Louisiana Health Cooperative (LAHC) overview
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On September 28, 2012, Louisiana Health Cooperative (LAHC) was selected by the United States Department of Health and Human Services (HHS) to receive loans to create and operate a Consumer Oriented and Operated Plan, or “CO-OP”. Since that time, LAHC officials have been working with the Louisiana Department of Insurance to obtain approval to operate as an insurer statewide with open enrollment beginning on October 1, 2013 and coverage starting on January 1, 2014. Once operational, LAHC will intensely pursue those individuals and small employers (2-50 employees) who want health insurance coverage, but are not eligible for public assistance in other forms. Based in Louisiana, LAHC is sponsored by a coalition of health care providers and business leaders who plan to improve health outcomes by providing better access to high quality care at an affordable price. LAHC’s mission is to promote community health and well-being by engaging the members and providers it serves in the valued delivery of high quality, integrated health care services. CO-OPs, like LAHC, are non-profit, member-owned and member-governed health insurance companies with a focus on developing programs intended to improve the quality of health care delivered to members
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Louisiana Health Cooperative (LAHC) overview
- 1. Louisiana Health Cooperative, Inc. (LAHC) OVERVIEW HealthCare.gov mylahc.org
- 2. What is a Health CO-OP? Consumer Oriented and Operated Health Plans or “CO- OPs” are non-profit, member-owned and member- governed health insurance companies. The CO-OPs were created by the Affordable Care Act and will operate in several states across the nation. The application for the Louisiana Health Cooperative (LAHC) was selected by the United States Department of Health and Human Services (HHS) to receive loans to create and operate a CO-OP in the state of Louisiana. HealthCare.gov 1/30/2013 mylahc.org 2
- 3. What are CO-OPs? CO-OPs focus on developing programs intended to improve the quality of health care delivered to members, such as: • preventive programs offered with early health screenings; • focusing on health outcomes based on sound clinical evidence; • ongoing measurement and comparison of performance to clinical quality standards; • a comprehensive medical network; • coordinated care programs; • opportunities for members to participate in their care. HealthCare.gov 1/30/2013 mylahc.org 3
- 4. What is the Affordable Care Act? The development of health insurance Exchanges and CO-OPs like Louisiana Health Cooperative (LAHC) are a direct result of the Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act (ACA). The ACA is the landmark health reform legislation passed by Congress and signed into law by the President in March 2010. HealthCare.gov 1/30/2013 mylahc.org 4
- 5. What is the Affordable Care Act? ACA legislation includes a long list of health-related provisions that are intended to: • extend coverage to millions of uninsured Americans, • implement measures that will lower health care costs and improve system efficiency, and • eliminate industry practices that are harmful to patients, such as rescission and denial of coverage due to pre-existing conditions. HealthCare.gov 1/30/2013 mylahc.org 5
- 6. What is LAHC? LAHC is currently working with the Louisiana Department of Insurance to obtain approval to operate as an insurer statewide with open enrollment beginning on October 1, 2013 and coverage starting on January 1, 2014. Once operational, LAHC will intensely pursue those individuals and small employers (2-50 employees) who want affordable health insurance coverage, and are not eligible for public assistance in other forms. HealthCare.gov 1/30/2013 mylahc.org 6
- 7. LAHC Mission Louisiana Health Cooperative (LAHC) exists to promote community health and well being by engaging the members and providers it serves in the valued delivery of high quality, integrated health care services. HealthCare.gov 1/30/2013 mylahc.org 7
- 8. What are health insurance Exchanges? Exchanges are organized marketplaces authorized by the Affordable Care Act where individuals and small employers can purchase health insurance. • An Exchange is a set of government-regulated and standardized health care plans. • Low and moderate income individuals can receive premium and cost-sharing subsidies that will only be available through Exchanges. • Exchanges will make insurance markets more transparent, facilitate consumer choice and encourage competition among insurers. HealthCare.gov 1/30/2013 mylahc.org 8
- 9. What are health insurance Exchanges? Within the Exchange markets, you can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for you. • None of these plans will deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. • All plans must cover preventive care without any out of pocket expense. • Under federal law, all Exchanges must be fully certified and operational by January 1, 2014. HealthCare.gov 1/30/2013 mylahc.org 9
- 10. What are health insurance Exchanges? Major requirements affecting insurers in the individual Exchanges include: • guaranteed issue - insurers will not be permitted to refuse to insure any individuals • plans will be offered in four comparable tiers, covering the same basic benefits so you can compare them easily. • You get to choose your level of out of pocket expense • strict regulations on rescission or the retroactive cancellation of a health insurance policy • elimination of lifetime and annual limits on claims payments HealthCare.gov 1/30/2013 mylahc.org 10
- 11. LAHC Provider Network LAHC intends to contract with physicians, hospitals and other health care providers in markets throughout Louisiana to serve as participating providers for the health plan. Based in Louisiana, LAHC plans to partner with providers that share in its mission of promoting community health and well- being and providing high quality, integrated health care services. HealthCare.gov 1/30/2013 mylahc.org 11
- 12. Who will regulate LAHC? The federal Department of Health and Human Services provides initial loan funding and monitoring. The Louisiana Commissioner of Insurance will provide all insurance-related supervision. LAHC will be governed by a community board composed of: Members of LAHC Providers Employers Individuals providing particular expertise to LAHC Eventually all directors will be elected by the members HealthCare.gov 1/30/2013 mylahc.org 12
- 13. More information: For additional information about the Louisiana Health Cooperative (LAHC) visit www.myLAHC.org or call toll-free: 1-888-517-3802. For additional information about the Affordable Care Act, health insurance Exchanges and CO-OPs visit www.Health care.gov. HealthCare.gov 1/30/2013 mylahc.org 13
Notes de l'éditeur
- Louisiana Health Cooperative, Inc. (LAHC)Service Area: LouisianaAward Amount: $65,040,660Award Date: September 28, 2012
- OVERVIEW:“New Loan Program Helps Create Customer-Driven Non-Profit Health Insurers” – HealthCare.govThe Affordable Care Act creates a new type of private nonprofit health insurer, called a Consumer Operated and Oriented Plan, or “CO-OP.”CO-OPs are directed by their customers and designed to offer individuals and small businesses more affordable, consumer-friendly and high quality health insurance options.The CO-OP program offers low-interest loans to eligible nonprofit groups to help set up and maintain these issuers. To date, a total of 22 non-profits offering coverage in 22 states have been awarded $1,691,348,280.Starting January 1, 2014, CO-OPs, will be able to offer health plans through the new, competitive health care marketplaces in their state, called the Affordable Insurance Exchanges. In addition to offering health plans through an Exchange, CO-OPs may also offer health plans outside of an Exchange.CO-OP loans are only made to private, nonprofit entities that demonstrate a high probability of financial viability. All CO-OPs receiving loans were selected by CMS on a competitive basis based on external independent review by a multi-disciplinary team. As CO-OPs meet or exceed developmental milestones, funds are allowed to be incrementally drawn down.CMS will closely monitor CO-OPs to ensure they are meeting program goals and will be able to repay loans.To ensure strong financial management, CO-OPs are required to submit quarterly financial statements, including cash flow and enrollment data, receive site visits, and undergo annual external audits.This monitoring is concurrent with the financial and operational oversight by state insurance regulators. Source: HealthCare.gov
- Rescission is defined as a cancellation or discontinuance of coverage that has a retroactive effect. For example, a cancellation that treats a policy as void from the time of enrollment, or that voids benefits paid before cancellation, is considered a rescission. When a coverage rescission occurs, the insurance company is no longer responsible for medical care claims that they had previously accepted and paid. In contrast, a cancellation or discontinuance of coverage is not considered a rescission if it: has only a prospective (future) effort; or is effective retroactively to the extent it is attributable to a failure to timely pay required premiums or contributions toward the cost of coverage.
- A health exchange is a website that allows people to compare prices and benefits of health insurance plans before purchasign a plan through the website. The plans must meet federal guidelines laid out in the health care law. Health insurance exchanges function like a mall for health insurance, giving consumers multiple options to buy insurance, instead of just one or two.This encourages competition among insurers to provide the best product to attract customers. Exchanges also give small businesses (2-50 employees) many of the advantages of large businesses by reducing the burden and cost of enrolling employees in small group plansA health insurance exchange is a set of government-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies
- Insurance companies selling on exchanges will have to meet new minimum standards and offer a range of health plans. Some will have low deductibles and cost-sharing, but are expected to be more expensive; others will have lower premiums but higher deductibles and more out-of-pocket costs.Americans making less than four times the federal poverty line — about $44,000 for a single adult or $92,000 for a family of four — will qualify for federal subsidies to offset their premiums. Those below 138% of the poverty line will be able to sign up for Medicaidcoverage in states that elect to expand their Medicaid programs.
- Rescission is defined as a cancellation or discontinuance of coverage that has a retroactive effect. For example, a cancellation that treats a policy as void from the time of enrollment, or that voids benefits paid before cancellation, is considered a rescission. When a coverage rescission occurs, the insurance company is no longer responsible for medical care claims that they had previously accepted and paid. In contrast, a cancellation or discontinuance of coverage is not considered a rescission if it: has only a prospective (future) effort; or is effective retroactively to the extent it is attributable to a failure to timely pay required premiums or contributions toward the cost of coverage.
- One of LAHC’s primary sponsors is Ochsner Health System, a premier nonprofit health care system based in New Orleans.Ochsner is a national leader in medical research and one of the largest non-university based physician training centers in the nation. Ochsner Health System includes eight hospitals and more than 38 medical centers in the Baton Rouge and New Orleans metropolitan areas.