Insurance Exchanges

The Department of Health and Human Services (HHS) has released its proposed rule regarding training and meaningful access standards for navigators and other personnel who will help individuals shop for health insurance in the new health exchanges. 

To spur competition among plans, the ACA created the Multi-state Plan Program (MSPP). The Office of Personnel Management (OPM), which administers health insurance programs for federal employees and members of Congress, will certify and oversee health insurance issuers to offer at least two plans in every state exchange. This policy brief explores the background of the MSPP, the challenges facing OPM in administering it, and the issues associated with offering health insurance plans in multiple states.

This brief explores how states may be able to use CHIP to help meet some of the child-specific requirements for exchanges in the ACA. Options for doing so include: using CHIP as model for pediatric benefits and providers in the exchange; using CHIP funds to provide premium assistance for eligible children to buy exchange coverage that would allow families to be insured by one coverage program; and using CHIP to wrap around Essential Health Benefit benchmark benefits to ensure children’s unique needs are met.

The Office of Personnel Management (OPM) released its final rule on how it will administer two multi-state plans (MSPs) on insurance exchanges nationwide. While the final rule has not changed substantially from the proposed rule, it does finalize the provision giving MSP issuers the choice to either offer coverage that meets the standards set by the state benchmark plans or those of OPM’s benchmark plans.

HHS has issued its proposed rule for the Small Business Health Options Program (SHOP), which highlights special enrollment periods for the small-business exchanges and proposes policies for facilitating the transition for employers entering the new marketplaces. It also announced that the employee choice and premium aggregation components of SHOP will not be required until January 1, 2015, delaying them by one year.

This report examines the ACA’s 3:1 age rating band, which stipulates that premiums for adults age 64 can be no more than three times higher than the premiums for adults age 21 for the same coverage, and its impact on health insurance premiums. 

HHS released the final rule on essential health benefits (EHB), actuarial value, and accreditation of qualified health plans. This rule finalizes the state benchmark approach for defining EHB in 2014 and 2015. It also sets forth limits on cost-sharing, allows for a slight leeway – plus or minus 2 percent – in the actuarial value of the metal level requirements, and finalizes the drug coverage requirements in the exchange.

With the passing of the partnership deadline on February 15, 26 states have defaulted to the Federally Facilitated Exchange (FFE), and it will now be the responsibility of the Department of Health and Human Services to get the exchanges up and running in these states. This brief provides an overview of the requirements necessary to establishing a FFE and the challenges that the federal government may face in implementing them in 26 different states. 

This analysis was prepared to assist in planning for the design, implementation, and operation of a successful SHOP Exchange in New York State. It provides an overview of state and federal laws and regulations relating to the design and implementation of the SHOP; identifies potential options and decision points related to the design of the SHOP; summarizes other states' approaches to developing a SHOP; and provides a SHOP concept of operations, including the identification of key SHOP business processes.

Maryland Health Benefit Exchange has issued an RFP to procure a contact center, called the Consolidated Service Center (CSC) to support Maryland consumer inquiries for exchange services. The CSC will need to be easily accessible via toll free number and website with live agent support; utilize culturally and linguistically appropriate communication channels; provide safeguards to ensure customer privacy and data security; provide clear, accurate, responsive information tailored to meet Maryland consumer needs; and be fully compliant with American Disabilities Act requirements.