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On Tuesday, February 19th, LISI held its monthly Healthcare Reform Update, featuring Micah Weinberg, PhD, Senior Healthcare Policy Advisor at the Bay Area Council, and LISI Director of Product and Marketing, Peter Diaz. In this webcast, “Will Anyone Shop at the SHOP,” Micah both explained the new small business health insurance exchange, and answered essential questions about its prevalence, including “will anyone shopSHOP-Exchange-Graphic it?” The answer to this questions is yes, but enrollment is expected to be somewhat modest in the SHOP exchange compared to the individual exchange. Micah explains why brokers still need to be prepared and certified to sell and talk SHOP come fall 2013.

Over 340 of you tuned in for the webcast, but in case you missed it, you can access the recording for free at www.lisiacademy.com. Here’s a brief overview of what transpired. First, Micah explained the framework for the SHOP exchange. Businesses with 2-50 full-time equivalents (not full-time employees) are eligible to participate in the SHOP*. In 2016, this will likely open up to businesses with up to 100 full-time equivalents. The health plans in the exchange will be organized by actuarial value. The different levels will represent the average amount of medical expenses that will be paid over the course of a year; with bronze (60%) covering the fewest expenses and platinum (90%) covering the most. In this model, the employer chooses the benchmark plan and the employee chooses the product they would like. These offerings will be drawn from entirely new carrier product suites, which will now include an Essential Benefits Package. California has chosen the Kaiser Small Group HMO 30 Plan as the model for our state’s essential benefits.

Micah then explained the broker’s role in the SHOP Exchange. In the SHOP model, broker commissions will be collected and distributed by the exchange and will be the same across products. Non-agents operating in the exchange as assisters and navigators will receive a $58 flat fee instead of earning commissions. The SHOP Exchange will work with General Agencies, including LISI, to recruit brokers, promote exchanges, and perform other essential functions. Brokers who would like to sell in the SHOP Exchange will need to be certified as assisters, and should be prepared to spend a portion of summer 2013 getting certified. Micah details the certification process in the recording, and touches on new opportunities for brokers within the exchange.  

The webcast included two interactive listener polls, and a live Q&A session at the end. The first poll asked broker if their clients had asked them about the exchange to-date. Of the respondents, 51% said yes, clients had asked them about the exchange, and 49% said no they had not. Brokers were then asked whether they plan to get certified as assisters to sell Exchange products. Of this pool of respondents, 91% said yes, they do intend to gain SHOP certification, and 9% said no, they do not.

To learn more about the SHOP exchange, what to expect, and how to proceed, visit LISI Academy and view the full webcast recording.

*The Covered California website states the following about full-time equivalents: “The federal government has not yet defined ‘full-time’ or ‘full-time equivalent’ for purposes of determining whether a business is small or large. More information will be forthcoming in the months ahead.”

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