There have been a lot of questions surrounding the state run health insurance exchanges that are required by the Patient Protection Affordable Care Act (PPACA). The state run exchanges will certainly change the health insurance marketplace, but it remains to be seen exactly how it will affect individuals and businesses. Here are ten things you should know about state health insurance exchanges:
- There is rolling enrollment for employers, but, upon enrollment, the employer is locked into the plan for one-year periods, during which the plan and premiums cannot change.
- Massachusetts and Utah are the only states with currently operating exchanges, and so far, the costs of plans on the exchange are higher than outside the exchange.
- The function of the state health insurance exchanges is to qualify health insurance options, maintain a hotline and website, assign prices and quality ratings to plans while taking into consideration eligibility for tax credits and cost sharing reductions, and present options in a standardized format.
- The Department of Health and Human Services is responsible for marketing the state run exchanges, ensuring quality and standardizing the enrollment procedures.
- All of the state run exchanges must meet federal requirements for networks, plans, information availability, call centers and websites.
- State run exchanges must ensure that each health insurance plan offered is a qualified health plan (QHP) according to PPACA, meaning that it offers “essential health benefits.”
- PPACA sets the minimum functions required by the state run exchanges and oversees the exchanges to ensure quality. Plans participating in the exchanges also must comply with state insurance laws and federal requirements in the Public Health Service Act.
- The Department of Health and Human Services provides a framework to assist states in building health insurance exchanges, but each state can decide what plans will participate and whether their exchanges should be local, regional, or operated by a nonprofit organization.
- The health reform law requires that employers provide all new hires and current employees with a written notice (Employer Exchange Notice) about the exchange and some of the consequences if an employee decides to purchase a qualified health plan through the exchange in lieu of employer-sponsored coverage.
- An individual can be enrolled in a QHP through an exchange with the assistance of an agent or broker only if the agent or broker ensures that the individual receives an eligibility determination through the state’s exchange website.
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A Plus Benefits can assist companies in navigating and maintaining compliance with the complicated and ever-changing health care laws. Contact your Client Account Manager if you have questions about PPACA or state run health insurance exchanges.