Colorado Health OP A Health Insurance Cooperative That

Colorado Health. OP A Health Insurance Cooperative That Is Turning Health Insurance Upside Down 12/8/2020 Colorado Health. OP Slides 1

Introductions ● Denise Denton, Rural Outreach Advisor ● denise. denton@cohealthop. org ● (303) 941 -0181 ● Jack Westfall, MD, Chief Medical Officer ● jack. westfall@cohealthop. org ● (303)927 -0770 12/8/2020 Colorado Health. OP Slides 2

Colorado Health. OP Overview ● Created through funds from the Affordable Care Act. ● Developed with the partnership of the Rocky Mountain Farmers Union. ● A new, statewide, non-profit health insurance cooperative. ● Board will be a majority of members who purchase COOP insurance and will help to make decisions about how funds are spent. ● Commitment to community health through on-going partnerships and campaigns 12/8/2020 Colorado Health. OP Slides 3

History of Health Insurance Cooperatives ● ACA included provisions for states to create nonprofit, private, Consumer Operated and Oriented Plans, called CO-OPs. ● Provided an application process and low interest loans for entities in each state to develop CO-OP health insurance plans. 12/8/2020 Colorado Health. OP Slides 4

ACA CO-OP Requirements ● Must be private, non-profit organizations that sell health coverage. ● Subject to the same state rules and regulations as other health insurers. ● Focused on – but not limited to – individual and small group markets. ● Consumer oriented and operated. 12/8/2020 Colorado Health. OP Slides 5

Map of Health CO-OPs 12/8/2020 Colorado Health. OP Slides 6

Colorado Health. OP ● July 2012 – DHHS awarded Colorado CO-OP a loan of $69, 396, 000. ● $12 M start up (to be paid back in 5 years) ● $57 M reserves (paid back in 15 years) ● MISSION: To improve the health of individuals and communities through trusted partnerships with members, employers, and providers. 12/8/2020 Colorado Health. OP Slides 7

Cooperative Principles ● Governed by the people who use their products or services ● Controlled by their members, not outside investors ● Surplus revenues used to improve member services or lower member costs ● Motivated by service and members’ needs, not by profit ● Concerned for their communities 12/8/2020 Colorado Health. OP Slides 8

A Consumer Operated and Oriented Health Plan ● Members have a voice ● No profits As a CO-OP, we are specifically designed for people who want to make a difference in their own health and that of their community. 12/8/2020 Colorado Health. OP 9

Insurance Designed to Make Members Sustainably Healthy ● Preventive care incentives ● Shared responsibility ● Primary care provider partnerships Insurance is supposed to help when people get sick or injured; we think insurance should also be there to help people stay healthy. 12/8/2020 Colorado Health. OP 10

Get Healthy! Stay Healthy! Save Money! ● Rewards members for staying healthy ● Partners with providers that cost less ● Helps children remain cavity-free at three ● Covers home blood pressure monitoring ● Gives members tools to price shop 12/8/2020 Colorado Health. OP Slides 11

“No Surprises” Philosophy of Customer Service ● Philosophy of resolution ● Exceptional customer service ● Committed to paying members’ healthcare ● Easier claims process for all When it comes to customer service, we are not like other insurance companies; we aim to design it right the first time and do it right every time. 12/8/2020 Colorado Health. OP 12

Advancing Health in Colorado ● Bending the cost trend ● Healthcare decisions by members and providers ● Statewide partnerships We are more than just an insurance company; we want to change the way healthcare is delivered now and in the future. 12/8/2020 Colorado Health. OP 13

A Collaborative Relationship Among Patient, Provider, and Payer ● Healthier patients ● Reduced costs ● Reduced inefficiencies ● www. COHealth. OP. org 12/8/2020 Colorado Health. OP 14

To Get Involved With CO-OP Efforts ● Host an educational event for your office, group, or association ● Volunteer at a local community event ● Share information with your network ● “Opt in” to join the movement ● Join us on social media ● Facebook: https: //www. facebook. com/COHealth. OP ● Twitter: @COHealth. OP ● You. Tube: http: //www. youtube. com/user/COHealth. OP 12/8/2020 Colorado Health. OP Slides 15

A brief overview of the ACA ● Health Insurance Marketplace for individual and small group market ● No annual dollar limits on essential health benefits ● No preexisting condition restriction for ANY enrollee ● No lifetime maximum dollar limits on essential health benefits ● Children eligible to remain covered under parents health plan until age 26 ● Individual mandate means there will be a penalty for not having minimal coverage; increases over time 12/8/2020 Colorado Health. OP Slides 16

Connect for Health Colorado (the Marketplace) ● Colorado Health. OP is one of the options on the marketplace (AKA: Exchange) ● Works like a airline booking website – you can compare plans and rates ● Guides/Navigators are individuals/organizations working across the state to help educate and sign people up on the marketplace (Certified agents/brokers can be guides. ) ● Metal tiers help to distinguish each plan and its benefits (bronze, silver, gold, platinum) 12/8/2020 Colorado Health. OP Slides 17

Subsidies Available ● Tax Credits/Subsidies are available for many individuals and small businesses ● Individuals – generally earning $15, 000 -$46000; for families of four - $31, 000 -$94, 000 ● Small Business – under 25 FTE; pay at least 50% of insurance cost; pay average annual wages below $50, 000. ● With the expansion of Medicaid many new Coloradans may qualify ● The Marketplace will help identify any benefits a person would qualify for and send them to the right site to complete their signup or purchase 12/8/2020 Colorado Health. OP Slides 18

Connect for Health Colorado (the Marketplace) ● Plans available starting on October 1 st ● Coverage begins on January 1 st 2014 ● www. connectforhealth. CO. com 12/8/2020 Colorado Health. OP Slides 19

● QUESTIONS? Thank you! 12/8/2020 Colorado Health. OP Slides 20