utah health exchange program    

Product Description

Creates Utah NetCare Plan, and provides it as an alternative to current federal COBRA, state mini-COBRA, and conversion products. In developing it, legislators aimed for a product 33% below the average costs. NetCare must include healthy lifestyle and wellness incentives; and the following benefits or at least their actuarial equivalent:
A.    Lifetime max: 1 million per person
B.    Annual max: $250K per person
C.    Well-child exams and shots to age five
D.    The following benefits before a deductible applies:
        1.    Up to $500 in preventative care annually
        2.    Up to $300 in other office and urgent care visits annually
        3.    Up to $500 in supplemental accident coverage annually
E.    Copayments of:
        1.    $15 for preventative care and well-child exams
        2.    $25 for primary care
        3.    $50 for urgent and specialist care
        4.    $200 for emergency room visits after the deductible
F.    No more than a 30% coinsurance after deductible for most services
G.    Prescription coverage may include formularies and cost-sharing of:
        1.    $15 copayment for generic drugs
        2.    Up to 50% for name brand drugs
H.  Most mandates may be excluded
I.    A low-deductible plan with:
        1.   Deductibles
            A.    $2000/individual plan
            B.    $4000/two party plan
            C.    $6000/family plan
        2.    Out of Pocket Maximums:
            A.     $5000/individual
            B.    $10,000/Two party plan
            C.    $15,000/Family plan
J.    A high-deductible plan with:
        1.    High deductible plans:
            A.    $4000/individual
            B.    $8000/two party plan
            C.    $12,000/family plan
        2.    Out of Pocket Maximuns:
            A.    $5000/individual
            B.    $10,000/two party plan
            C.    $15,000/family plan

Allows employers to offer employees a defined contribution health plan. The employer may not offer any other major medical health benefit plan, thought they may offer supplemental policies, or federally qualified health savings accounts. Employers determine the criteria for eligibility, etc., and the amount they they will contribute. They will choose a default plan employees will be enrolled in if they do not choose otherwise. The employer group will be rates as a group, and that rating will follow the employee as they choose from any of the defined contribution plans sold through the portal, available 2010 to small employers and 2012 to large employers.

Insurers offering defined contribution plans must offer at least:
    A.    One federally qualified high-deductible plan with the lowest qualifying deductible and an OOP max of less than three times deductible
    B.    One plan with benefits that have an actuarial value at least 15% greater.

Insurers may not dictate employer contribution levels, but may mandate minimum participation levels.

Establishes a board to develop a "back-end risk" adjustment mechanism to apportion risk among insurers participating in the defined contributions portal.

Authorizes fees to cover portal processing costs for such things as processing applications and multiple premium payment sources. It is not clear if fees will be paid by consumers.

Continues the Health System Reform Task Force, and requires various studies and reports.

 

 

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