Human Resources News & Insights

New rules for setting up health exchanges

The deadline is rapidly approaching for states to prove they’ve made significant progress setting up health exchanges. And now they have a new set of rules to follow.

By Dec. 31, 2012 states must report on the progress they’ve made in readying their health insurance exchanges for their 2014 launch. If they haven’t made enough progress, the feds will take over.

The healthcare reform law mandated that states establish health insurance markets called “exchanges” to help consumers and small businesses shop for competitively priced health insurance.

If it appears a state’s exchanges won’t be ready by 2014, the federal government is required to step in.

New rules issued

The feds have issued new rules on how the exchanges will be formed and how they will work.

Some highlights:

  • States can decide whether their exchanges should be operated by a non-profit organization or a public agency, how participating plans will be selected, and whether to partner with the Department of Health and Human services for some key functions
  • a state can choose to operate its exchange in partnership with other states through a regional exchange or it can operate multiple exchanges that cover distinct areas within the state
  • states are allowed to police insurers by using “secret shoppers” to ensure sick people aren’t discouraged from signing up
  • exchanges must operate a website that facilitates comparisons among qualified health plans and operate a customer support hotline
  • exchanges must conduct outreach to educate consumers regarding the exchanges
  • exchanges must determine and explain the eligibility requirements for enrollment in a qualified health plan (one that satisfies minimum benefit standards), and
  • individuals participating in exchanges must be allowed to change from one qualified plan to another outside of open enrollment if certain things occur — like marriage, birth or adoption.

Even though the new rules don’t impact employers directly, companies can use them to determine what they should offer for their plans to be considered competitive when measured against plans offered in an exchange.

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