The California Health Benefit Exchange has efforts to set up health insurance exchange programs for individuals and small employers well under way.
The exchange agency is making, and implementing, detailed plans for setting up “Covered California” — a state-run, state-based exchange program for individuals and — a Small Business Health Options Program (SHOP) exchange for small employers.
The exchange agency is working to set up a health insurance exchange program, or Web-based insurance supermarket, in time for the program to distribute coverage that will take effect Jan. 1, 2014.
The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for states to set up exchanges for their residents, especially to help individuals and small groups use new tax credit systems to buy coverage. A California company – Word & Brown, Orange, Calif. – helped popularize the health insurance exchange concept by developing a large private health insurance exchange program.
The agency also has hired Accenture to set up the exchange enrollment system — the California Healthcare Eligibility, Enrollment & Retention System (CALHEERS), and it has started to post specific hiring and budget plans.
Juli Baker has told exchange managers in a written report, for example, that Covered California managers to expect to fill 850 people to do customer support.
Some of the workers who handle the initial open enrollment rush will be “intermittent workers,” Baker said.
Program managers have suggested in a separate “blueprint overview” that the individual and small group exchange programs now have 45 employees and could employ a total of 1,161 people in 2014.
The managers are hoping to get $706 million in grants to cover expenses incurred from January 2013 through December 2014.
By Jan. 20, 2014, the exchange could serve about 1.6 million enrollees if it starts off slowly and more than 2.4 million if it gets off to a fast start, managers estimate.
In 2015, for example, managers are predicting that the exchange programs could be serving 1.6 million people, collecting $8.6 billion in premium revenue, and getting $258 million in revenue from assessments on participating health plans.
The exchange programs could be spending about $100 million on outreach, education and grants and $92 million on customer service operations, the managers estimate.
In the QHP solicitation, program managers indicate that they expect QHPs to work with health insurance agents and brokers and want to see details about how the QHPs will go about doing that.
Starting on page 42 of the document, managers include the following:
- Do you currently provide agent-oriented marketing materials for the individual and small business market?
- If yes, please include sample materials or your broker kit as an attachment labeled “Broker Kit.”
- What initiatives is your organization undertaking in order to partner more effectively with the small business and agent communities? …
- Describe your health plan agent compensation schedule for your individual and small group business.
- Describe any bonus program your company currently has in place for additional agent compensation. This may include cash bonuses or in-kind compensation programs.
- In 2011 or 2012, did your health plan place ads in agent-related trade publications?
- Bidder must include sample trade publication advertisements in Appendix III labeled “Sample Advertisements.”