The Texas Bar Journal Staff 2013-10-03 02:51:37
How the State Bar of Texas is working to provide health care options to members. IN ANTICIPATION OF KEY ASPECTS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT TAKING EFFECT IN THE UPCOMING MONTHS, the State Bar of Texas recently announced the Texas Bar Private Insurance Exchange, a multi-carrier private exchange exclusively designed for its members and their staff and dependents. After carefully evaluating and comparing Private Exchange models offered by other state bars across the nation and models developed by third-party administrators and health insurance carriers, the State Bar of Texas Insurance/Member Benefits Subcommittee selected Florida based Member Benefits Inc. to administer the Texas Bar Private Insurance Exchange. Member Benefits Inc., a third-party administrator, impressed subcommittee members with its successful history (more than 30 years) of specializing in association programs. The company currently provides services to more than 10 groups, including the Florida Bar, the State Bar of Georgia, the Florida Medical Association, and the Florida Institute of CPAs. Member Benefits also maintains strong ties and relationships with A-rated national insurance providers, such as Cigna, Aetna, MetLife, Guardian, and United- HealthOne. “The State Bar has been trying to find a way to deliver health insurance to its members for about the past seven years,” said Tim Kelly, Chairman of the Insurance/Member Benefits Subcommittee. “The company that we picked has a phenomenal reputation for customer service. Their technology is second to none. I think we’ve picked a great partner in terms of the administrator.” Launching Nov. 1, the Texas Bar Private Insurance Exchange serves as an online marketplace where members can compare plans from multiple providers that compete for enrollment. The federal Public Exchange consists of four basic plans—bronze, silver, gold, and platinum—that are qualified by the guidelines set forth in the Affordable Care Act. As consumers move through the plans, premiums become more expensive as coverage becomes greater. “Some people, depending on their income level, are going to be entitled to subsidies from the federal government,” said David Chamberlain, a member of the Insurance/Member Benefits Subcommittee. A calculator and counseling will be available to determine if the member will be better off in the Public Exchange. The new Private Exchange, however, offers more than the four metal plans, including plans from carriers that aren’t listed on the public exchange. “A-rated health insurers will be competing for the members’ insurance needs,” Chamberlain said. There will be more health care providers to choose from, which could be an important deciding factor to someone who has been seeing the same doctor for years. Certain Non-qualified Plans, which don’t meet all the qualifications the law provides, might be a preferred option for some State Bar members. An example would be a plan that is designed to cover catastrophic expenses. But because Non-qualified Plans don’t meet the requirements of the Affordable Care Act, consumers who choose this option must pay a tax. However, the combined cost of the tax and lower premium may be significantly lower than the premium for a Qualified Plan. The Texas Bar Private Insurance Exchange works to help members compare and customize the coverage that is best for them and offers both individuals and employer groups a wide range of health insurance options, including access to and choices from: • The Public Exchange • The Private Exchange • Non-qualified Health Plans The Texas Bar Private Insurance Exchange is divided into two extranet portal components—one for individuals and another for employer groups. Decision support and live customer service are available to help members and their employees determine the best plans for their needs. A comprehensive suite of products is also available for purchase, including dental, vision, disability, life, accident, wellness, and more. HOW IT WORKS FOR INDIVIDUALS Members are assisted with subsidy eligibility and enrollment, if desired, on the Public Exchange. The Private Exchange offers members and their dependents a variety of health plan options, including some plans and carriers that may not be on the Public Exchange. After creating an online account, members shop for suitable plans for their needs, and the selection processes make it easy to find a plan that carries the health care providers members want. The Private Exchange also offers coverage options such as dental, disability, vision, accident, and life. Accounts are accessible 24/7 via smartphone and online portal. Some members may be interested in a Non-qualified Health Plan that may have a lower premium. HOW IT WORKS FOR EMPLOYER GROUPS Employers may choose to create an account on the exchange, set a budget, and provide employees with a fixed amount of money, or a “defined contribution.” Employees then shop and choose a plan that best fits their needs. If an employee selects a plan or mix of benefits that exceeds the defined contribution, the employee pays the difference. If the employer does not choose to create a defined contribution plan, members have access to the Individual Portal. Streamlined administrative tasks, billing, and annual renewal processes make the system easy to navigate for employers. “It is quite literally a one-stop shop,” Chamberlain said. “All indications are that this is going to be a very attractive and competitive program.” For more information, go to memberbenefits.com/ texasbar. 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