About MNSURE
Minnesota’s health insurance marketplace
Overview
What is Mnsure
What has been done to date
What’s next
What is MNsure?
What is MNsure?
A new marketplace where Minnesotans
can find, compare, choose, and get
quality health care coverage that best
fits your needs and your budget.
Why a Health Insurance Marketplace?
Subject of ongoing dialogue
in Minnesota since 2006
Provision within the federal
Affordable Care Act (ACA)
enacted in March 2010
Why a Health Insurance Marketplace?
More Choice
Lower Costs for
Consumer
Consumer has many plans to pick from and
can pick the one that best fits their needs
Multiple plans in one place means greater
market incentives for competition on quality
& cost
Simple One-Stop
Shop
Makes it easier to search, select and enroll,
plus greater mobility and portability
Quality Ratings
Consumer can find transparent comparison
information on the plans and health
providers
Marketplace Set Up Options
Option 1:
State Based Exchange
Option 2:
State Partnership Exchange
Option 3:
Federally-facilitated Exchange
without Partnership
Minnesota’s Choice
Option 1:
State Based Exchange
Option 2:
State Partnership Exchange
Option 3:
Federally-facilitated Exchange
without Partnership
How will MNsure Work?
How will MNsure work?

One process to determine eligibility for

Qualified Health Plan

Financial assistance/tax credits to lower premiums

Medicaid

Children’s Health Insurance Program (CHIP)

Reduced cost sharing

Offers choice of plans and levels of coverage

Insurance companies compete for your business
Projected Audience –
Over 1 million Minnesotans
 Individual Consumers – 370,000
 Small Businesses and Employees – 155,000
 Medical Assistance Enrollees – 690,000
Who can use MNsure?
 Not be incarcerated
 Live in service area
 Be a U.S. citizen
When can you enroll?

Initial open enrollment starts October 1, 2013 and
ends March 31, 2014

Annual open enrollment periods after that run
October 15 through December 7

Special enrollment periods available in certain
circumstances during the year

Members of federally-recognized tribes may enroll
or change plan designations one time per month
Consumer Assistance Network
Website
+
Toll-free
call
center
+
In person
assistance
=
Help when
you need it
What’s Been
Done to Date
Grant Funding
Federal Grant of
$1 M
February 2011
Federal Grant of
$4.2 M
August 2011
Federal Grant of
$23 M
February 2012
• Planning
• Development
• Technical Infrastructure
• Stakeholder
Consultations
• Market Research
Federal Grant of
$42.5 M
August 2012
Federal Grant of
$39.3 M
January 2012
Technical Infrastructure
Program Integration
Operations
Outreach
Branding
Stakeholder Engagement
Advisory Task Force
15 members
Provides guidance on issues related to
the development of a health insurance
marketplace for Minnesota.
Technical Work Groups
185 members
Develop, discuss, and provide technical
assistance on options to the Advisory
Task Force
• Adverse Selection
• Finance
• Governance
• Individual Eligibility
• IT and Operations
• Measurement and Reporting
• Navigators and Agents/Brokers
• Outreach, Communications & Marketing
• Plan Certification
• Small Employers and Employees
• Tribal Consultation
Federal Planning Landmarks
Design Review
May 2012
Assessed progress on IT and operational functions
Blueprint Certification Application
November 2012
Described readiness to perform exchange activities and functions for states
seeking approval to operate a state-based exchange
Conditional Approval Received
December 20
Certification Documents and Approval Notification
http://www.mn.gov/hix/planning-activity/certification/
System Development
Marketplace Interactions
The User Experience
Helps to design a user experience that is responsive to
people’s different needs, desires and expectations.
How might MNsure look?
MNsure Legislation
HF5/SF1
Introduced January 10, 2013
•Heard and passed in 18 House and Senate Committees
•More then 100 amendments offered
•Over 100 hours of debate
Signed into law March 20, 2013
MNsure Governance
Executive Branch Board
7 members
Appointed by the Governor
Confirmation by the House and Senate
4 year staggered terms
2 term limit
MNsure Governance
Board Members
Commissioner of DHS
6 appointed to represent interests of consumers, small
employers, uninsured, health care system
Board appoints advisory committees of stakeholders
MNsure Oversight
Legislative Oversight Committee
10 members from House and Senate
6 of the majority
4 of the minority
Review the finances, operations and rules of the marketplace
MNsure Funding
2014
2015
2016
• May withhold up to 1.5%
of policy premiums
• No more than 25% of
2012 MCHA assessment
• Approx. $42 million
• May withhold up to 3.5% of
policy premiums
• No more than 50% of 2012
MCHA assessment
• Approx. $84 million
• May withhold up to 3.5%
of policy premiums
• No more than 100% of
2012 MCHA assessment
• Approx. $168 million
Qualified Health Plans
All plans meeting requirements allowed in
2014; Board may select best starting in
2015
Plans must meet minimum “certification”
requirements
Plan submissions by mid-May
Certification Criteria:
http://mnsure.org/hix/your-benefits/plan-carriers.jsp
Plan Levels of Coverage
Enrollees Pay on
Average* (in
Levels of
Coverage
Plan Pays on
Average
Bronze
60 %
40 %
Silver
70 %
30 %
Gold
80 %
20 %
Platinum
90 %
10 %
addition to the
monthly plan premium)
Consumer Assistance Services
Qualifications
1. Demonstrate proven connections to the
communities MNsure will serve, or
demonstrate the ability to form relationships
with consumers, including uninsured and
underinsured consumer
2. Successfully complete MNsure's certification
training program
3. Comply with any privacy and security
standards applicable to MNsure
Consumer Assistance Services
Eligible Organizations
Have existing, or could readily establish, relationships with consumers in
Minnesota, including uninsured and underinsured, likely to be eligible to
enroll through MNsure
•
•
•
•
•
•
•
•
•
Community and consumer non-profit focused groups
Trade, industry and professional organizations
Farming organizations
Religious organizations
Chamber of Commerce
Agents/Brokers
Coalitions and collaborative efforts
Tribal organizations
State and local human services
Consumer Assistance Services
Duties/Responsibilities

Maintain expertise in eligibility, enrollment & program
specifications

Conduct public education activities

Provide information & services in fair, accurate and impartial
manner Religious organizations

Facilitate enrollment in QHPs offered in MNsure

Provide referrals for grievance, complaint or question

Provide information in culturally and linguistically appropriate
manner to needs of the population
Consumer Assistance Services
Certification Training
Consumer Assistance Partners
• MNsure will develop a certification training program
• MNsure will administer web-based training
• Applicable staff (navigator, in-person assister, or certified application counselor)
must complete training with minimum passing score
Agents/Brokers
• Establish minimum certification training standards
• Training and proficiency assessment administered by MNsure
• Applicable staff must complete training with minimum passing score
Consumer Assistance Services
Compensation
In-Person Assister

Infrastructure and outreach grants – competitive solicitation process

Payment per enrollment (until funds are depleted)

Pay-for-performance payments
Certified Application Counselors

Do not receive payment from MNsure or health carriers
Agent/Brokers

Continued commission from carriers
What’s Next
Next Steps
Business
Operations
•
•
•
•
•
Customer Service/Call Center
Navigators/Brokers
Plan certification and comparison info
Eligibility and enrollment
Premium processing
Technology
•
•
•
•
Hardware/software
Federal Hub
Privacy/Security
Program Integration
Outreach &
Marketing
• Branding – Name/Logo for the Exchange
• Messaging
• Outreach – TV, radio, social media, etc.
Public Education Website
Upcoming Key Dates
April:
May:
May:
Summer:
Consumer
Assistance
Program
finalized
MNsure
Board
appointed
Health
insurance
plans filed
with DOC &
MDH
System
usability
testing;
Consumer
Assistance
training;
MNsure at the
MN State Fair
September: October 1:
Call Center
opens
Enrollment
begins
Tribal Specific Topics

Tribal Consultation

Tribal Sponsorship

Certification Requirements – Indian Addendum

Consumer Assistance / In-Person Assisters

Eligibility
MNsure Tribal Process
Registration
Tribes will register as a Tribal third party payer
• Submit sponsored individual’s membership
data or information
• Select QHP the Tribe will subsidize
• Submit banking information for monthly
payments
MNsure Tribal Process
Premiums
• Tribes will be responsible for notifying members/sponsored
individuals of their eligibility for Tribal subsidies and
information on QHPs selected.
• Individual’s portion of premium will be adjusted on individual
invoice or on small employer employee share of invoice.
• Sponsored individuals and Tribal sponsors will be notified
when premiums change for change in plan or other life
event changes impacting plan selection and/or premium.
MNsure Tribal Process
Payments
• MNsure will aggregate premiums for Tribes so one
invoice/payment per month per Tribe will be sent.
• Tribes will be responsible for notifying MNsure and
sponsored members when amending amount paying for
members and/or members sponsoring.
• MNsure will send funding to appropriate carrier.
• All payments will be electronic