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Posted by on Aug 29, 2013 in Utah | 0 comments

Utah’s Dual Exchange Model

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Where do I go to compare health insurance options and purchase coverage?

The provisions of the Affordable Care Act will be split, making Avenue H the official state-based health insurance marketplace for small businesses, while the federal government will operate the individual exchange at healthcare.gov.

Utah’s former Governor Jon Huntsman signed legislation in 2008 and 2009 that directed the Office of Consumer Health Services to create the Utah Health Exchange, before federal health reform had taken place. With the Affordable Care Act, the state examined options for bringing the current health insurance exchange for small employers into compliance with the new health reform law.

Despite the state’s initial intentions to operate a fully state run exchange, in May of 2013, the Department of Health and Human Services (HHS) granted approval for a dual exchange system. Utah’s individual health exchange will be facilitated by the federal government with Utah performing plan management functions. The state’s SHOP exchange for small businesses, Avenue H, will be operated by the state of Utah.

Will there be many options for health insurance through the exchanges?

The Utah Insurance Department has approved 99 individual plans to be offered on Utah’s federally-facilitated exchange and recommended the plans to HHS for approval. The Utah Insurance Department has also approved 70 small group plans to be offered on Avenue H.

Which insurance companies have been approved by the Insurance Department to offer health insurance plans on the exchanges?

Six carriers are seeking to offer individual plans on the federally-facilitated individual exchange.

Altius Health Plans, Inc., a subsidiary of Coventry Health Care, Inc., currently offers plans statewide in Utah under the AltiusOne name.

Arches Mutual Insurance Company or Arches Health Plan is the new state CO-OP that is taking a Medical Home approach to health insurance.

BridgeSpan Health Company is technically a new entrant in the health insurance market. The company was actually created by Cambia Health Solutions (whose companies span health care information technology and software development, retail health care, and health insurance plans among other things). BridgeSpan will be offering products for individuals in Utah as well as Oregon, Washington, and Idaho. Cambia happens to also be the parent company of Regence (which also operates in Utah, Oregon, Washington, and Idaho) and Asuris Northwest Health. Based on what the company is doing in Oregon and Washington, I would look for BridgeSpan to rent their networks, most likely from Regence BCBS of Utah.

SelectHealth Inc. currently offers plans through Utah’s Avenue H exchange. Plans are available with a variety of networks. Currently, the select value product offers the narrowest network, followed by select med, and the broadest network is available with select care.

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Humana Medical Plan of Utah, Inc. and Molina Healthcare of Utah, Inc. will also be competing in the individual exchange.

Three carriers submitted plans to be offered on Avenue H.

The companies include Arches Mutual Insurance Company or Arches Health Plan and SelectHealth Inc., the only two companies to submit plans for both the individual and small group exchanges in Utah. United HealthCare of Utah has also been approved to offer plans through Avenue H.

SelectHealth and UnitedHealthcare already offer medical plans through Avenue H along with Regence, which has withdrawn from the small group exchange market in Utah.

Will coverage and premiums be the same statewide?

While some carriers will be offering plans statewide, some insurance companies will only offer plans in specific areas of the state. Insurance premiums can also vary depending on the region of the state in which you live. Utah is broken up by counties to create five different Geographic Rating Areas, which are used to help determine health insurance premiums. This means the same person may have a different premium in Area 1 than they would have in Area 6. Here is the breakdown of the rating areas in Utah:

AREA COUNTIES
1 Cashe, Rich
2 Box Elder, Morgan, Weber
3 Davis, Salt Lake, Summit, Tooele, Wasatch
4 Utah
5 Iron, Washington
6 Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Uintah, Wayne

New information is being released every day. Follow this blog to receive updates as new information is released in Utah.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

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