Private Exchanges

Question 1

Private Exchanges

Elements of Private Exchange

Answer 1

• EE choice
• ER subsidies
• Ancillary product offerings
• Online enrollment and decision-making tools
• Benefits administration

Question 2

Private Exchanges

Private vs. Public Exchanges

Sponsor

Answer 2

• Private = Employer
• Public = Government

Question 3

Private Exchanges

Private vs. Public Exchanges

Enrollees

Answer 3

• Private = Employees and Retirees
• Public = Individuals and Small Group

Question 4

Private Exchanges

Private vs. Public Exchanges

Types of Coverage

Answer 4

• Private = Medical, Rx, Dental, Vision, Other
• Public = Medical, Rx

Question 5

Private Exchanges

Private vs. Public Exchanges

Plan Design

Answer 5

• Private = Created by exchange operator or ER
• Public = Actuarial Value of 60/70/80/90%

Question 6

Private Exchanges

Private vs. Public Exchanges

Who Pays?

Answer 6

• Private = ER provides subsidy and members pay remaining balance
• Public = Individuals (may have subsidies), Small ERs (May have tax credits)

Question 7

Private Exchanges

Model Types

Answer 7

• Fully Insured, Single Carrier
• Fully Insured, Multi Carrier
• Self-Insured, Single Carrier
• Self-Insured, Multi Carrier

Question 8

Private Exchanges

Fully Insured, Single Carrier

Advantages and Disadvantages

Answer 8

• Adv = Risk Transfer
• Disadv = Increased cost

一个由私人运营的福利平台，里面只展示一家保险公司的多种计划，并且这家保险公司承担全部理赔风险

Question 9

Private Exchanges

Fully Insured, Multi Carrier

Advantages and Disadvantages

Answer 9

• Adv
  
  • Leverage competition
  • Best in-market efficiencies
  • EE choice
  • Risk Transfer
• Disadv = Less control over plan design

风险完全转移，员工可在不同保险公司间选择，竞争更充分

Question 10

Private Exchanges

Self-Insured, Multi Carrier

Advantages and Disadvantages

Answer 10

• Adv
  
  • Best in-market efficiencies
  • EE choice
• Disadv = Less leverage over carriers

雇主承担风险，但通过交易所借用多家保险公司的网络和管理服务

Question 11

Private Exchanges

Advantages of Private Exchange

Answer 11

• Increased EE choice
• Increased consumerism from members buying down benefits
• Robust online decision-support tools
• Benefits administration simplification
• Improved cost transparency

Question 12

Private Exchanges

Disadvantages of Private Exchange

Answer 12

• Less control/flexibility over plan design
• Need to increase defined-contribution amount over time
• Member concerns (less generous benefits, fear of change)
• Items Increasing Cost
  
  • Cost of moving from self-funded to fully-insured
  • Exchange operator fee

Question 13

Private Exchanges

Member Buy-Down

Answer 13

Private Exchange members enroll in options with higher cost-sharing and lower premiums when compared to traditional ER-sponsored insurance