New York Health Benefit Exchange Invitation Fact Sheet

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New York Benefits Exchange Fact Sheet: http://www.zanebenefits.com/

The New York Health Benefit Exchange today issued an invitation to health insurance companies to participate in the Exchange, which will offer individuals, families and small businesses a choice of Qualified Health Plans.

“The goal is to build an Exchange that is robust and offers a variety of affordable, quality health plans,” said Donna Frescatore, executive director, New York Health Benefit Exchange. “Individuals, families and small business owners who purchase health plans through the Exchange will be able to easily compare Qualified Health Plans and choose a product that will best match their specific needs.”

Enrollment in New York’s Health Benefit Exchange will begin October 1, 2013, with coverage starting January 1, 2014. The initial open enrollment period will run for six months and end on March 31, 2014. It is estimated that, at full enrollment, more than one million New Yorkers will obtain insurance through the Exchange, including 615,000 individuals and 450,000 employees of small businesses.

Qualified Health Plans approved by the Exchange will provide comprehensive health insurance coverage, follow limits on out-of-pocket expenses (such as deductibles, copayments, and federal out-of-pocket maximums), and meet other state and federal requirements.

Through the certification process for Qualified Health Plans, the Exchange will:

Offer comprehensive, affordable coverage in all areas of the state
Balance innovation with reasonable choice
Make it easy for consumers to compare options
Ensure Qualified Health Plans have adequate provider networks
Monitor quality, utilization of services and consumer satisfaction
Preserve consumer protections, as defined in federal and state laws and regulations
Ensure consistency with the market outside the Exchange
The health plan invitation was developed with input from the Exchange stakeholder community.

The first step in the application process is submission of a non-binding letter of interest that should be provided as soon as possible, but no later than February 15, 2013. Letters should be sent via email to the Invitation Administrator at nyhxpm@health.state.ny.us, or by mail to: New York Health Benefit Exchange, NYS Department of Health, Corning Tower, Suite 2378, Albany, NY 12237. All questions about the application process should be directed to the Invitation Administrator.

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New York Health Benefit Exchange Invitation Fact Sheet

  1. 1. New York Health Benefit Exchange Health and Dental Plan Invitation January 31, 2013On January 31, the Department of Health issued an invitation to health plans and dental plans to applyfor certification to participate in New York’s Exchange.Goals of the Invitation: • Offer comprehensive affordable, coverage in all areas of the State • Balance innovation with reasonable choice • Make it easy for consumers to compare options • Ensure health plans have adequate networks • Monitor health plan quality, utilization of services, and consumer satisfaction • Preserve consumer protections, as defined in federal and state law and regulation • Ensure consistency with the outside marketHighlights: • All licensed, certified insurers are invited to apply • Insurer may choose to participate in the Individual Exchange, the SHOP Exchange or both • Insurer must agree to participate in its entire approved Service Area, unless granted an exception by the Exchange • Insurer must offer “standardized products” at each of the metal tiers to make it easier for consumers to compare options, but also allows them to offer up to 3 non-standard products to ensure innovation • Insurer must demonstrate they have an adequate network of providers • Insurer must report quality results and financial data • Comply with federal and state law and regulationsTimeline: • Invitation Released on January 31, 2013 • Letter of interest from Insurers due February 15, 2013 • Written Questions re: Invitation due March 1, 2013 • Responses to Written Questions re: Invitation due March 15, 2013 • Participation Form Submission due April 5, 2013 • Provider Network Submission date April 12, 2013 • Submission of Rates and Forms due April 15, 2013 • Anticipated Notification of Certification by July 15, 2013 • Plans posted to Exchange webportal for consumer shopping in September 2013 • Exchange Enrollment begins October 1, 2013

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