Oregon’s HIX: An Update
Barney Speight
Portland Actuarial Club
Feb. 22, 2011
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Today’s Topics

Overview of components in pending
legislation that establishes Oregon’s
Health Insurance Exchange (HIX)


SB 99-1
Addressing children’s coverage in
Oregon before 2014
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Type of Entity: Choices



State agency
Public corporation
Contract with private not-for-profit
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Type of Entity: Proposed

Public corporation  
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Number of Entities: Choices





Individual HIX + Small Group HIX
Combined HIX with 2 business lines
Statewide
In-State Regions
Multi-State
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Number of Entities: Proposed


Combined HIX with 2 business lines  
Statewide  
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Governance: Proposed

9 member Board

6 members appointed by Governor




With Senate confirmation
4-year terms
US citizens & residents of Oregon
No more than 2 from “industry”


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Insurance, Trade Assns., Providers
At least 2 consumers (individual & small group)
3 ex-officio

OHA, DCBS, OHPB Chair (or designee)
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Advisory Committees: Proposed

Consumer Advisory Committee


Individual consumers, small group
purchasers, enrollment assisters
Advisory & Technical Committees

Business sector, insurance carriers,
producers, providers
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HIX Duties: Proposed - 1

Uniform information for consumers


Screen, certify & recertify health plans as
Qualified health plans


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Cost, benefits, networks, etc.
Use federal & state guidelines
Ensure QHPs provide meaningful coverage choices
Decertify QHPs that fail to meet federal &
state standards
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HIX Duties: Proposed - 2

Promote fair competition of carriers
participating & not participating in HIX



Standardized health benefit plan options
Web-based clearinghouse for comparison of health
plan coverage & cost
Make QHPs available to individuals & small
employers, assist with enrollment,
collect/remit premium where appropriate
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HIX Duties: Proposed - 3




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Facilitate community-based enrollment
assistance (navigators)
Grade health plans using federal criteria &
distribute grading information
Certify exemptions from individual mandate
Establish various open enrollment periods
Provide information on eligibility for publicly
funded programs & assist with enrollment
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HIX Duties: Proposed - 4




Establish an electronic calculator to
assist consumers in determining cost of
coverage net of tax credits
Provide necessary information to federal
government
Adopt necessary administrative rules
Etc.
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Exchange Operations - 1

January 1, 2014



January 1, 2016


Individuals
Employers with <51 employees
Employers with 51 to 100 employees
“Groups meeting additional criteria
established by the exchange for
qualified purchasers”
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Exchange Operations - 2

A health plans shall be certified as a
QHP if:


It provides coverage that, at minimum,
include the “essential health benefits” &
“Making the health plan available is in the
best interests of the individuals &
employers in Oregon”
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Exchange Operations - 3


The HIX is authorized to limit the
number of QHPs available in each level
of coverage (bronze, silver, gold & platinum)
The HIX shall establish a streamlined &
seamless application & enrollment
process for both the HIX & state
medical assistance (OHP)
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Exchange Operations - 4

The HIX shall coordinate the federal & state
risk mediation programs:




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Federal reinsurance
Federal risk corridors
State risk adjustment
The HIX shall define the role of insurance
agents & brokers in accordance with federal
guidelines & HIX policies
The HIX shall assure premium parity for plans
sold inside & outside the exchange
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Assessments for HIX Expenses

HIX authorized to impose & collect
assessments on all insurers


Carrier Assessment = Total Assessment x
carrier market share %
Market share calculation excludes:

Medicaid, disability income, hospital only,
dental, vision, accident only, auto, specific
disease, Medicare supplement, TRICARE,
CHAMPUS, Rx only, LTC, FEHBP
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More Information on SB 99-1

http://www.leg.state.or.us/committees/

Senate Subcommittee on Health Care

February 17 Exhibits
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Early Innovator Grants


Grantee: Oregon Health Authority
Award Amount: $48,096,307
Oregon is using commercially available, off-the-shelf software to
create the Exchange. The Exchange Early Information
Technology Innovation Grant will help Oregon create a modular,
reusable IT solution that will provide the Exchange’s customers
with seamless access to information, financial assistance and
easy health insurance enrollment, with no gaps in coverage or
assistance cliffs for anyone up to 400% of the federal poverty
level. The OHA estimates that 516,000 Medicaid clients and
277,000 commercial insurance consumers will use the Health
Insurance Exchange to shop for and enroll in health coverage.
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Children’s Reinsurance Program



Addresses guaranteed issue
requirements for kids < age 19 prior to
2014
SB 514 will be vehicle for amendments
Financial risk ceded to OMIP


Kids remain enrolled with carrier
Watch for hearing & amendments
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Contact Information
Barney Speight
Vice President, Health Care Reform
speighb@odscompanies.com
(503) 412-4008
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