Statewide Open Enrollment 2021 Kickoff - MOVING AHEAD IN UNCERTAINTY 2021 AND BEYOND - California's Health ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Statewide
Open
Enrollment
2021
Kickoff
MOVING AHEAD
IN UNCERTAINTY
2021 AND BEYOND
September 15, 2020
Agenda
• Looking Ahead to 2021 And Beyond
• Keeping California Healthy
• Covered California for Small Business
• 2021 Open Enrollment Readiness
• Department of Managed Health Care
• Open Forum/Questions
1
LOOKING AHEAD
2021 And Beyond
Terri Convey, Outreach & Sales Director
2
Live Talk with Peter Lee, Dr. Mark Ghaly, &
Will Lightbourne
September 10, 2020.
Recording available online.
• A time like no other time in our
history
• Uncertainty about COVID
pandemic, the economy and the
election
• What this all means for the state
and the health system and
insurance markets
3
Top three takeaway topics from the talk
1. There is a ‘new normal’ for open enrollment 2021
2. Leaning in on what works
3. State of the State
4
1. There is a ‘new normal’ for open
enrollment 2021
Remote enrollment replaces in-person enrollment
Storefronts retro-fitted to encourage social distancing
1,300 Covered California call center workers fully-
enabled to work from home
COVID pandemic and recession continues
throughout open enrollment and into 2021
Fall/Winter flu season requires more vigilance and
adherence to safe practices
5
2. Leaning in on what works
Increased spending on marketing and outreach $140 MM for
Marketing and
State subsidies for middle income consumers and individual Outreach in 2021
mandate and penalty
Keeping the special enrollment door open for job loss, loss of Extra marketing
income and wildfire victims spend during special
enrollment helped
Ensuring access to care during stay-at-home orders with nearly 300,000 people
telemedicine get coverage
6
3. State of the State
Record number of people filing for unemployment insurance
means record numbers of people needing to replace their
employer-sponsored coverage
You can help people in this time of high anxiety learn about
affordable coverage options available to them
Premium changes for 2021 will be .6%. And, if consumer shops
and switches that increase can be -7%.
Forced-changes like turning telemedicine on overnight
demonstrates that the health care system can evolve and we can
see more changes to improve efficiency, quality and equity
California is committed to building on the Affordable Care Act
7
KEEPING CALIFORNIA
HEALTHY
Adam Unger, Sales Statewide Field Manager
8
Policies and Outreach Make a
Difference in 2020 Plan Year
Average dollar amount of financial help received by middle income
households between 400-600% of Federal Poverty Level*
25% 23%
1.5 ~625,000
(42%)
QUALIFIED
20%
15%
15%
17%
11%
13%
MILLION FOR STATE
SUBSIDES
10%
7% 8% 7%
PLAN SELECTED FOR 2020
PLAN YEAR 5%
0%
$1 - $50 $51 - $101 - $201 - $401 - $600 - $801 - $1,001 +
$100 $200 $400 $600 $800 $1,000
Nearly 32,000
middle-income consumers qualified for the new financial help,
which averaged $504 per month for eligible households, and lowered their monthly premium by half.
92021 State Subsidy Program
• Maintain the current level of state subsidies as
adopted in the 2020 state subsidy program
$349 Million design into 2021.
• Maintain requirement to allocate 17% of the
subsidies to individuals between 200%-400%
Nearly 58,000 FPL.
Enrollees in the • Estimates still anticipate enrollment growth in
400%-600% FPL will the 400 to 600% FPL group that are receiving
state subsidies for 2021, relative to 2020.
receive state
subsidy
102021 Program Design
Required Contribution Curve
112020 Covered California
Enrollment Profile
Qualified health plan enrollment Enrollment by metal plans
2020 Enrollment data as of 3/31/2020 .
122021 California
Individual Market Rate
Statewide
Weighted Average
Shop & Switch
Statewide
Weighted Average
13Rate Change Year over Year
3 Year
Overall Average
2015 2016 2017 2018 2019 2020 2021
Average (2019-
2021)
Weighted
4.2 4.0 13.2 12.5* 8.7 0.8 0.6 6.3 3.3
Average
Shop &
- -4.5 -1.2 3.3 -0.7 -9.0 -7.3 -3.2 -5.7
Switch
*The weighted average rate increase in 2018 was 21.1 percent, but much of that increase was directly offset for consumers by an increase in federal subsidy which lowered their net premium.
California’s Efforts to Build on the Affordable Care Act Lead to a Record-Low Rate Change for the Second Consecutive Year: https://www.coveredca.com/newsroom/news-releases/2020/08/04/californias-efforts-to-build-on-the-affordable-care-
act-lead-to-a-record-low-rate-change-for-the-second-consecutive-year/
14California’s Individual Market
Rate Change by Carrier
Weighted Average Rate
Carrier
Change
Anthem Blue Cross 6.0
Blue Shield of California - 2.4
CCHP - 1.3
Health Net 3.4
Kaiser Permanente 1.0
LA Care Health Plan - 4.6
Molina Healthcare - 3.8
Oscar Health Plan of California 7.6
Sharp Health Plan - 0.5
Valley Health Plan 9.0
Western Health Advantage - 2.6
Overall 0.6 Averages for on-exchange plans
152021 Covered California Health
Plan Offerings
• 2 carriers will be expanding their coverage areas
• Anthem EPO expands to include Inyo, Mono,
Imperial, and Kern counties (Regions 13 & 14)
• Anthem HMO will be available in Orange County
(Region 18)
• Oscar in San Mateo County (Region 8)
• Nearly all Californians (99.8%) will have a choice of 2
carriers
• 87% Californians will have a choice of 3 or more carriers
162021 Health Benefit Design by Metal Tier
. Metal Tier Bronze Silver Gold Platinum
Covers 60% Covers 70% Covers 80% Covers 90%
average annual cost average annual cost average annual cost average annual cost
Annual Wellness Exam $0 $0 $0 $0
*
Primary Care Visit $65 $40 $30 $35 $15
*
Urgent Care $65 $40 $30 $35 $15
*
Specialist Visit $95 $80 $65 $30
40%
Emergency Room Facility $400 $350 $150
after deductible is met
Laboratory Tests $40 $40 $40 $15
X-Rays and Diagnostics $85 $75 $30
40%
after deductible is met $275 $150 copay or 20% $75 copay or 10%
Imaging $325
coinsurance* coinsurance***
Individual: $6,300 Individual: $4,000
Medical Deductible N/A N/A
Family: $12,600 Family: $8,000
Individual: $500 Individual: $300
Pharmacy Deductible N/A N/A
Family: $1,000 Family: $600
Annual Out-of-Pocket $7,800 $8,200 individual $7,800 $8,200 individual $7,800 $8,200 individual $4,500 individual
Maximum $15,600 $16,400 family $15,600 $16,400 family $15,600 $16,400 family $9,000 family
Benefits in blue are NOT subject to a deductible. Benefits in blue with white corner are subject to deductible after first three visits
*Copay is for any combination of services (primary care, specialist, urgent care) for the first three visits. After three visits, future visits will be at the full cost until the medical deductible is met
***See plan evidence of coverage for imaging cost share
172021 Family Dental Carriers
Changes RETURNING
NEW WITHDRAW
https://www.coveredca.com/individuals-and-families/getting-covered/dental-coverage/family/
182021 Family Dental Carrier
Offerings
HMO Network
• Blue Shield DHMO is entering the
individual market in Rating Regions 2
– 19
PPO Network
• Blue Shield DPPO is entering the
individual market in Rating Regions 1
- 19
• Guardian DPPO is entering the
individual market in Rating Regions 1
- 19
• Premier Access DPPO is
withdrawing from Covered
California Marketplace
192021 Family Dental Plan Products
Dental HMO (DHMO) Plans Dental PPO (DPPO) Plans
• Copays and lower premiums • Co-insurance
• No waiting period or annual benefit limit • Adults: six-month waiting period* for
major services
• No deductible
*Waived with proof of prior
• Out-of-network services are not covered
coverage; proof of prior coverage
requirements may vary by plan.
• Deductible (no changes for 2021)
202021 Vision Plans
http://coveredca.eyemed.com/ https://www.vspdirect.com/4CA/welcome
http://www.coveredca.com/individuals-and-families/getting-covered/vision/
212021
COVERED CALIFORNIA
FOR SMALL BUSINESS
Dan Tyler, Vice President, CCSB Sales & Eligibility
22CCSB Updates
Through July 1, 2020: 62,367
7,633 employers Jan Renewals:
Weighted
Employer Groups: CCSB Membership Growth Average:
• 1-100 FTE’s 70000 1.5% !!
60000
Employer Choice:
• One or two metal tiers
50000
offered to employees. 40000
30000
Employee Choice:
• Any Carrier/Plan on 20000
metal tiers offered. 10000
0
1-Jan
1-Apr
1-Jul
1-Oct
1-Jan
1-Apr
1-Jul
1-Oct
1-Jan
1-Apr
1-Jul
1-Oct
1-Jan
1-Apr
1-Jul
1-Oct
1-Jan
1-Apr
1-Jul
1-Oct
1-Jan
1-Apr
1-Jul
1-Oct
1-Jan
1-Apr
1-Jul
23Where We Excel
The best multi-carrier exchange:
Employees free to choose what is best for them.
Single billing makes it easy: • As little as 2 weeks of
Employers love the administration. payroll
Defined contribution: • PEO takeover
Predictable budgeting for employers. • Union carve-out
Employee only coverage option: • Out of State Employees
Allows other family members to qualify for APTC. covered by Blue Shield’s
Tax Credit for qualifying employers. Blue Card
Flat 5% Commission + Bonus!!
24Qualified Health Plan Partners
25New Business & Renewal Submission
Submission Options:
o MyCCSB portal
o Ease
o General Agent
o CCSBeligibility@Covered.CA.gov
26MyCCSB Portal
Driving Administrative Efficiencies
Portal Capabilities for Groups
and Brokers:
o Process Adds + Terms
o ACH payments
o Online Processing of renewal
o Look up Member ID’s
o Review current enrollment
o Look up prior bills
o Enrollment portal enhancements Q2 2021
27Agent Incentive Program
A Partnership That Pays
Bonus Program - Coverage Effective:
January 1, 2020 - January 1, 2021
Earn extra when you sell new small groups
Group Size (Enrolled Employees) Incentive Earned
51 - 100 $ 8,000
26 - 50 $ 4,000
16 - 25 $ 2,000
6 - 15 $ 1,000
28Contact Us – We’re here to help!
CCSB Sales
(844) 332-8384
www.CoveredCA.com/ForSmallBusiness
CCSB Agent Service Center
(855) 777-6782
Agents@Covered.CA.gov
(Option 1 for English or 2 for Spanish > then 1 for Agents > then 2 for the Call Center)
Case Submission & Eligibility
CCSBeligibility@Covered.CA.gov
Quotes
SmallBusiness@Covered.CA.gov
292021
OPEN ENROLLMENT
READINESS
Adam Unger, Sales Statewide Field Manager
30Shop & Compare Tool
NEW DOCTOR SEARCH
NEW
Information*
NEW PLAN RATES Oct
NEW APTC AMOUNTS 1
* Date is subject to change to include all new information.
312021 Renewal Dates
Renewal Renewal
starts ends
Oct Dec
1 15
• Active Renewal: 10/1/20 – 12/15/20
• Passive (Auto) Renewal: 10/31/20 – 11/23/20
32Renewal Notice (NOD12A) Changes
33Renewal Notice (NOD12A) Changes
Renewal
Steps
Account
Access
Code
Delegated
Enroller’s
Information!
34Consumers needing to provide
consent
• August 3-6, 2020: Consent for
Verification “CalNOD11” mailed to
members who need to provide
consent
• Members need to provide consent to
Covered California to keep their
APTC for the 2021 benefit year
352021 Open Enrollment Dates
Open Open
Enrollment Enrollment
starts ends
Nov Jan
1 31
36Penalty & Exemptions
• Penalties will begin to be enforced by the Franchise Tax Board beginning next year
when Californians file their 2020 taxes. You can find a penalty estimator on the
Franchise Tax Board website. https://www.ftb.ca.gov/file/personal/filing-
situations/healthcare/estimator/
• Exemptions - There are some exemptions you must apply for through Covered
California. Other exemptions do not require an application – instead, you can claim
them when you file your state tax return.
37CalHEERS Release 20.9
• Case Management Pages
Release
• Consumer Premium Payment starts
• Create an Individual Account Sept
• My Enrollment Dashboard
• My Profile Page
21
38Consumer Real Stories
Who best to tell our story than
those who’ve benefited from
Covered California.
We’ll be working with our agents
and community enrollers to help
identify great stories we can use
while we promote open
enrollment 2021.
39Virtual Press Events
Covered California is developing ideas to reach media virtually. As in years’ past, we’ll look to utilize
our community partners to help generate local news in their communities.
402021
MARKETING
Yuliya Andreyeva
41KEY RESEARCH FINDINGS
The value to having health insurance is universally recognized
Even among those who are currently uninsured, there was a recognition of the
benefits associated with having health insurance
Cost and complexity continue to be the barriers
While cost is the top barrier and many stated that they simply cannot afford
health insurance, complexity and uncertainty about coverage, specifically with
pre-existing conditions are also factors that limit having insurance
Awareness of Covered California is strong, but does not always
translate to clear understanding
Most associations are related to providing health insurance, though some
believe it is meant specifically for lower-income
Few people understand the help and resources we offer and many don’t check
to see if they can get financial help
42
Source: July 2020 Campaign Evaluation Research conducted by Alternative Routes on behalf of Covered CaliforniaTHE PROBLEM
what the uninsured say what it means
“Too expensive, I can’t afford it” not for me
“It’s for those with lower income” not for me
“I’m healthy, so I don’t need it” not for me
“It’s too complicated” not for me
Many just don’t feel
Covered California is for them.
43CORE CHALLENGE
Replace negative From To
Fear Empowerment
emotions with Anxiety Peace of mind
Confusion Clarity
positive ones. Avoidance Confidence
For them For me
Spike confidence early on.
Build positive associations with
Covered California over time.
44MAIN IDEA
Covered California is the starting point for health
insurance for Californians
45MESSAGE STRATEGY
We represent better access to better health insurance.
Not a health insurance company or healthcare itself.
Not a business at all, but a public good.
46CREATIVE STRATEGY
Create a sense of “for-me-ness” in tone and content. Choose
scenarios and cultural cues that feel authentic and real.
Find balance in making something that feels aspirational but remains
grounded in reality.
Make it feel living and human and real, made by people who
understand them.
47CREATIVE PLATFORM EXPLORATION
48AND THE WINNER IS…
49THE FRAMING
I didn’t have health insurance,
but not because I didn’t want it.
I just needed help.
Covered California offered the help I
needed, and they can help you, too.
Covered California
This way to health insurance.
50TV / VIDEO
TV script (Affordability)
Highlight a diverse cross section of Californians
Talent will deliver emotional stories to camera
4 branded DR concepts with single message focus:
• Affordability (featured)
• Comprehensive coverage (incl. mental health)
• Free expert help in multiple languages
• Loss of job & health coverage
1 umbrella DRTV concept to stitch stories and all
key message points together
51BUILD POWERFUL VISUAL EQUITY, BE RECOGNIZABLE
52OE 21 MARKETING PLAN HIGHLIGHTS
What’s NEW What’s SAME
• New ad campaign “This • Maintain similar solid investment YOY (including incremental)
way to health • Statewide efforts
insurance”
• Reach diverse populations of CA in language and in culture
• Leverage :30s and :15s
(bookends) TV spots to • Multi-channel paid media mix tailored to each audience segment’s media
maximize reach and consumption habits
frequency Launch November 9 after the election to avoid political window
Heavy-up weigh levels leading up to the enrollment deadlines (12/15
• General market Out-Of- & 1/31)
Home in key
geographies • Robust database member and funnel outreach efforts to drive active
renewal, retention and conversion including utilization of SMS (texting) as
• Content marketing a communication channel
program to help enable
enrollment via • Reach and engage current and potential members with compelling social
education media content and provide customer service across all social platforms
53DEPARTMENT OF
MANAGED HEALTH CARE
Lezlie Micheletti,
Stakeholder Engagement and Outreach Coordinator
54Department of Managed
Health Care
Covered California Open Enrollment 2021 Kick Off
Statewide Virtual Meeting - September 15, 2020
Lezlie Micheletti, Stakeholder Engagement & Outreach
55
HealthHelp.ca.govAccomplishments
June 2020
56
HealthHelp.ca.govCOVID-19 Response
• All Plan Letters
• Telehealth and Access to Care
• Diagnostic Testing and Coverage
• Cost Sharing, Reimbursement Rates &
Financial Risk
• Emergency Regulations
57
HealthHelp.ca.govHelp Center
Assists consumers with health care
issues and ensures that managed care
patients receive the medical care and
services to which they are entitled.
• Contact Center
• Division of Legal Affairs and Policy
• Independent Medical Review/Complaint
Branch
• Provider Complaint Unit
58
HealthHelp.ca.govConsumer Complaints Resolved in 2019
59
HealthHelp.ca.govLezlie Micheletti, Stakeholder
Engagement & Outreach Coordinator
lezlie.Micheletti@dmhc.ca.gov
916-414-0996
DMHC Help Center: 1-888-466-2219
DMHC Provider Complaint Unit: 1-877-525-1295
60
HealthHelp.ca.govENROLLERS UPDATES
Adam Unger, Sales Statewide Field Manager
61Navigator Grantees 2020-2021
• Allocate $6.4 MM to 41 lead
entities
• 47 sub-entities
• 470 site locations
• 81% of total California
population lives within a 15-
minute drive time of a
Navigator location
62Storefront Program
• 545 Storefronts
• Helping consumers
enroll in health
coverage
• Adapting to virtual
support and setting
appointments for
social distancing
63Help On-Demand Tool
64Toolkits, Webinars, Briefings
https://www.coveredca.com/resources/
https://hbex.coveredca.com/toolkit/
652021 OE Kickoff
Regional Virtual Events
September 16, 2020 through October 1, 2020
13 Regional Sales Enrollers
Kickoff Virtual Meetings
Eight Agent & 5 Community Partners
Brought to you by Covered California Outreach and Sales Team
Questions, email Kickoffevents@covered.ca.gov
66OPEN FORUM
Adam Unger, Sales Statewide Field Manager
67Statewide
Open
Enrollment
2021
Kickoff
MOVING AHEAD
IN UNCERTAINTY
THANK YOU!
2021 AND BEYOND
kickoffevents@covered.ca.gov 68You can also read
