Insure Montana

1
Insure Montana

• Producer Information Session
• March 14, 2007

2
Insure Montana Purchasing Pool or Tax Credit?

• Businesses are eligible for the purchasing pool
  if they have NOT offered health insurance in the
  past 24 months
• Businesses are eligible for a tax credit if they
  currently offer group health insurance for their
  employees/ dependents

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General Overview of the Tax Credit

• Refundable tax credit is for small businesses,
  with 2-9 eligible employees who offer group
  coverage currently
• Tax credit will not exceed 50 of employers
  contribution
• Up to 100 per employee (125 if average age is
  over 45)
• Up to 100 per spouse
• Up to 40 per dependent (not to exceed 80)

4
General Overview of the Purchasing Pool

• Insurance coverage is now a reality for over
  4,500 previously uninsured individuals
• 667 small businesses currently participating
• Pool enrollment provides monthly premium
  assistance and incentive payments to employees
  and employers

5
Eligibility Requirements for the Purchasing Pool

• Previously uninsured businesses who
• Have not offered GROUP health coverage in the
  past 24 months
• Have no delinquent state income individual or
  business taxes
• Have no employee (excluding owners) who earn over
  75,000 per year
• Any employee who earns over 75K will disqualify
  the entire group from participation
• Have 2-9 eligible employees
• Defined as any employee who works 30 hours or
  more work hours can be between 20-30 at the
  employers discretion
• Related employers (other business) are counted in
  the 2-9 requirement

6
Employer and Employee Incentive and Assistance
Payments

• Employers receive monthly premium incentive
  payments
• Employees receive monthly assistance payments
• Incentive and Assistance payments are based on
  Standard Healthlink plan
• Incentive and Assistance payments are capped at
  rate tier 6 and age 54
• Age and rate tier caps are necessary to enable IM
  to insure the maximum number of lives

7
Employer Incentive Payments

• Employers are required to contribute 50 of the
  employee only rate
• Insure Montana (IM) reimburses the employer 50
  of their contribution amount through a monthly
  incentive payment, based on the Standard
  Healthlink plan (subject to rate tier 6, and age
  54)
• If an employer contributes more than 50,the
  incentive payment will not increase

8
Employee Assistance Payments

• Employees receive monthly premium assistance
  payments
• Amount of premium assistance is based upon the
  employees contribution amount and household
  income
• Assistance ranges from 20-90 of their share of
  the premium
• Premium assistance amounts are greater if
  covering dependents

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Employee Assistance Payment Determination

• Sliding scale based upon household income
• Based on Federal Poverty Level guidelines
• Must look at total household income when
  determining assistance amounts Husband and wife
  income should not be split
• Unearned income (S-Corp and business income,
  rental income, social security, child support,
  etc) do not need to be included

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Premium Assistance ScheduleEmployee Only
(Single, no kids)

• Less than 9,570 90
• 9,570 to 14,355 80
• 14,355 to 19,140 70
• 19,140 to 23,925 60
• 23,925 to 28,710 40
• 28,710 and over 20

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Premium Assistance Schedule Employee Spouse
(No kids)

• Less than 12,830 90
• 12,830 to 19,245 80
• 19,245 to 25,660 70
• 25,660 to 32,075 60
• 32,075 to 38,490 40
• 38,490 and over 20

12
Premium Assistance ScheduleEmployee and
Child/Children (Single w/kids)

• Less than 16,090 90
• 16,090 to 24,135 85
• 24,135 to 32,180 80
• 32,180 to 40,225 65
• 40,225 to 48,270 50
• 48,270 and above 20

13
Premium Assistance Schedule Family (Married with
kids, 1 or more)

• Less than 19,350 90
• 19,350 to 29,025 85
• 29,025 to 38,700 80
• 38,700 to 48,375 65
• 48,375 to 58,050 50
• 58,050 and above 20

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Examples of Subsidy Payments

• Employee 1 Single Coverage, 35-39 Based on
  rate tier 3
• Monthly premium 214.74
• Employer contribution 107.37
• Employer incentive payment 53.69
• Employee contribution 107.37
• Employee assistance 96.93 (90)
• Employee total 10.74

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Additional Examples

• Employee 2 Family Child, 35-39 Based on rate
  tier 6
• Monthly premium 742.07
• Employer contribution 152.78
• Employer incentive 76.39
• Employee contribution 589.29
• Employee assistance 383.04 (65 assistance)
• Employee total 206.25

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Examples continued

• Employee 3 2 party, 55-59 Based on rate tier
  6 Remember, assistance and incentives are
  capped at age 54
• Monthly premium 1,116.46
• Employer contribution 293.81
• Employer incentive 115.84
• Employee contribution 822.65
• Employee assistance 139.01 (20 assistance)
• Employee total 683.64

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Distributing Premium Assistance and Incentive
Payments

• Insure Montana distributes payments approximately
  5 days before the 1st of the month, for the
  upcoming month (in certain situations this may
  vary). Efforts are made to get the subsidy
  payments to employers and employees prior to
  their bill being due
• Incentive payments go directly to the employer
• Assistance payments go directly to each employee
• Employer incentive and employee assistance
  payments are maximized with the 50 employee only
  contribution amount

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Employee Assistance Information

• Employers are encouraged to deduct the employees
  contribution amounts through pay check
  withholdings
• Employees can sign an Opt In form to have
  assistance payments go directly to their employer
• Unless a Section 125 Plan is in place, those
  contribution amounts are to be withheld post-tax
• Premium assistance payments are not considered
  tax-able income- employees will not receive a
  1040 MISC form
• Premium assistance payments are directly
  deposited into an employees account (EFT) if
  bank information has been provided. Otherwise, a
  check will be mailed.

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Employer Application ProcessStep One

• Small business applies for Insure Montana through
  an Employer Application
• Insure Montana determines eligibility and
  responds to group via letter
• Eligible groups are placed on a waiting list
  until funds become available for the group

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Enrollment Process Step Two

• Funds become available and a group is mailed an
  Enrollment Packet from Insure Montana
• Groups cannot receive an IM quote until they have
  received their enrollment packet
• Enrollment packet includes
• Health Statements, Premium Assistance forms,
  Agent listing
• Group submits required forms to Agent
• Groups have 30 days to complete all required
  paperwork
• Agent submits completed paperwork to BCBS and IM

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Enrollment ProcessStep Three

• BCBS sends quote to Agent and IM
• Insure Montana calculates premium assistance and
  incentive amounts and emails quote to agent
• Agent quotes Insure Montana product to group
• Group makes final decision based on quote
• Agent notifies BCBS and IM of groups decision
• Coverage starts the 1st of the upcoming month
• All policies renew January 1, no matter what
  month the group signed up for coverage (may not
  be a 12 month rate guarantee)

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Reminders for Enrollment

• If a group has not submitted paperwork stating
  they have been working with a producer, a
  producer will be assigned to the group by
  underwriting
• When submitting the paperwork (health statements,
  premium assistance applications, group roster,
  election form) please make sure all forms have
  been filled out correctly and thoroughly
  (birthdays and social security numbers are
  important)
• Incomplete paperwork will result in a delay in
  the quoting process
• Health applications, group roster and election
  form needs to go directly to BCBS (IM does not
  need these)
• Premium assistance applications need to go
  directly to Insure Montana (BCBS does not need
  these)
• If providing bank account information with the
  premium assistance form, please include a voided
  check to ensure accuracy
• Please assure clients that all information
  submitted is held confidential

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Plans Offered Through Insure Montana

• Standard Healthlink
• 1000/2000 ded.
• 70/30 copay
• Preventative services covered at 70/30- no ded.
• 2 professional office visits per year covered at
  100
• Dental plan included (not optional)
• Rx 100 ded.

• Premier Healthlink
• 500/1000 ded.
• 80/20 copay
• Preventative services covered at 80/20- no ded.
• 2 professional office visits per year covered at
  100
• Dental plan included (not optional)
• No Rx ded.

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Dental Coverage Offered

• Outline of Coverage
• Exam and Cleaning 2 per benefit period, paid at
  100 (No ded.)
• Full month x-ray 1 per benefit period
• Supplementary bitewing1 set per benefit period
• Fillings/Oral Surgery Paid at 80 up to plan
  maximum of 1000 per benefit period

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Preventative Services

• Routine Services for members age 3 and older
• Pap Tests, related lab charges and related office
  visit
• Proctoscopies, sigmoidoscopies, colonoscopies or
  hemocults and related office calls
• Immunoassay for tumor antigen or prostate
  specific antigen (PSA) and related office calls
• Physical examination and related tests as
  recommended for routine physical exams.
• Routine diagnostic xray and laboratory services
  including but not limited to, chemistry screens,
  cholesterol and other blood fat tests and thyroid
  (T4) test
• Immunizations and vaccinations
• If there is a medical diagnosis, services will be
  paid as any other illness, subject to any
  applicable deductible and copayment

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Association Plans and Premium Assistance and
Incentive Payments

• In addition to the IM products, groups can
  receive premium assistance and incentive payments
  through a qualified association
• Qualified Association Plans (QAP) include
• Montana Chamber Choice
• Montana Logging Association
• State Bar of Montana
• Montana Dental Association
• Montana Association of Certified Public
  Accountants
• Employers Association of Western Montana
• Montana Nonprofit Association

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Qualified Associations and Insure Montana

• Groups must be eligible and have received an
  enrollment package for IM in order to receive a
  quote for assistance through a QAP Groups must
  also receive an IM quote for comparison
• Premium assistance and incentive payments will be
  less for association plans based on the coverage
  provided
• QAP quotes will take IM staff additional time to
  compute than the Insure Montana quote
• Should SB140 pass legislation, groups who choose
  a QAP will be grandfathered into the Insure
  Montana purchasing pool

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Once a Group has Accepted Coverage

• Groups/Agents must submit any changes
  (adding/deleting people, coverage change) to both
  BCBS and Insure Montana within 30 days of change
• IM encourages groups to contact their agent when
  making any change
• Policy change sheet must be submitted to IM(NEW)
• New quotes with the change will be sent to the
  agent
• Any overpayment in premium assistance and
  incentive payments due to a policy change must be
  returned to IM within 30 days
• Changes can be submitted to Health-e-Web, however
  the group must still notify IM of the change

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Insure Montana Renewals for Purchasing Pool

• Renewal forms for all participating groups will
  be mailed to groups in September of every year
• Renewal application must be returned between
  October 1-31 in order to remain eligible for
  continued premium assistance and incentive
  payments for the upcoming year
• All policies renew January 1
• Producers and groups will receive updated quote
  sheet if there is a change in rates at renewal
  this will occur in Nov/Dec
• All changes must be communicated to both BCBS and
  IM

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BCBS Renewal Process for Purchasing Pool

• Contracts and Member Certificates must be
  approved by the DOI prior to sending renewal
  notifications to group
• All participating groups will receive renewal
  information 60 days prior to policy renewing
• Automatic renewal will be dependent on benefit
  and rate changes
• Open enrollment period Dec. 1- Dec. 31

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Funding and Waiting Lists

• Purchasing pool is nearing capacity expected to
  cover 750 businesses with current funds, over
  5000 lives
• We anticipate we will have approximately 250
  groups still on a waiting list for the program
• Groups that applied and were deemed eligible but
  will be unable to participate due to available
  funds will be contacted once the pool reaches
  capacity
• Funding at current level should continue at least
  through 2011
• Additional funds could be allocated in the future
  through legislative action
• Governor Schweitzer has proposed an additional 1
  million to Insure Montana

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Insure Montana the 2007 Legislature

• Senate Bill 140, Introduced by Sen. Weinberg
• Proposes changing group size to include groups
  from 1-15 (dependent upon fund availability and
  Board and Commissioner approval)
• Allow the Board to implement a wellness benefit
  and offer cafeteria plan assistance (Section 125
  plans) for groups
• Allocate all premium assistance and incentive
  payments to go directly to purchasing pool
  participants
• Allow 40 of the Governors proposed budget to go
  for a tax credit to previously uninsured
  businesses who choose coverage through a
  qualified association plan
• Redefine income restrictions to include owners
  75,000 cap
• Currently enrolled groups with owners who earn
  over 75K will continue participation but will
  not be able to receive premium assistance and
  incentive payments for themselves or their
  dependents

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What You Can Do

• Contact your legislator to encourage an increase
  in funds for premium assistance and incentive
  payments
• Encourage your clients to contact their
  legislators
• Volunteer to testify for Insure Montanas SB140
  Submit letters to be used for testimony during
  the legislative session
• Contact Lisa for additional information

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Producer Agreement

• Signed Producer Agreements must be signed and
  returned to Insure Montana (if you already signed
  this we dont need another one)
• Requirements for Insure Montana
• Read the Producers Manual and all bulletins that
  are released throughout the year
• Attend at least 1 IM training session (this
  counts as 1!)
• Have access to email and will read electronic
  communications
• I will work with IM staff during the quoting
  process and when my group makes changes to
  policies
• I will facilitate at least 1 follow up contact
  per year in addition to the initial and renewal
  contacts
• I will attend the BCBS rep trainings as
  provided
• For those participating employers, I will provide
  an Insure Montana quote with any qualified
  association quote I provide

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Producers Manual

• Please read newest 2007 version
• Updated version available at www.insuremontana.org
  

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Frequently Asked Questions

• What if a groups grows to over 9 eligible
  employees?
• If a group grows to over 9 eligible employees,
  the group can remain in the purchasing pool but
  will no longer receive premium assistance or
  incentive payments.
• What if a group falls down to only 1 employee on
  the plan?
• If an enrolled business drops down to 1 eligible
  employee, they may remain in the pool, receiving
  premium assistance and incentive payments for a
  maximum of 90 days or until their renewal,
  whichever comes first. After 90 days, the
  business may remain in the pool but will no
  longer receive assistance or incentive payments
  until the group is rebuilt to eligible size.
• If at renewal, they still only have 1 they will
  be ineligible to remain in the pool and receive
  premium assistance and incentive payments.
• What if a business is enrolled and changes
  owners? Will we need to reapply?
• If the same employees are working for the
  business that are currently covered we can update
  the owner information and keep the group
  enrolled.
• If a group no longer owns the business and the
  owners were the only employees, premium
  assistance and incentive payments will cease
  immediately.

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Frequently Asked Questions

• A group called and hasnt received a premium
  assistance payment for an employee who just
  started on the policy Where is it?
• Call the Insure Montana staff to verify we know
  that this person is now on the policy
• Why is the premium assistance payment higher for
  one person than the other?
• Premium assistance payments are based upon
  household income amounts reported to IM.
  Household income amounts can vary based on each
  individuals situation.
• How long is the waiting period right now?
• Currently, the wait is about 4 months from the
  time the group applied, dependent upon fund
  availability. However, please know that groups
  that applied in late November or later will most
  likely not have funds available for them If a
  group has not yet received an enrollment packet
  they will remain on our waiting list.
• Once the program reaches capacity, enrollment for
  new groups will only occur if another group
  cancels coverage. Unless additional funds are
  added to this program, groups on the waiting list
  will not have an anticipated enrollment date, and
  may not be able to participate in Insure Montana.
  

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Insure Montana Contact Information

• Lisa Crowley, Program Director
• Email lcrowley_at_mt.gov Phone [phone]
• Helen Taffs, Purchasing Pool Program Specialist
• Email htaffs_at_mt.gov Phone [phone]
• Wendy Theodore, Tax Credit Program Specialist
• Email wtheodore_at_mt.gov Phone [phone]
• Insure Montana Office
• 840 Helena Ave, Helena MT 59601
• Fax [phone]
• Website www.insuremontana.org