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June 13, 2013

The 10 Things Health Insurance Exchanges Must Do

In April we published a story on the basics of ACA Health Insurance Exchanges, highlighting the responsibility of each state to either run their own exchange or hand it over to the federal government, as well as the role that these programs will play in the marketplace. Whether you are well versed in the details of the Affordable Care Act or are still finding the new law challenging to fully grasp, there are 10 things that all health insurance exchanges must do.

Health Insurance Exchanges (fully operational by January 1, 2014) must do the following:

1. Certify, recertify and decertify Qualified Health Plans (QHPs)

2. Assign a rating to each exchange plan using the Bronze, Silver, Gold & Platinum levels

3. Offer a toll-free hotline for consumers

4. Maintain a website to compare plans

5. Standardize the format in which their exchange plan options will be presented

6. Inform individuals of eligibility requirements for Medicaid, CHIP or any other state or local program

7. Enroll individuals if through the screening process the exchange determines they are eligible for one of those programs [Applications will start being accepted October 1, 2013]

8. Provide for a calculator to determine the actual cost of coverage to individuals after taking into account any premium credits and cost-sharing subsidies [139-400% of the federal poverty level]

9. Certify whether individuals are exempt from the individual mandate excise tax and transfer the list of such individuals to the Treasury Secretary

10. Provide the name of the employees who dropped the employer's coverage and received premium tax credits to the employer because his or her plan was unaffordable or did not provide the required minimum actuarial value

Before you determine how much the Affordable Care Act will cost you, have a discussion with someone who understands the details surrounding the reform. The Memphis office of CBIZ MHM has a specialized team of individuals trained in all facets of healthcare reform. Schedule a meeting with one of our experts by contacting Megan Murdock, 901.685.5575.

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