate)
보험에 가입하지 않은 사람: 약 8만 167명
● Qualify for Marketplace: 34,056 (estimate)
마켓플레이스 자격 해당자: 3만 4천 56명
● Off Marketplace: 15,420 (estimate)
마켓플레이스 제외 대상자: 1만 5천 420명
Data source: Centers for Medicare and Medicaid Services
All figures are estimates
3
New Jersey’s Korean Population
뉴저지 한인 인구
● Korean Population in NJ saw a growth rate of 43.4% from
2000 – 2010 뉴저지 한인 인구 증가율 43.4%
● Korean Population in NJ
93,679 (12.9% of Asian
Population in the State)
● Korean Population in Bergen County
56,773 (60%)
뉴저지 한인 인구
버겐카운티 한인 인구
● Uninsured Koreans in Bergen County
6,495 (11.4%)
버겐카운티 무보험자
Data source: Centers for Medicare and Medicaid Services and Labor Market & Demographic Research
All figures are estimates as of 2010
4
Target 대상
• Individuals & families with earnings between138% 400% of the Federal Poverty Level (FPL)
개인 & 가족 연방 저소득 수준이 138% ~ 400% 까지 증가
• Individuals & families earning >400% of FPL
• Small businesses (< 50 FTEs)
자영업자
Who We Are; 뉴저지 핼스리퍼블릭 보험
Health Republic Insurance of New Jersey (HRINJ)
One of 23 non-profit CO-OP’s, member-governed health insurance
companies in America. 비영리단체, 정부보험회사
•Part of the Affordable Care Act:
– goal of bringing down health care costs and making health insurance
accessible to millions of people 건강 비용 감소와 보험 가입 증가
– HRINJ received start up and “reserve” loans from the U.S. Department of
Health and Human Services to get started 미보건국으로 부터 지원금 비축
– An idea of Freelancers Union, New York, New York 뉴욕 프리렌서 조합
•A Progressive Champion: 혁신적인 최고의 건강플랜 제공, 커뮤니티 건강우선
– Our mission is to provide innovative health plan choices and put the
interests of our members first. We aim to ensure that high-quality
benefits are provided in an affordable way that works for all members.
We are the persistent advocate and change-agent working for the health
and wellness of the communities we serve.
Our Priorities 우선 순위
• Provide a new choice for consumers
소비자를 위한 새로운 선택을 제공
• Give enrollees a voice in their health plan and health
care (51% of Board of Directors will be comprised of
health plan members)
가입 멤버에게 플랜에 관한 의견 발언 기회 제공, 수렴 및 채택
• Use our surplus revenues wisely as a CO-OP to benefit
enrollees 비영리 단체로서 사업수익을 가입한 멤버의 혜택을 위해 사용
Our Advantage 플랜 장점
– focus on members of the CO-OP and their health care needs
비영리단체로서 맴버의 건강 관리 및 요구에 촛점
– use the QualCare network 퀄케어 네트워크
– non-tiered hospitals
– health plans that will promote:
• preventive care and wellness 예방 관리와 건강 증진
• early treatment for health problems 건강 문제를 조기에 치료
• special programs for chronic conditions and managing a serious
illness 만성질환을 위한 특별 프로그램과 심각한 질병에 대한 관리
Federal Poverty Level 연방 저소득 수준
9
Eligibility for Tax Credits & Cost Sharing
세금 공제 & 비용 공유 가능
10
Four Questions 4가지 질문
Here are four questions consumers should ask
when enrolling in an insurance plan:
소비자가 보험 플랜에 가입 전 반드시 알아야 할 4가지 질문:
1. What are my choices for health insurance?
건강보험을 위한 나의 선택은 무엇인가요?
2. How do I get it? 어떻게 선택한 플랜을 가입할 수 있나요?
3. How much will it cost me? 선택한 플랜의 비용은 얼마인가요?
4. How will I use it? 어떻게 선택한 플랜을 사용할 수 있나요?
Costs Covered on Average 평균 커버 비용
•
•
•
•
Bronze:
Silver:
Gold:
Platinum:
Plans cover 60% of costs 브론즈:비용의 60% 커버
Plans cover 70% of costs 실버:비용의 70% 커버
Plans cover 80% of costs 골드:비용의 80% 커버
Plans cover 90% of costs 플래티넘:비용의 90% 커버
12
Essential Health Benefits
Providing essential health benefits:건강에 관한 필수 혜택
• Ambulatory patient services (outpatient care you get without being
admitted to a hospital) 외래환자 서비스
• Emergency services 응급실 서비스
• Hospitalization (such as surgery) 입원
• Maternity and newborn care (care before and after your baby is born)
출산과 신생아 케어
• Mental health and substance use disorder services, including behavioral
health treatment (this includes counseling and psychotherapy) 정신건강
• Prescription drugs 처방된 약
• Rehabilitative services and devices (services and devices to help people
with injuries, disabilities, or chronic conditions gain or recover mental and
physical skills) 재활의학 서비스와 기구
• Laboratory services 실험실 서비스
• Preventive and wellness services and chronic disease management
•
예방과 건강 서비스, 만성 질환 관리
Pediatric services 소아과 서비스
13
Streamlined Eligibility & Enrollment Process
보험 가입 자격 & 가입 프로세스
Submit application
to the Exchange
가입신청서 제출
•
•
•
•
Online
Phone
Mail
In Person*Certified
Application
Counselors
From CMS presentation - A Seamless Path
to Affordable Coverage in 2014
Eligibility is verified
& determined
자격 확인 & 결정
• Supported by
Federally managed
data services.
• Determine eligibility
for Medicaid & Chip.
• Advanced tax credit
& cost sharing
reduction calculated.
Enroll in affordable
coverage 최적의
커버리지 플랜 가입
• Online plan
comparison tool
available to inform
selection
• Enrollment in
Medicaid or CHIP
• Advanced payment
of tax credit applied
to premium payment
14
Small Business Health Option Plan (SHOP)
자영업자 건강 옵션 플랜
• Rolling monthly enrollments for employers after
January 1 2014 고용주를 위해 매월 가입 가능
• Once enrolled, rates guaranteed for 12 months
한번 가입시, 12개월간 가격 보장
• Employer must pay 50% of premiums 고용주가 보험료의 50%
지불해야 함
•
•
•
•
Average FTE salary must be less than $50k
Must have less than 50 FTE’s
Tax credits for employers with less than 25 FTE’s
Tax credits are currently 35%; 2014 50%
15
16
What happens if I don’t get Insurance
만일 보험에 가입하지 않으면 어떻게 되나요?
2014
1% of your yearly household income. The maximum penalty is the
national average yearly premium for a bronze plan.
매년 총가족 수입의 1% 벌금. 최대 브론즈 플랜 프리미엄 비용 정도의 벌금
$95 per person for the year ($47.50 per child under 18). The
maximum penalty per family using this method is $285. 매년 성인
한명 당 $95 벌금 최대 한가족당 $285 정도의 벌금
2015 ---- 2% of income or $325 per person. 총수입의 2% or 한명 당 $325
벌금
2016 & later----- 2.5% of income or $695 per person. After that it is
adjusted for inflation. 총수입의 2.5% or 한명당 $695 벌금
If you’re uninsured for just part of the year, 1/12 of the yearly penalty
applies to each month you’re uninsured. If you’re uninsured for less
than 3 months, you don’t have a make a payment.
FAQ’s
How do I enroll? Online, by mail, or by telephone. 온라인,우편,전화 가입
*Telephone: 1-888-990-5706
*Online: www.healthcare.gov or www.newjersey.healthrepublic.us
What if I don’t’ want insurance? The fee for not being insured will be
$95 for the first year and increase up to $600 by year 2016
How much will this cost me? It depends on your income and size of
your family. 총수입과 가족수에 따라 비용 결정
How do I get a subsidy? Your tax credit will depend on your previous
year tax return 지난해 세금보고에 따라 세금 공제 결정
Is my doctor part of Health Republic Insurance Network?
HRINJ is working with QualCare a NJ based network of health
providers. To find out a list of all of our providers please visit
www.qualcareinc.com 본인 주치의가 핼스리퍼블릭 보험을 받는지 확인은
퀄케어 보험을 통해서 확인가능.
18
Resources
www.newjersey.healthrepublic.us
www.healthrepublic.us
www.healthcare.gov/law/features/choices/co-op/index.html
www.healthcare.gov/law/features/choices/exchanges/index.html
http://kff.org/health-reform/
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
http://kff.org/interactive/subsidy-calculator/ (Kaiser Calculator)
http://101.communitycatalyst.org/ (Health Insurance 101)
www.enrollamerica.org
www.familiesusa.org
www.getcoveredamerica.org
http://iom.edu/~/media/Files/Perspectives-Files/2013/Discussion-Papers/BPH
HelpingConsumersUnderstand.pdf