October 11, 2013
Re: Update on Ohio’s Federally-Facilitated Marketplace/Exchange
Dear Cornerstone Alliance, Inc. Providers
This note is to provide basic information about the Marketplace/Exchange plans which will be offered in our service area via the Federally-Facilitated Marketplace/Exchange effective January 1, 2014. In addition to this letter, we are planning an Annual Meeting for later this year to bring speakers to Lima to answer your questions on this matter. We have two slide presentations to describe the role of the Marketplaces and how they are structured: one from Mary Wachtel (HPIO) and another from Jocelyn Guyer (Manatt Health Solutions). Once arrangements for the Annual Meeting are finalized a notice will be sent to all Member offices.
Briefly, here are the most important facts for you:
- The entire Cornerstone primary service area (Allen, Auglaize and Putnam counties) are located in Region #2 of the Ohio Geographic Rating Areas;
- The Health Policy Institute of Ohio estimates that 160,000 persons statewide will enroll in the Marketplace/Exchange products. That would mean that there will probably be fewer than 10,000 covered persons in Region 2 over the entire year.
- Member offices participating with HealthSpan and MMO through Cornerstone will be providers to patients enrolling via the Marketplace in those carrier’s plans. No additional action by providers participating with HealthSpan and MMO via Cornerstone are needed (A letter will be posted on our website in the near future from HealthSpan informing Cornerstone participating providers that by being contracted with HealthSpan that you are also included in the HealthSpan Select network. The HealthSpan Select network will be used for their Marketplace product).
- Many of the bronze plans in the Exchange will have out-of-pocket maximums of $6,350 and $12,700 for individual and family coverages. Another item to mention is that the out-of-pocket maximums in the Marketplace/Exchange products for both the individual and small group plans have ALL out-of-pocket expenses accumulating to the out-of-pocket. This may different than what the providers may have encountered in some current PPO plans.
- Cornerstone may offer a solicitation with at least one other carrier in order for our Members to participate in an additional Marketplace carrier. This solicitation may be mailed to our Members within the next few weeks.
- Finally, it is vital that Cornerstone providers understand that the Anthem Marketplace product –Community—Anthem is not contracted via Cornerstone Alliance, Inc. Catholic Health Partners –the parent organization to St. Rita’s Medical Center—and Anthem could not agree upon mutually acceptable terms and consequently, Cornerstone Alliance is not contracted with Anthem for their Marketplace product nor is St. Rita’s Medical Center.
Please review the slides in the two presentations (first paragraph f this letter) for much more detailed information on the Marketplace offerings. If you still have any questions on Cornerstone plans offering products on the Marketplace, please email my office at: email@example.com
Harold L. Bischoff, FACHE
October 29, 2013 UPDATE
We have learned that Molina Healthcare will not be offering an “Exchange Product” in Region 2 of the State of Ohio. Therefore, Cornerstone will not pursue an “Exchange Agreement” with Molina Healthcare. If you have questions regarding this information, please contact Harold Bischoff, Executive Director of Cornerstone at 419-996-5317 or firstname.lastname@example.org