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Home My WebLink AboutMINUTES - 08062013 - D.2RECOMMENDATION(S): ACCEPT a report from the Health Services Director, Contra Costa Health Plan Chief Executive Officer, and Employment and Human Services Director regarding health care reform, the Affordable Care Act, status of implementation in Contra Costa County, and the impact to the residents of Contra Costa County. FISCAL IMPACT: No fiscal impact - informational only. BACKGROUND: This report will include an update on the current status of preparation for the implementation and the impacts of the Affordable Care Act. The presentation will cover 1) CCRMC and Health Center strengths and challenges, work underway to implement health reform, organizational priorities, and strategic planning; 2) Contra Costa Health Plan approval as an eligible health care plan in the Covered California Exchange; and 3) the progress made in implementation of changes needed in the Employment and Human Services Department to assist residents with enrollment through the Exchange or Medi-Cal. There are two attachments: Attachment I - A table showing examples of rates and federal subsidy for the the Silver Plan and tables showing premiums based on age, family size and income for the five health plans in Region 5. Contra Costa is located in this region. 1. 2. APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 08/06/2013 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Candace Andersen, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor Federal D. Glover, District V Supervisor Contact: Dorothy Sansoe, 925-335-1009 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: August 6, 2013 David Twa, County Administrator and Clerk of the Board of Supervisors By: June McHuen, Deputy cc: D. 2 To:Board of Supervisors From:William Walker, M.D., Health Services Director Date:August 6, 2013 Contra Costa County Subject:Health Services Department Workshop BACKGROUND: (CONT'D) Attachment II - Contra Costa Health Plan's standard benefits, rates, and co-pays for each of the Covered California plans. CONSEQUENCE OF NEGATIVE ACTION: The Board and the public may not have important information. CHILDREN'S IMPACT STATEMENT: Not Applicable. CLERK'S ADDENDUM The Board requested future reports to include the Federal Poverty Line figures. ACCEPTED the report. ATTACHMENTS Attachment I Attachment II Covered California Health Plans40 | May 23, 2013 Rating Region 5 Contra Costa Plan 150 FPL 200 FPL 250 FPL 400 FPL Blue Shield PPO $38 $289 $102 $226 $174 $154 $328 $0 Kaiser Permanente HMO $57 $289 $121 $226 $193 $154 $347 $0 Contra Costa Health Plan HMO $63 $289 $126 $226 $198 $154 $352 $0 Health Net PPO $73 $289 $136 $226 $208 $154 $362 $0 Anthem PPO $77 $289 $140 $226 $212 $154 $366 $0 Number of subsidy eligible individuals: 36,000 HMO – Health Maintenance Organization PPO – Preferred Provider Organization For further explanation, see the glossary on pg. 80 The table below is an example of the rates a 40 year old single individual might pay in Region 5 for a Silver Plan. That amount is shown in each box at the top and in black. The federal subsidies are shown in green. Starting this fall, individuals and families will be able to determine the exact amount they would pay based on family size, age and income. FPL = Federal Poverty Level Attachment I Covered California Health Plans May 23, 2013 | 41 Rating Region 5 Contra Costa 25 YEAR OLD Plan Catastrophic Bronze Blue Shield PPO $204 $215 Kaiser Permanente HMO $203 $205 Contra Costa Health Plan HMO $174 $237 Health Net PPO $150 $249 Anthem PPO $186 $217 If you are one of the 2.6 million uninsured Californians who does not qualify for a subsidy, you can still purchase high quality aff ordable health insurance through Covered California. The table below is an example of the rates in Region 5. Starting this fall, individuals and families will be able to determine the exact amount they would pay based on family size, age and income. 40 YEAR OLD Plan Bronze Silver Gold Platinum Blue Shield PPO $273 $328 $390 $447 Kaiser Permanente HMO $261 $347 $426 $458 Contra Costa Health Plan HMO $301 $352 $398 $448 Health Net PPO $317 $362 $411 $463 Anthem PPO $276 $366 $444 $515 Attachment I CONTRA COSTA HEALTH PLAN COVERED CALIFORNIA – STANDARD BENEFIT PLAN PATRICIA TANQUARY, CEO DESIGNS SILVER COPAY PLAN BRONZE PLATINUM GOLD CATASTROPHIC 100%-150% FPL 150%-200% FPL 200% - 250% FPL INDIVIDUAL 250% - 400% PLAN COPAY PLAN COPAY PLAN PLAN 21-30 YEARS ACTUARIAL VALUE – FINAL AV CALCULATOR COSTS INSURANCE COMPANY PAYS 94.9% 87.8% 73.3% 68.3% 60.4% 88% 78% 60.4% COSTS INDIVIDUAL PAYS 5.1% 12.2% 26.7% 31.7% 39.6% 12% 22% 39.6% OVERALL DEDUCTIBLE FOR SINGLE INDIVIDUAL * $0 N/A N/A N/A $5,000 INTEGRATED MED/RX DEDUCTIBLE $0 $0 $6,350 INTEGRATED MED/RX DEDUCTIBLE OTHER DEDUCTIBLES FOR SPECIFIC SERVICES MEDICAL $0 $500 $1,500 $2,000 N/A $0 $0 N/A BRAND DRUGS $0 $50 $250 $250 N/A $0 $0 N/A DENTAL $0 $0 $0 $0 $0 $0 $0 $0 (FOR SINGLE INDIVIDUAL*) OUT-OF-POCKET LIMIT ON EXPENSES: $2,250 $2,250 $5,200 $6,350 $6,350 $4,000 $6,350 $6,350 COMMON MEDICAL EVENT SERVICE TYPE MEMBER COST SHARE DEDUCTIBLE APPLIES MEMBER COST SHARE DEDUCTIBLE APPLIES MEMBER COST SHARE DEDUCTIBLE APPLIES MEMBER COST SHARE DEDUCTIBLE APPLIES MEMBER COST SHARE DEDUCTIBLE APPLIES MEMBER COST SHARE DEDUCTIBLE APPLIES MEMBER COST SHARE DEDUCTIBLE APPLIES MEMBER COST SHARE DEDUCTIBLE APPLIES VISIT TO A HEALTH CARE PROVIDER’S OFFICE OR CLINIC PRIMARY CARE VISIT TO TREAT AN INJURY OR ILLNESS $3 $15 $40 $45 $60 AFTER 1ST 3 NON- PREVENTIVE VISITS $20 $30 0% AFTER 1ST 3 NON-PREVENTIVE VISITS SPECIALIST VISIT $5 $20 $50 $65 $70 X $40 $50 0% X OTHER PRACTITIONER OFFICE VISIT $3 $15 $40 $45 $60 X $20 $30 0% X PREVENTIVE CARE / SCREENING / IMMUNIZATION NO COST SHARE NO COST SHASE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE $40$30 TESTS LABORATORY TESTS $3 $15 $40 $45 30% X $20 $30 0% X X-RAYS AND DIAGNOSTIC IMAGING $5 $20 $50 $65 30% X $40 $50 0% X IMAGING (CT/PET SCANS, MRIS) $50 $100 $250 $250 30% X $150 $250 0% X $5 DRUGS TO TREAT ILLNESS OR CONDITION GENERIC DRUGS $3 $5 $20 $25 $25 X $5 $20 0% X PREFERRED BRAND DRUGS $5 $15 X $30 X $50 X $50 X $15 $50 0% X NON-PREFERRED BRAND DRUGS $10 $25 X $50 X $70 X $75 X $25 $70 0% X SPECIALTY DRUGS 10% 15% X 20% X 20% X 30% X 10% 20% 0% X OUTPATIENT SURGERY FACILITY FEE (E.G., ASC) 10% 15% 20% 20% X 30% X $250 $600 0% X PHYSICIAN/SURGEON FEES 30% X 0% X NEED IMMEDIATE ATTENTION EMERGENCY ROOM SERVICES (WAIVED IF ADMITTED) $25 $75 X $250 X $250 X $300 X $150 $250 0% X EMERGENCY MEDICAL TRANSPORTATION $25 $75 X $250 X $250 X $300 X $150 $250 0% X URGENT CARE $6 $30 $80 $90 $120 AFTER 1ST 3 NON- PREVENTIVE VISITS $40 $60 0% AFTER 1ST 3 NON-PREVENTIVE VISITS HOSPITAL STAY FACILITY FEE (E.G., HOSPITAL ROOM) 10% 15% X 20% X 20% X 30% X $250 PER DAY UP TO 5 DAYS $600 PER DAY UP TO 5 DAYS 0% X PHYSICIAN / SURGEON FEE 0% X MENTAL HEALTH, BEHAVIORAL HEALTH, OR SUBSTANCE ABUSE NEEDS MENTAL/BEHAVIORAL HEALTH OUTPATIENT SERVICES $3 $15 $40 $45 $60 AFTER 1ST 3 NON- PREVENTIVE VISITS $20 $30 0% AFTER 1ST 3 NON-PREVENTIVE VISITS MENTAL/BEHAVIORAL HEALTH INPATIENT SERVICES 10% 15% X 20% X 20% X 30% X $250 PER DAY UP TO 5 DAYS $600 PER DAY UP TO 5 DAYS 0% X SUBSTANCE USE DISORDER OUTPATIENT SERVICES $3 $15 $40 $45 $60 AFTER 1ST 3 NON- PREVENTIVE VISITS $20 $30 0% AFTER 1ST 3 NON-PREVENTIVE VISITS SUBSTANCE USE DISORDER INPATIENT SERVICES 10% 15% X 20% X 20% X 30% X $250 PER DAY UP TO 5 DAYS $600 PER DAY UP TO 5 DAYS 0% X N PREGNANCY PRENATAL AND POSTNATAL CARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE DELIVERY AND ALL INPATIENT SERVICES HOSPITAL 10% 15% X 20% X 20% X 30% X $250 PER DAY UP TO 5 DAYS $600 PER DAY UP TO 5 DAYS 0% X PROFESSIONAL 30% X 0% X 30%X HELP RECOVERING OR OTHER SPECIAL HEALTH NEEDS HOME HEALTH CARE $3 $15 $40 $45 30% X $20 $30 0% X REHABILITATION SERVICES $3 $15 $40 $45 30% X $20 $30 0% X HABILITATION SERVICE $3 $15 $40 $45 30% X $20 $30 0% X SKILLED NURSING CARE 10% 15% X 20% X 20% X 30% X $150 PER DAY UP TO 5 DAYS $300 PER DAY UP TO 5 DAYS 0% X DURABLE MEDICAL EQUIPMENT 10% 15% 20% 20% 30% X 10% 20% 0% X HOSPICE SERVICE NO COST CHASE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE NO COST SHARE CHILD NEEDS DENTAL OR EYE CARE EYE EXAM (DEDUCTIBLE WAIVED) 0% 0% 0% 0% 0% 0% 0% 0% GLASSES 1 PAIR PER YEAR 1 PAIR PER YEAR 1 PAIR PER YEAR 1 PAIR PER YEAR 1 PAIR PER YEAR 1 PAIR PER YEAR 1 PAIR PER YEAR 1 PAIR PER YEAR DENTAL CHECK-UP–PREVENTIVE & DIAGNOSTIC PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED PEDIATRIC DENTAL STANDARD PLAN DESIGN ATTACHED DENTAL RESTORATIVE AND ORTHODONTIA SERVICES DID YOU KNOW: WHILE YOU HAVE TO PAY A MONTHLY PREMIUM, YOUR COPAYS (DUE TO FEDERAL SUBSIDY AND COST-SHARE SUBSIDY) ARE LOW. OUT-OF-POCKET EXPENSES STOP AT $2,250 / YEAR WHILE YOU HAVE TO PAY A MONTHLY PREMIUM, YOUR COPAYS (DUE TO FEDERAL SUBSIDY AND COST-SHARE SUBSIDY) ARE LOWER. OUT-OF-POCKET EXPENSES STOP AT $5,200 / YEAR WHILE YOU HAVE TO PAY A MONTHLY PREMIUM, YOUR COPAYS (DUE TO FEDERAL SUBSIDY AND COST-SHARE SUBSIDY) ARE REDUCED. OUT-OF-POCKET EXPENSES STOP AT $6,350 / YEAR WHILE YOU HAVE NO MONTHLY PREMIUM WITH SUBSIDIY, NEARLY ALL CARE IS SUBJECT TO DEDUCTIBLE OF $6,350/YEAR WITH EXCEPTION OF 3 NON-PREVENTIVE VISITS/YEAR TO M.D. OR URGENT CARE. THEN CO-PAYS ARE HIGH UNTIL EXPENSES STOP AT $6,350 / YEAR WHILE YOU HAVE NO DEDUCTIBLE, YOUR PREMIUMS AND COPAYS ARE STILL HIGH. EXPENSES STOP AT $4,000 / YEAR WHILE YOU HAVE NO DEDUCTIBLE, YOUR PREMIUMS AND COPAYS ARE STILL HIGHER. EXPENSES STOP AT $6,350 /YEAR WHILE YOU HAVE NO COPAYS, NEARLY ALL CARE IS SUBJECT TO DEDUCTIBLE OF $6,350/YEAR WITH EXCEPTION OF 3 NON PREVENTIVE VISITS /YEAR TO MD OR URGENT CARE. EXPENSES STOP AT $6,350 / YEAR * FAMILY DEDUCTIBLE AND OUT-OF-POCKET LIMIT IS TWICE THE AMOUNT SHOWN. PRINT DATE: JUNE 14, 2013 Attachment II