The 10 required benefits. How much variation in his there in benefits Going Forward . We know from the bronze to the silver that has to do with the degree of coverage of premium but in terms of benefits how much variety is that is for the given product so what is that is a representation and across all types of products was the average rate of increase . Spittoons your question after 2014 the variability of benefits, you are correct there is the much lower variability among the level of insurance and deductibles as well as Provider Networks and of formulary. What you will see i think is we are competing more ought Customer Service and value added things that is the ability to help keep you healthy to get you engaged and the variability is greatly reduced. I have to go locale but we offer and again looking at that valueadded how to keep people engaging keep tight people healthy . With Congressional Research service of the question is a top Provider Networks. From where we set it may be more anecdotal that the premiums that it was artificially low that is not my phrase but but because of Narrow Networks cobia humbled because were not sure if this is truly what is going on in the marketplace or people who found people who word new to insurance. If anybody could provide insight for this issuestp if it is real . That would be helpful but then specific question to elizabeth in a march letter that cms sent out they mentioned they would scrutinize Network Adequacy in 2014 and i dont believe any Additional Information has come up. Who would like to speak on that . Is anybody . No takers. I do want to put it in a commercial were holding a briefing july 21st . Were doing a program on july 11th where weve looked at some results from a survey of the Commonwealth Fund will put together about the exchanges and what is going on there. Later in the month we will join the explicitly focus program some stay attuned. Bravo. As the one who represents putting together the networks i will try in with my fellow panelists. I think a lot of the focus around Provider Networks for tickets and they from Blue Cross Blue Shield where you are used to a Broad Network. What i would say in terms of pricing is we would never artificially price anything. We feel strongly we have to price on the information and that we have, appropriately and accurately with the policy as the company do not go after quoteunquote market share at a of loss purposely which ultimately impacts the consumer in a negative manner because you have to increase prices is later. I would say that our3r pricing is scrutinized very heavily including having networks scrutinized by regulators. I cannot speak to us praise saying artificially low. But you are correct we have not gotten Additional Guidance but we are very conscious of the scrutiny and generally even the smaller Network Products we are still covering around 80 percent of the hospitals and our states and 70 percent of the primarycare providers. Even though the network is smaller than traditional it is still a Broad Network and we go obama above and beyond to make sure we ensure with adequate specialist for very key issues. From considers youd end up policy advocacy arm of consumer reports. We talk about providing content but even in your over year increases of rates dont we want to know if the rates requested reflects the robusta efforts of regulators and insurers and providers to keep costs low . The institute of medicine in would claim 30 of Health Care Spending is waste even off by 50 percent and in terms of figuring that out what we really want to know is there is a driver that was not mentioned is rate review contrary to the promise of the Affordable Care act is not very transparent. In the states the public cannot see the detail justification for the rate increase the few states that that happens despite the entire justification of being public with robust competitionq and that extreme scrutiny suggests they try to keep them low by every means possible. Id like the panel to comment on the value of greater publicity in terms of keeping rates low to get to that thing that we really want to know are actually keeping it as long as possible . They q. I think that in terms of know i did not mention rates review but part of this is with the Greater Transparency if not the complete rate filing that there are some proprietary things that i think is appropriate to not divulged all of those details but there is Greater Transparency in the rates that it self the goal is to have that information puts more pressure on the insurers to better manage care Provider Networks that have a high value provider to keep the pressure on to keep spending low. Soviet idea behind the competition is to get at this to some extent. That process is much more transparent and there will be date set to use the we have to be realistic pricing perspective does not allow us to have providers that is one way to get that price but there isqc no ability to regulate what provider charges a carrier. What you are saying is in massachusetts they are trying to address issues with reimbursement and Health Care Spending to increase of the Consumer Price index and the average review process that is a good way to get the data output to elect more globally. I have the question that if anybody else wants to jump in as well let is your average rate increase iman your companys if you could share that with us and tell us about the impact of the three rs program. With your level of the enrollment are balt the same as they were or are you retaining your members are getting people to the special Enrollment Period . The reinsurance, Risk Assessment. I will try to do my best. Were not active again it is somewhat of proprietary were not talking about our rates of less release publicly but what i will say some are up and some are down summer up more than others i am happy aid to talk offline about the specific states where it is public and that particular increase is you may be interested in. With regard to the rs the Risk Mitigation tools in the art reinsurance and readjustment and risk corridor with the impact of pricing and how it is reflected reinsurance very clearly you cans see it to help transition in the underwritten market for many individuals the elimination it is designed as the transition payment to help mitigate those increases to help the market transition so that is included in all insurers rate filings. At this point in time we dont have enough information on reinsurance excuse me Risk Assessment wray doubt have enough Public Information compared to our competitors. The Risk Adjustment Program is among those carriers. With a highrisk individuals there be a payment made and the Risk Corridor Program both risk corridors and risk adjustments we will not know what our pavements are or to receive any payments and tells summer of next year. We will not go through the full reconciliation process intel late in the spring and that will come once the process is completed. A and it is difficult to know exactly where we sit with the Risk Corridor Program we did not price for the wrist corridors or purposely to make or lose money through the Risk Corridor Program we did say very small payable but at this point in time we did not price for it and we dont know where we come out and all next year at the earliest. And wrestle level of the moment i am happy to talk to you off like a model for all levels. We did just revised upward to have 700 if 50,000 in royalties through the exchanges by the end of the year. We continue to receive to the special enrollment process just like outside the open Enrollment Period for who have lost coverage or had a life change summary see a steady level of the moment. I want to highlight what was said because adopting gets lost because it is shifting funds speech we ditchers wednesday arguing fair estimate what the cost will be they also have to figure out what the market will look like as the whole . Enrollment not only for my plan but the market has so whole . That is exacerbating the uncertainty because they have to think about not only their particular experience but the market as a whole steve hickey mention of the risk pools are constructed it includes both the Exchange Plans and the un on Exchange Plans in having someone asked about the changes that might have contributed doesnt affect the calculation . Talk about the single risk pool on and off the of the exchange specifically about the aca compliance rates on and off the exchange is that aca complying and plans to have the traditional role treated separately because have the choice in certain states by reviewing the nine aca compliant coverage to decide what makes more sense to move to a Compliance Plan but that means that risk pool pinsetter outside the exchange could be a little worse than expected. In to change dramatically before the end of the year remember we have had very limited pharmacy data as is. As we get more experience lovely sea today can change drastically if you follow the law street analysis it is difficult to draw longterm conclusions for various purposes just to put that disclaimer on it. Good afternoon. As an independent Health Care Business communications consultant. Here are really getting the questions. [laughter] talk about the considerations of pricing to comment on the role of Specialty Pharmaceuticals to drive up the premiums. That is an excellent question. No doubt the cost or die a price of many Specialty Pharmaceuticals it is a major driver. R]r to have an impact this year as italy continues to go up particularly as there are several drives in the pipeline and that is a fantastic thing. It is a high a price point with a large population. The etiquette is evolve faster. It is difficult in this environment to know exactly what the cost will be but not estimate it could be very significant. It has been a diver. And at this point we dont see a mitigating factor for that right now. To what extent with the individual market and it carries over tuesday Insurance Market but with the up and down these to have ripple effects overpricing. That is a really good question and something we have to watch over the next few years. As we went into the Exchange Market place where individuals were subsidized and since then but how will live players respond . Will pay increase coverage your pull back . But something we are watching closely i cannot say it is factored into prices but it is definitely something we are watching. I have great green the cards to want to3 i just want to ratify and point to that what i thank you may see it is generally speaking for larger carriers they have independent relationships on Provider Networks the mac providers say this carrier does Narrow Networks but as a provider icahn][q to that myself or they are entering the market as the and serve because they can middays the pricing in the delivery of care so over time you may see more provider organizations move to the carrier side. One comment that is less of what you might see coming into the of market with a Network Alone of lot of the work we are a gauge stand as a plan right now is true the delivering system reform that network side is one minor aspect to look at the quality indicators ofc the biggest patient centered primaries care to pate providers to support them in the primary care feel to expand their reach and hours and to put the care plans to gather for their patients there is a lot beyond just the networker how many providers you having and more that goes to how meaningful is the relationship are they doing the right things for the patient at the right time . There is a lot of focus and i hope you talk about this with the next panel with the focus but also the value and the quality. To go back to you with the initial question that is triggered that people have switched plans in the individual market to avoid the premium increases hallowed you experience or explain that in the 2015 Exchange Market where people see premiums change in relation to the benchmark plan that subsidies are tied i think it happen before the plans which becoming less generous but i think what will happen is the important question as cms just issued to be be a role if they dont change our choose a new plant that we have seen those switching in that context but the data was clear but i think it was critically important we promote important tools says much as possible llord techniques for individuals every year people hate filing taxes but it is an important decision in a couple of hours to make a big difference and we should set up tools while they allow people felt want to Pay Attention but to promote as much as possible peoples choices attractively shop because this Dynamic Market with a lot of insurance with a new networks and it is important to promote the ability toc get the right choices. He meant to this but did not say it out loud the importance of looking beyond just the premium amount to look at cautionary to have the Decision Support tools that combined the premium plus at of pocket cost is what is important. What she said. Just to emphasize with ion research of Medicare Part d be found only 12 percent of seniors showed the lowest cost plan and they left about 30 percent of the dollars on the table because of lecter premiums only. And arent there very high rates of Free Movement real and it . Once they make the mistake they stick with that and have people of reevaluate if life circumstance changesb. With the National Association of underwriters of course, i represent agents sam brokers to right think are great tool to help people navigate the difficult system. Is an important decision with the risk tolerance and Health Status and agents and brokers to know what the networks looks like than some People Choose it for a lower price on purpose it is not necessarily a terrible thing to choose a more Narrow Network but the thought of the decision on Health Insurance coming down to a tool is something that shed be evaluated and with all the new plants coming in it would be of malpractice not to look at other plants. I agree it is very important people shop carefully but i do think everyone has their handheld theyd have the Financial Resources to do that and a computer based tools could to choose the best there is a lot of people making for decisions to get premium e< just for our Exchange Products and customers and the average white get those calls talks about the benefits and coverage to get to that place where they need to go because of familiarity or experience with the individual Insurance Marketplace took a lot longer. So we might spend less on some of those underwriting dollars but we should spend those to work with customers tear navigatetzr the system to choose plans were focused on helping customers use their plans and understand that. Also is marketing dollars dont assume we have reduced those we have lots of people to reach that may not be a native English Speakers store food may not have a Traditional Television or receive traditional male as an advertising tool so we have to get creative how we reach potential customers. Overall beer very focused on reducing our administrative cost bets even more to make sure we spend them wisely. That medical loss ratio requirements to have a certain amount of premium dollars that excludes the administration is cost that she was talking about sova that correlation it is not there because it has been stripped out with the requirement to pay rebates simic we have time for one or two more questions. With the National Association of treated the help centers with delivery reform has there been any Data Collected with bundled payments and a staff had any effect on the insurance premiums . I am not aware of anything with the coronation back to the underlying premium and i am not sure we will see a reflection that underlying premium yet because i dont think Health Care Costs growth has gone down but that is sealed nicole. I know of that will reduce the premium but it will be something that should be reflected of the overall cost of care in the successful to bring thatf[ down. There is the town of data on the reduced cost i unjust not sure if we have a link dip back into a premium yet.