HealthPartners has put out a communication regarding the 2018 changes to the 2018 Small Employer portfolio. Please read it below.
Contact Sales@LeClairGroup.com to get appointed with HealthPartners.
Many of you have asked for a written summary of the changes for the small group market for 2018 that we covered during our recent webinar. A summary is provided below. If you’re interested in viewing the full webinar, you can do so here. To view the webinar, you’ll need to log in or register.
Policy and provision changes
All changes are effective upon renewal after 1/1/18 unless otherwise noted.
- The State of Minnesota reinsurance program only applies to the individual market.
- New plan limits – all amounts listed below are Single / Family
- 2018 annual out-of-pocket (OOP) limits on cost sharing increase from $7,150 / $14,300 in 2017 to $7,350/ $14,700.
- 2018 HSAs –the minimum deductible increased by $150 to $1,350 and the OOP max increased by $100 to $6,650 and $200 for family coverage to $13,300.
- The annual HSA contribution limit increased by $50 for single coverage to $3,450 and $150 for family coverage to $6,900.
- Multiple plan rules have changed to help with affordability. Small employers with 1-9 employees can have one plan; 10-24 employees can have up to two plans; 25+ employees can have up to three plans.
- Some of our products had changes to things like copays, deductibles or OOP maximums to fall into the new metal level bands. Our renewals and change exhibits outline these changes. Any products that have been retired will be automatically mapped to the next lowest Actuarial Value alternative, but you are of course free to offer any product that your client wants.
- HSA Rx Plus plans have a new value-based preventive benefit to encourage generic utilization; all preventive generics will now be covered at 100 percent.
- A $2 copay for allergy injections and all other injections in a physician’s office was added on copay plans to comply with new testing guidelines required by the Mental Health Parity law.
- Member use of specialty coupons from pharmacy manufacturers will be communicated to the plan and only the amount the member actually pays out of pocket will accumulate to deductible and out-of-pocket amounts. This change is effective 1/1/18 regardless of renewal date.
- There will be no coverage for a new excluded drug list of egregiously priced non-formulary drugs that have a formulary or over-the-counter alternative and do not demonstrate any difference in treatment.
Rates and products
- Minnesota market rate increase:
- Overall average rate increase comparing rates from 1/1/16 to 1/1/17 is 13.4 percent for HMO license (metro area and St. Cloud area), and 11.4 percent for insurance company license (typically greater MN).
- The filed quarterly increase is 1.7 percent for MN.
- Actual rates will vary depending on your clients’ area, network and products.
- Area factors have changed slightly in MN – see the rate area map on the broker portal for details.
- HealthPartners premiums will continue to be competitive.
New Network—CentraChoice Small Employer
- There is a new high-performing central Minnesota ACO network called CentraChoice Small Employer. It is powered by a collaboration between HealthPartners, CentraCare Health, and their local care delivery partners. It is available as a stand-alone option and groups can save up to 5.8 percent when switching from Open Access.
- All CentraChoice SE providers are covered in-network and do not require a referral. If members need medically necessary care that cannot be delivered by the CentraChoice SE network, their provider will coordinate with us to get them the care they need.
Achieve Small Employer
- We have a few changes to Achieve for 2018. Since we’re launching CentraChoice SE in the St. Cloud area, we will no longer sell Achieve in Stearns and Benton counties. This means that the providers in this area are also out-of-network for Achieve. Employers in Sherburne and Wright counties will have an option of either Achieve or CentraChoice SE. If the majority of their employees live and seek care in the St. Cloud area, they will want to consider CentraChoice SE. But if the majority of their employees live and seek care in the Twin Cities metro area, they will want to look at Achieve.
- We annually review our high performing networks to ensure that the provider set meets our thresholds for cost and affordability. This helps us ensure that we can keep costs lower for our members without sacrificing quality care.
- For 2018, North Memorial no longer meets the cost/affordability threshold to be included in Achieve, so their primary care clinics will no longer be offered in-network. This change is effective 1/1/18 regardless of the renewal date.
- We’re pleased to share that we have new options for access in Wright county. We’ve added all Stellis Health locations, the Allina Clinic in Buffalo, and the Buffalo Hospital.
- Groups can save between 5.8 and 8.7 percent when switching from either Perform or Open Access.
- Achieve may be offered as a stand-alone option or can be paired with either Open Access or Perform.
- All Achieve providers are covered in-network and do not require a referral. If members need medically necessary care that cannot be delivered by the Achieve network, their provider will coordinate with us to get them the care they need.
Perform Small Employer
- Perform Small Employer includes new Sanford options in southwestern Minnesota and expands the sales area to new counties: Brown, Cottonwood, Jackson and Murray
- Network discounts: the relative value between the Open Access network (at 1.0) and the Small Group Perform network has changed slightly and is now a 3 percent savings (.971); an 8 percent savings for the Achieve SE ACO (.913). and new CentraChoice SE ACO (.942) is up 5.8 percent savings.
- Network combination policy
- You can still pair Achieve with either Open Access or Perform
- You cannot pair Open Access and Perform
- You cannot pair CentraChoice SE—it is a stand-alone option only
- You can pair the exact same benefit option with different networks, subject to the network pairing rules above. This makes it much easier to communicate to employees that the benefits are the same but the network of providers is different.
- Wisconsin market increase
- Average rate increase comparing rates from Q12017 to Q12018 for Wisconsin is 8.6 percent.
- In the Hudson area it is 7.9 percent for Q1 to Q1.
- The filed quarterly increase is 2 percent for Wisconsin.
- Actual rates will vary depending on the geographical area and products your client has.
- Area factors have changed slightly in WI – see the plan guide on the broker portal for details on new factors.
- Wisconsin uses the Open Access network.
- The Wisconsin transition policy was extended again to 12/31/18. All current non-ACA groups will need to transition no later than 1/1/19 to ACA compliant plans.
- Wisconsin adopted the new Federal Standard Age Curve for children. For 2018 children will be rated as a single age band for individuals age 0 through 14; and one-year age bands for individuals age 15 through 20. This does not apply to Minnesota.
It’s important to us that we stay as consistent as possible and remain an affordable option from year to year. Please contact your account manager with any questions