Americans will have an extra six weeks to buy health coverage before facing penalty

Originally posted by Sandhya Somashekhar, Amy Goldstein and Juliet Eilperin on

The Obama administration said last Wednesday night that it will give Americans who buy health insurance through the new online marketplaces an extra six weeks to obtain coverage before they incur a penalty.

The announcement means that those who buy coverage through the exchange will have until March 31 to sign up for a plan, according to an official with the Department of Health and Human Services.

Administration officials said that the rejiggered deadline is unrelated to the many technical problems that have emerged with the Web site,, in its first three weeks. Instead, they said, it is designed to clear up a timing confusion about the 2010 law, which for the first time requires most Americans to buy health coverage or face a penalty.

Under the law, health plans available through the new federal or state marketplaces will start Jan. 1, but the open enrollment period runs through the end of March. The law also says that people will be fined only if they do not have coverage for three months in a row. The question has been this: Do people need to be covered by March 31, or merely to have signed up by then, given that insurance policies have a brief lag before they take effect?

The administration made clear Wednesday night that people who buy coverage at any point during the open enrollment period will not pay a penalty.

It is the latest sign that the health-care law remains a moving target, even after the launch of the federal insurance marketplace, which has faced myriad problems that have frustrated many people trying to sign up for coverage.

Contractors and others have begun assigning blame for the Web site troubles, and the fault-finding will get its first extensive public airing Thursday, when four of the contractors involved in the project will testify before the House Energy and Commerce Committee.

In the written testimony submitted to the panel in advance, CGI Federal, the main contractor on the project, takes partial blame for the site’s shortcomings. But it also notes that the Centers for Medicare and Medicaid Services (CMS), an agency within HHS, was the “ultimate responsible party for the end-to-end performance” of the site. And it blames a piece created by another contractor, Quality Software Services (QSSI), for creating the initial bottleneck.

QSSI built part of the online registration system that crashed shortly after the Oct. 1 launch and locked out many people for days. In a statement, the company counters that it was not the only one responsible for the registration system, which is now working.

“There are a number of other components to the registration system, all of which must work together seamlessly to ensure registration,” said Matt Stearns, a spokesman for UnitedHealth Group, the parent company for QSSI. “The [QSSI-built] tool has been working well for weeks.”

But both contractors are likely to be taken to task by Republican and Democratic committee members. They were among the vendors who testified at a Sept. 10 Energy and Commerce Committee hearing that their parts of the project were moving along well, and that the Web site would be ready Oct. 1. Those assurances are likely to be questioned Thursday.

The hearing is the first of many planned by Republicans, who are expected not only to question the contractors but also to examine the administration’s management of the project. Some Republicans have called for the ouster of HHS Secretary Kathleen Sebelius, who is scheduled to appear before the panel next Wednesday.

President Obama and his deputies have given no indication that they are considering replacing Sebelius. White House press secretary Jay Carney has consistently defended her, and officials have been focusing on fixing the site rather than assessing blame for its defects.

The administration, however, has sought to assure jittery business leaders and insurers that can fix the enrollment system. On Tuesday, Vice President Biden told business supporters in a conference call that the nation’s best technology minds were working on the site and urged them to “stick with us.” And on Wednesday, top Obama advisers met with insurance executives to discuss system repairs.

CMS had enormous responsibility, and was charged with ensuring that there would be a mechanism for millions of Americans to easily sign up for coverage in time for some of the law’s main benefits to begin Jan. 1. Officials have said ease of signing up is critical to the administration meeting its goal of getting 7 million uninsured people — many of them young and healthy — to sign up.

But the agency assumed an outsize role in the management of the project, coordinating the activities of 55 contractors rather than hiring a separate firm to serve as a systems integrator. That is likely to be a key issue during Thursday’s hearing.

People familiar with the project have said the time frame was too tight for adequate testing, which one source said would have highlighted the problems.

There also have been inconsistencies about how and when the decision was made to scrap a key feature of the Web site, with QSSI telling congressional investigators that it did not know about the major change until the site’s launch. But in the written testimony the company plans to deliver Thursday, it says it found out shortly before the rollout date.

Republicans have been eager to learn more about how and when the decision was made to end that feature. The feature would have allowed people to browse plans and rates before signing up for an account. Technology experts have said the last-minute decision to stop it put too much pressure on a different tool that was set up to handle a small number of simultaneous users, crashing the site.

People familiar with the project give conflicting accounts of the reason for the move. The decision was made at a two-day meeting in late September to which CMS invited all its major contractors. According to one person familiar with the project, CGI gave a presentation that convinced CMS officials that the shopping feature was not ready.

Another person close to the project had a slightly different account, saying that CGI believed that the feature was, in fact, ready.

Republican lawmakers have alleged that the administration made the change to hide the cost of insurance plans from consumers.

“Evidence is mounting that political considerations motivated the decision,” said a letter sent to two administration officials Tuesday from members of the House Oversight and Government Reform Committee, including Chairman Darrell Issa (R-Calif.).

Lena H. Sun, Ed O’Keefe and Tom Hamburger contributed to this report.

Open Enrollment Tips Under Health Care Reform

Originally posted September 6, 2013 on

This year's open enrollment season for selecting workplace benefits comes just before some of the biggest changes of health care reform go into effect.

Never before has it been more important to pay attention as you choose a health plan for you and your family.

"You really need to do your homework this year," says Carol Taylor, an employee benefit adviser with D & S Agency Inc. in Roanoke, Va.

Here are 5 tips for open enrollment this fall.

1. Understand the health care reform individual mandate: You must have coverage.

Starting in 2014, federal law will require virtually everyone to have health insurance or face a tax penalty. So if your employer doesn't offer health insurance for next year or your company's health plan doesn't meet certain minimum standards, you'll need to shop for health insurance on your own. Your employer must let you know by Oct. 1 whether its health plan meets "minimum standards," says Taylor, a member of the National Association of Health Underwriters National Legislative Council.

To meet the minimum standards under health reform, employers must offer coverage at the "bronze level," which is one of the four levels of coverage defined under health reform provisions. The other three are silver, gold and platinum. They are based on actuarial value, which measures the amount of financial protection the policy offers, or the percentage of health costs a plan would pay for an average person. For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person. Enrollees, on average, would be responsible for paying 40 percent of the costs.

If you're shopping for an individual health plan, you can buy one from an insurance company directly or through your state's new health insurance marketplace. The online health insurance marketplaces, sometimes called exchanges, are scheduled to open for business Oct. 1. Coverage can begin Jan. 1.

If you're not eligible for coverage through an employer or your employer's plan doesn't meet government standards, then you might qualify for a tax credit to save money on premiums when you buy a marketplace plan. People who earn up to 400 percent of the federal poverty level -- that's $94,200 for a family of four in 2013 -- will be eligible for premium subsidies in the form of tax credits. People who earn up to 250 percent of the federal poverty level will be eligible for lower deductibles and copayments.

2. Don't assume your family will qualify to save money in the new marketplaces.

Think you can get a better deal in the new marketplace than what your employer is offering? Maybe not. If you and your family have access to affordable employer-sponsored health insurance that meets minimum standards, then you and your dependents are not eligible for premium tax credits or help with cost-sharing - which includes aid in paying deductibles, copayments or co-insurance -- in the new marketplaces. You can shop there, but you'll pay full price.

"Affordable" means you pay no more than 9.5 percent of your household income toward the coverage for yourself. The amount you pay for your dependents to be covered on the employer-sponsored plan isn't factored into the equation. So even if you have to pay a bundle to keep your dependents on the employer plan, they're still not eligible for subsidies in the marketplace if the portion you pay to cover yourself is deemed affordable and they have access to the employer plan.

That could put a lot of moderate-income families with a sole breadwinner in a financial bind, says Mindy Anderson-Wallis, president of Employee Benefit Solutions of Indiana in Lafayette, Ind.

3. Compare benefits and health insurance plan networks.

Check out the provider networks of the plans you're offered to make sure your doctors and preferred hospital system are included, especially if you have a serious or chronic condition and are undergoing treatment. Given all the standards that must be met, one way health plans may cut costs is to cut the provider networks, Taylor warns.

You pay substantially more out of pocket to see providers outside the network with a preferred provider organization (PPO) plan. Except in special circumstances, you typically pay for the full cost of services for providers outside the network with a health maintenance organization (HMO) plan.

4. Understand that your employer doesn't have to offer coverage in 2014, and it won't have to offer coverage to your spouse.

Starting in 2015, the Patient Protection and Affordable Care Act will require employers with at least 50 workers to provide affordable health insurance for workers and their dependents or pay a penalty. The so-called employer mandate was supposed to go into effect in 2014, but the Obama administration delayed implementation for a year.

Still, most employers are gearing up for the mandate, and there's one tricky technicality you should know. The federal government will define dependents as children, not spouses. So even when the employer mandate goes into effect, your workplace won't have to offer coverage to your spouse.

Nobody knows yet how this will play out, but Anderson-Wallis says she doesn't think the definition of "dependent" will have much impact.

"I don't think we'll see large employers not continue to cover spouses," she says. "Benefits are seen as a way to attract and retain employees."

If your spouse isn't eligible for employer-sponsored coverage, then he or she will qualify for a tax credit to save money on a health plan in the new marketplace if your household income is less than 400 percent of the federal poverty level.

5. Crunch the numbers and pick the health insurance plan with the best value.

Compare the out-of-pocket costs of each health plan if your employer offers a choice of plans. Your costs include:

  • Deductible.
  • Doctor visits, urgent care and emergency room copayments.
  • Co-insurance -- the percentage the health plan pays after you satisfy the deductible.
  • Prescription drug copayments or co-insurance.
  • Your portion of the premium.

Consider how often you go to the doctor, the medicines you take and what services you might need in the next year. Run some scenarios to see how much each health plan would cost, and choose one that meets your unique needs.

"Don't just roll the dice without calculating," Anderson-Wallis says.

Be Prepared For Fall Open Enrollment Changes

Originally posted September 3, 2013 by Amy Gallagher on

The healthcare reform law requires employers to notify employees of available health exchange options by October 1. That means employees will face new health plan choices - and decisions - during open enrollment this year.

Education is Key

With new options comes the need for more education. And that doesn't just mean the health exchange option notice employers are required to provide, which is likely to confuse employees.

Since employees will get to choose between employer-sponsored plans or those offered by the exchanges for the first time, employers should make an extra effort with their communication plans for this fall's open enrollment. And employees should step up their participation in the process as well.

Employee questions...and answers

Employers should provide informative, detailed materials that will enable employees to evaluate their choices and make the best decisions. When reviewing open enrollment resources, employees should follow these five steps:

1. Review the benefits and costs of the employer-sponsored plan. Understand what the employee’s share of the cost is in dollars - an amount that's deducted pre-tax from your paycheck at whatever tax bracket you fall in. For example, an employee who pays $250 monthly of a $500 total monthly individual plan cost will have a deduction (assuming a 30% tax bracket) around $175 monthly.

2. Compare the employee costs above to an individual plan offered through a state-run exchange.Employees who are Rhode Island residents may visit and those who reside in Massachusetts can go to for details. Keep in mind that employees who purchase an individual plan through the exchange must pay the full cost of the plan unless you qualify for tax credits to offset, or eliminate, the cost.

3. Determine tax credit by using an online tool and estimating family income for 2014 (before taxes), telling the age of the oldest adult in the family, and entering the total number of adults and children in the household. Generally, employees may be able to get a subsidy if they are single and make up to $45,960, or are a family of four and earn up to $94,200. The exact amount of the subsidy is determed by size of family and level of income, so the less someone makes, the more they will receive.

4. Employees who receive the subsidy should subtract the earned tax credits from the total cost of the exchange plan to determine their total premium cost. Then compare this amount to what you would pay for an employer-sponsored plan.

5. Last, all employees must understand that, starting January 1, 2014, they are mandated to be insured.Whether through an employer or exchange plan, it’s up to you to get coverage, or pay penalties at tax time.

9 tips to help employees transition to public exchanges

Originally posted on

According to the Obama administration, the state insurance marketplaces set up under ACA are on schedule to begin open enrollment on Oct. 1. To aid in communicating health care reform changes this fall, here are nine tips for transitioning employees into the public marketplace from Sara Taylor, health solutions development leader at Aon Hewitt.

Supplement the 'Notice of Exchanges'

While the model notice provided by Health and Human Services helps employers comply with provisions of the Affordable Care Act, the notice itself is likely to generate confusion and more questions from employees than it answers. Employers should supplement the model notice with additional education on the ACA and proactively answer the question, "What do I need to do with this notice?"

Provide context

Explain your benefits strategy and provide context on how the public marketplaces fit within your benefits strategy.

Target your communication strategy as needed

The ACA and marketplaces may impact different employee groups in different ways. Think through the messages that impact all employees and those messages that affect only specific audiences.

Clearly explain required action and timing

What do employees need to do and by when? This information can get lost. Be sure to clearly call out specific required action steps and deadlines – both for your benefits plans and for marketplaces.

Don’t forget Medicaid

Public marketplaces are only one option for employees to obtain medical insurance. With many states expanding Medicaid eligibility, Medicaid or other public programs may be viable alternatives for some employees.

Be prepared for questions

No matter how well you communicate, some employees will have questions or need additional assistance and they will likely look to you for help. Ahead of time, determine who will be handling questions, identify likely questions and have answers and others resources prepared ahead of time.

Take advantage of external resources

Enrolling in health benefits can be overwhelming for many individuals, and the introduction of the marketplaces adds a whole new layer of complexity. There are resources and tools available today that can help individuals understand their options, model program eligibility — including whether they may qualify for a premium tax credit (or subsidy) in a marketplace — and in some cases, enroll in a health plan.

Engage HR and management

Ensure that your leadership is aware of and on board with your benefits strategy and how the public marketplaces fit into that strategy. Encourage your HR team and managers to be advocates for your strategy to employees.

Supply the details

Employees that apply for financial assistance in the marketplaces need to provide information about any health insurance available to them from an employer (e.g., cost of "you only" coverage). Individuals will be instructed to ask their employers to fill out the employer information section of the form. Know how you will handle these requests. Or better yet, give employees self-service access so they can complete the application themselves.


Five misconceptions that come with health care exchanges

Originally posted by Samuel H. Fleet on

The changing landscape of health care in the United States is causing confusion and alarm, particularly for an aging population of retired workers — a group with great reliance on health care. Trying to explain the intricacies of a specific market can be confusing to the coordinator, let alone the retiree who has been accustomed to one thing and is now being told they are getting another. Coordinated phone calls typically last 55 minutes, tying up call center personnel and doing little to reassure a confused retiree.

The creation of health care exchanges has done little to quiet the noise. Exchanges require that retirees navigate this uncertainty on their own, buying directly from the carrier with no familiarity or direction. Additional options come with more questions, but working with the right partner helps ease the minds of an organization’s former employees so they can enjoy their retirement.  Group plans have customer advocacy centers that cater specifically to an elderly population and can reinforce trust during such an ambiguous time.

The following misconceptions about health care exchanges will help shine light on some of this misinformation and show how group plans are a better option that individual plans in the post-65 space.

1.       Individual plans are cheaper than group plans

Not necessarily. A retiree who is 65 may be able to find an inexpensive individual plan, but that likelihood decreases exponentially as an individual ages.  One reason is because individual plans have costs built into them to help the carrier recover adverse selection. And because there is a “take it or leave it” component built into individual plans, meaning the individual can always go look for another plan if one isn’t to their liking, they will often have a charge (usually around 10%) to protect themselves.

Some carriers try to build-in other underwriting characteristics in an attempt to circumnavigate this situation, often with a questionnaire. Individuals who “pass” the underwriting questionnaire may then receive a preferred rate, but it isn’t an exact science. This maneuvering doesn’t exist with group plans, which are rated across the entire retiree segment rather than on an individual’s particular characteristics. Additionally, multiple plans are available to a retiree in a group setting, but with literally hundreds of individual plans available it can be difficult for one to feel assured that he or she is choosing the right plan.  A retiree can certainly pick the most inexpensive plan, but going that route almost guarantees poor coverage.

2.       Moving to an exchange eliminates employer financial liability

FASB106 liability is based on an obligation to pay for retiree benefits, regardless of whether these benefits are offered to the individual or a group. The reality is that these liabilities will continue to exist as long as the employer makes contributions in any form, and in any amount, to a retiree’s plan. This standard requires reporting of costs as well as advance mechanisms that ensure future payments to retirees will be available.

3.       Retirees want more coverage options at different price points

Choice is a good thing, but too much choice is often overwhelming. In a recent survey conducted by AmWINS Group Benefits, a pool of more than 1,500 retirees enrolled in a group plan was asked if they wanted more options, and responses came back 50/50.  Of those who wanted more, 82% said they only wanted two or three options at the most. Health care is critical to an aging population, and retirees are likely to have many questions when it comes to choosing their individual plans. Retirees want comfort in not only their coverage, but the stability that comes with consistent care.

4.       Exchanges eliminate the employer’s administrative burdens

Because health care is critical to an aging population, they are likely to have questions and concerns along the way. A large American auto manufacturer switched to an exchange model and knew what to expect – the noise level from retirees was deafening and it continued for nearly a year. The company had no choice but to take it. If administrative obligations and burdens are a concern, consider changes to the administrator, not the plan.

5.       The move to an exchange won’t cause any disruption for the retiree

The confusion that comes with a shift to an exchange model is likely to have a detrimental impact on the retiree, which can cause great disruption within the employer’s organizational structure. Retirees, the same group that built the company and carried it through hard times to prosperity, can feel forgotten once they are thrown into the exchange model. Often the people who made promises to former employees about their health care needs in the future are long gone, replaced by players in a management structure with no relationship with these retirees.

While inevitable, change is never easy.  It’s not too late to support loyal, former employees in the midst of health care reform by removing some of the anxiety around change and overwhelming choices.

Don't forget about employee ACA communication due Oct. 1

Originally posted by Keith R. McMurdy August 16, 2013 on

With the recent employer mandate delay, some businesses might be overlooking the requirement to provide a notice to employees about health insurance coverage that may be available through a public exchange.

Employers must provide a notice to each employee, regardless of plan enrollment status or part-time or full-time status, by Oct. 1. The notice must be provided automatically, free of charge, and written in language that the average employee can understand. It may be provided by first class mail or electronically, if the requirements of the U.S. Department of Labor’s electronic disclosures safe harbor are met. It must also be provided to new hires — for 2014, the DOL will consider a notice delivered timely to a new employee if it’s provided within 14 days of the start date.

The notice must inform each employee of three things:

  • The existence of state or federal health insurance exchanges.
  • If the employer plan’s share of the total allowed costs of benefits provided under the plan is less than 60%, then the employee may be eligible for a federal premium tax credit if the employee purchases a qualified health plan through an exchange.
  • If the employee purchases a qualified health plan through an exchange, then the employee may lose the employer contribution to any health benefits plan offered by the employer; also, all or a portion of such contribution may be excludable from income for federal income tax purposes.

The good news is that employers don’t have to create the notices from scratch. The DOL published model notices, one for Employers Who Offer Health Plans, and one for Employers that Do Not Offer Health Plans. If employers have questions about how to complete the forms, this is an opportunity for an employee benefit adviser to step in and provide guidance. Above all, advisers should remind employers that they need to issue them. Just because employers have a year to wait on the coverage mandate does not mean they can ignore other compliance rules like this one.


Feds add exchange employer site

Originally posted August 2, 2013 by Allison Bell on

Three federal agencies have joined to set up a Patient Protection and Affordable Care Act website for small businesses. offers a "wizard," or interactive tool, that offers to help business owners understand what they need to know about the new PPACA insurance options in a few quick steps.

The Small Business Administration worked with the U.S. Department of Health and Human Services and the U.S. Treasury Department to set up the site.

The wizard starts by asking visitors about their companies' location and size.

On the size menu, for example, the wizard asks whether the user is self-employed with no employees, has fewer than 25 employees, has up to 50 employees, or has 50 or more employees.

The site includes an explanation of how an employer can determine whether it has 50 or more full-time or full-time equivalent employees.

Users who, say, might want to set up group health plans will see information about the new PPACA Small Business Health Options Program small-group exchange program.

In most states, in the pages of information for employers interested in setting up health plans, the SBA gives an answer to the question, "Can I use an agent or broker to buy health insurance in the marketplace?"

"You will be able to use a licensed agent or broker to provide help or handle your SHOP business," the SBA says. "You won't pay more if you use a SHOP agent or broker."

For users in Vermont, a state that is trying to eliminate small-group market broker commissions, the SBA makes no mention of agents and brokers.


Employers get sneak peek at health care exchanges

By Kathleen Koster


Communicate early, say employers using retiree exchange

Before eligible individuals and small employers begin shopping in the public health care exchanges in 2014, private retiree Medicare exchanges provide a glimpse of what public and private health insurance exchanges could look like.

In two years, brokers and other benefit advisers will help people choose appropriate plans from an array of insurance carriers. In particular, platform providers of multi-carrier Medicare exchanges believe they are in a unique position to help employees navigate the public exchanges.

"We see our role as the air traffic controller helping to organize these exchanges and information, and on behalf of those organizations, helping enroll early retirees and part-time workers to the plan that's right for them," says Bryce A. Williams, president and CEO of Extend Health, Inc., which operates a large private exchange in the U.S.

Williams, who has been meeting with several states on health care exchange development, anticipates 15-to-20 states will have a fully functioning exchange ready to offer a broad diversity of plans starting Jan. 1, 2014. Those leading the pack are Maryland, Oregon and California. States not ready at that time will have access to the federal government exchange.

"There will be an array of new choices for employees, part-time workers and early retirees with some of America's biggest companies to access guaranteed-issue individual plans for the first time," explains Williams.

For many new entrants, the exchange will be new territory, so advisers like Extend Health hope to provide information and direction to help individuals find the right plan at the right price.

PPACA "allows for external agents and brokers to connect into the system ... and get ready to place individuals into the exchanges where it's the right fit," and alert them if they qualify for subsidies, Williams adds.

Each exchange must establish a navigator program to fund outreach and education efforts. Community-based organizations and professional associations will act as navigators to help consumers understand the new health insurance options available through the exchange. Navigators are also tasked with raising broad public awareness around the exchange and providing referrals to relevant consumer assistance programs. Agents and brokers may also serve as navigators, provided they meet required standards.


The Massachusetts experience

The Massachusetts exchange, enacted through state law in 2006 under former governor and Republican presidential nominee Mitt Romney, will continue to play a central role in delivering health care to the uninsured. The state plans to improve the usability of its current website interface with federal support, as well as link seamlessly to federal databases.

"We will be building Web functionality that links to federal databases so that we can, in real time, evaluate people's eligibility for coverage in the exchange, including their eligibility for subsidies, and quickly route them through a crystal clear, cutting-edge, simple and comprehensible shopping experience," says Glen Shor, executive director of Massachusetts's Commonwealth Health Insurance Connector Authority.

In addition to its website, the Massachusetts Exchange will continue to provide a call center with "top-notch customer assistance" for help with the benefit selection and billing process, as well as help picking the best value plan, says Shor.

"We're going to work extraordinarily closely with brokers ... We want to make it easier and more efficient for brokers to assess the landscape of health insurance options for the small businesses they serve," he adds. The state is also working with nonprofit organizations to help low-income people enroll for health care and receive any possible subsidies.

In addition, a new wellness track feature helps small business employees and individuals using the Health Connector tool make healthy behavior choices. By participating in the wellness program, a subset of small businesses can qualify for a 15% rebate on the employer share of a health insurance premium, which can then put toward covering their employees.

To qualify for a wellness rebate, employers need a certain percentage of employees to get an annual physical. Outreach to small employers has already begun, and public education will escalate as 2014 approaches. The state introduced the Health Connector through employer road shows.

"We've learned in Massachusetts that outreach and public education, including around opportunities to access affordable coverage through the Health Connector, is critical to bringing people into the ranks of the insured and keeping them [there]," says Shor, adding that "in general, the Affordable Care Act gives us an opportunity in Massachusetts to [expand] what has been a very successful model," he says.


Exchange transparency

When Extend Health first introduced retirees to its private Medicare exchange six years ago, many people simply chose the cheapest plan - no matter their health status and needs. Once they realized how high their out-of-pocket costs were in high-deductible health plans, they would call the support team asking to switch plans.

In order to prevent that buyers' remorse, Extend Health now has 1,000 benefit advisers in call centers ready to take retiree questions and advise them on plan choices based on their health needs and medications.

For the public exchanges, Extend Health believes that trained, licensed advisers who have access to federal databases can be helpful in determining eligibility for employees and early retirees.

Individuals will either shop in the public exchange or get coverage from one of the 80 carriers on Extend Health's exchange platform.

Bryce says the company will provide "private and public exchange products from one platform, one call, one place." In addition, employers will be able to monitor in real-time when their population makes an exchange election or connects with an adviser.


Expectation of paternalism

"People have an expectation if they've just come off of a group plan of open enrollment selection," Williams says. "Employers have an expectation of paternalism; they expect that everyone is going to get coverage."

Four employers have used the beta version of Extend Health's BenefitView tool, each successfully completing their pilot test. Extend Health is now rolling out the tool to all its employer-clients. The tool helps ensure that every retiree is contacted and advised on choosing the best plan that meets the individual's needs. BenefitView assures that the employer-client has full transparency on the status of the transition of its retirees' from group coverage to individual coverage.

Employers can monitor engagement of specific population segments and reach out more aggressively to groups not making appointments with advisers or benefit selections.

The Web platform also shows the HR department how many plans have been selected over how many carriers, and the average insurance premium. It can also give HR statistics about the anticipated or past wait times for the call center.

U.S. retirees and Medicare-eligibles at International Paper entered the Extend Health exchange in July 2012, and over 10,000 people have selected 806 different plans among 66 different carriers.

The company started communicating about the new process in February and has monitored retirees' progress.

"We wanted to make sure [participants] were getting the information they needed, because this is a very different animal for them as opposed to the one-size-fits-all methodology that we had in the past from our medical plan," explains Melissa (Missy) Hartfiel, benefits planner, International Paper.


Lessons learned

By watching what communication efforts retirees were responding to and what modes weren't engaging, the company was able to make adjustments and prod groups that weren't getting involved. The best part: HR could gather information itself and present it immediately to executives when needed.

"As an HR professional, it's nice when you can pull your own information. Through BenefitView, I could look at any population, day or night," says Hartfiel.

Reflecting on its marketing campaign, Hartfiel advises sponsors to start strategizing and communicating early about the public exchanges.

"Once you start parsing down [to communicate to different group populations], it takes time to really craft that message," she explains.

Another user of the exchange agrees: "You need to overcommunicate to make sure you reach the intended audience that you're trying to reach," says Scott McIntyre, manager of employee benefits, Oak Ridge National Labs.

McIntyre and the Extend Health advisers were able to contact 99% of the company's retirees, and 3,360 were enrolled in 68 different plans from 30 different carriers.

"If I'm an employer and I'm going to subsidize the health care cost [for employees or early retirees], I certainly would want a mechanism to ensure that employees enroll in plans that they are interested and comfortable in," McIntyre says.

Hartfiel explains that using Extend Health's model - even though it's a retiree Medicare exchange - has "given us an idea of how [the public and private] exchanges will work as we start planning our strategy for the 2014 exchanges."

International Paper plans to analyze its population health data later this year to decide whether it will engage any segment of employees in the future public or private exchanges.