Take advantage of hCentive's deep expertise in the healthcare insurance industry. Browse through or download our white papers to get an in-depth understanding of the industry.
Did you have time to read the 1,990 page healthcare bill that was recently passed through Congress? Have you since wondered about the impact that massive bill will have on the average American, health insurance providers, business owners and YOU? If yes, then join the Young Professionals of Chicago as we host a panel of diverse health care professionals that will be discussing current healthcare reform and taking questions on the impact of the United States' new healthcare policy. The distinguished panelists will also provide some insight and clarity into what this massive bill means for individuals like you. There will also be an opportunity for open networking with other young professionals before and after the discussion.
Did you have time to read the 1,990 page healthcare bill that was recently passed through Congress? Have you since wondered about the impact that massive bill will have on the average American, health insurance providers, business owners and YOU? If yes, then join the Young Professionals of Chicago as we host a panel of diverse health care professionals that will be discussing current healthcare reform and taking questions on the impact of the United States' new healthcare policy. The distinguished panelists will also provide some insight and clarity into what this massive bill means for individuals like you. There will also be an opportunity for open networking with other young professionals before and after the discussion.
Obamacare in Pictures: Visualizing the Effects of the Patient Protection and ...The Heritage Foundation
“Obamacare in Pictures: Visualizing the Effects of the Patient Protection and Affordable Care Act” shows in detail the impact of the sweeping health care law for Americans.
The Affordable Care Act and Its Impact on Workers’ CompensationCognizant
While the Affordable Care Act (ACA) is expected to reduce the number of uninsured and improve personal wellness in the U.S., the law's changes in workforce definitions will significantly impact workforce dynamics, employee hiring, employers' benefits strategies and wellness programs -- requiring a reevaluation of how workers' compensation is accounted for and delivered.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
US Healthcare Reform Landscape - Addendum to June 2018 Presentation to the Ch...Dan Wellisch
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http://www.symbiusmedical.com/ - This article can help you navigate the often misunderstood new world of healthcare - the Affordable Care Act. As of 2014 non-grandfathered individual and small group health plans must provide the essential health benefits (EHBs). EHBs will include items & services in 10 statutory benefit categories. Individuals are able to shop for insurance coverage on state health insurance exchanges, called “marketplaces.” The article is written by Symbius Medical Corporate Compliance Manager, Natalie Franklin.
Obamacare in Pictures: Visualizing the Effects of the Patient Protection and ...The Heritage Foundation
“Obamacare in Pictures: Visualizing the Effects of the Patient Protection and Affordable Care Act” shows in detail the impact of the sweeping health care law for Americans.
The Affordable Care Act and Its Impact on Workers’ CompensationCognizant
While the Affordable Care Act (ACA) is expected to reduce the number of uninsured and improve personal wellness in the U.S., the law's changes in workforce definitions will significantly impact workforce dynamics, employee hiring, employers' benefits strategies and wellness programs -- requiring a reevaluation of how workers' compensation is accounted for and delivered.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
US Healthcare Reform Landscape - Addendum to June 2018 Presentation to the Ch...Dan Wellisch
This is an addendum to the June 2018 presentation (to the Chicago Technology For Value-Based Healthcare Meetup https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/) containing interesting info. about what may replace the Affordable Care Act
http://www.symbiusmedical.com/ - This article can help you navigate the often misunderstood new world of healthcare - the Affordable Care Act. As of 2014 non-grandfathered individual and small group health plans must provide the essential health benefits (EHBs). EHBs will include items & services in 10 statutory benefit categories. Individuals are able to shop for insurance coverage on state health insurance exchanges, called “marketplaces.” The article is written by Symbius Medical Corporate Compliance Manager, Natalie Franklin.
hCentive Webinsure Medicare Part D & Part C PlatformAlisha North
hCentive's WebInsure Medicare is an ACA/HIPAA compliant solution. WebInsure Medicare simplifies the implementation of health reforms and provides a cost-effective, profitably-tailored solution for insurers.
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Increasingly, it's a technology-driven world, and health care is no exception. Those who work at the intersection between health care and information technology say the Affordable Care Act will only bring the two fields even closer.
Everyone deserves legal protection. And at LegalShield, our mission is to make sure everyone can access it.
With the commitment of over 1.4 million LegalShield members, we are able to negotiate comprehensive legal services with dedicated law firms nationwide, at a fraction of what they traditionally cost.
By offering uncommonly accessible legal services at an uncommonly affordable price, our hope is
that everyone can live their lives worry-free, every day, every night, now and forever.
Please note - Services for the following locations are different than what are presented on this document. Hawaii, New Jersey, New York, South Dakota, Vermont, Washington and the Canadian provinces. Please contact me for service information if you live in those states or Canada.
Obamacare crashes onths in coming not easily repaired - hCentive newsAlisha North
In the weeks before the start of Obamacare, officials failed to complete exhaustive testing of the program’s website in a push to begin signups by Oct. 1, according to people involved in the rollout.
hCentive's WebInsure Consumer is the perfect solution for insurers looking for a proactive approach towards web based insurance solutions. WebInsure Consumer simplifies the implementation of the complex health reforms and offers a cost-effective and highly tailored solution for insurers looking to leverage retail-focussed opportunities arising in the industry.
Obamacare markets debut as early hurdles may slow signups - hCentive newsAlisha North
The three-year effort to open the Obamacare health-insurance exchanges culminates today, beset by logistical delays and a U.S. government shutdown borne of Republican opposition to the Affordable Care Act.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
This gives a good base knowledge of where the current insurance industry is, a timeline of when certain mandates go into effect and a simplified description of the mandats being launched on Sept 23, 2010.
Health Reform in America: An Overview of the Patient Protection and Affordabl...Adam Dougherty
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GDG Cloud Southlake #33: Boule & Rebala: Effective AppSec in SDLC using Deplo...James Anderson
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Bob Boule
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Gopinath Rebala
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Securing your Kubernetes cluster_ a step-by-step guide to success !KatiaHIMEUR1
Today, after several years of existence, an extremely active community and an ultra-dynamic ecosystem, Kubernetes has established itself as the de facto standard in container orchestration. Thanks to a wide range of managed services, it has never been so easy to set up a ready-to-use Kubernetes cluster.
However, this ease of use means that the subject of security in Kubernetes is often left for later, or even neglected. This exposes companies to significant risks.
In this talk, I'll show you step-by-step how to secure your Kubernetes cluster for greater peace of mind and reliability.
Builder.ai Founder Sachin Dev Duggal's Strategic Approach to Create an Innova...Ramesh Iyer
In today's fast-changing business world, Companies that adapt and embrace new ideas often need help to keep up with the competition. However, fostering a culture of innovation takes much work. It takes vision, leadership and willingness to take risks in the right proportion. Sachin Dev Duggal, co-founder of Builder.ai, has perfected the art of this balance, creating a company culture where creativity and growth are nurtured at each stage.
JMeter webinar - integration with InfluxDB and GrafanaRTTS
Watch this recorded webinar about real-time monitoring of application performance. See how to integrate Apache JMeter, the open-source leader in performance testing, with InfluxDB, the open-source time-series database, and Grafana, the open-source analytics and visualization application.
In this webinar, we will review the benefits of leveraging InfluxDB and Grafana when executing load tests and demonstrate how these tools are used to visualize performance metrics.
Length: 30 minutes
Session Overview
-------------------------------------------
During this webinar, we will cover the following topics while demonstrating the integrations of JMeter, InfluxDB and Grafana:
- What out-of-the-box solutions are available for real-time monitoring JMeter tests?
- What are the benefits of integrating InfluxDB and Grafana into the load testing stack?
- Which features are provided by Grafana?
- Demonstration of InfluxDB and Grafana using a practice web application
To view the webinar recording, go to:
https://www.rttsweb.com/jmeter-integration-webinar
Elevating Tactical DDD Patterns Through Object CalisthenicsDorra BARTAGUIZ
After immersing yourself in the blue book and its red counterpart, attending DDD-focused conferences, and applying tactical patterns, you're left with a crucial question: How do I ensure my design is effective? Tactical patterns within Domain-Driven Design (DDD) serve as guiding principles for creating clear and manageable domain models. However, achieving success with these patterns requires additional guidance. Interestingly, we've observed that a set of constraints initially designed for training purposes remarkably aligns with effective pattern implementation, offering a more ‘mechanical’ approach. Let's explore together how Object Calisthenics can elevate the design of your tactical DDD patterns, offering concrete help for those venturing into DDD for the first time!
Generating a custom Ruby SDK for your web service or Rails API using Smithyg2nightmarescribd
Have you ever wanted a Ruby client API to communicate with your web service? Smithy is a protocol-agnostic language for defining services and SDKs. Smithy Ruby is an implementation of Smithy that generates a Ruby SDK using a Smithy model. In this talk, we will explore Smithy and Smithy Ruby to learn how to generate custom feature-rich SDKs that can communicate with any web service, such as a Rails JSON API.
Encryption in Microsoft 365 - ExpertsLive Netherlands 2024Albert Hoitingh
In this session I delve into the encryption technology used in Microsoft 365 and Microsoft Purview. Including the concepts of Customer Key and Double Key Encryption.
The Art of the Pitch: WordPress Relationships and SalesLaura Byrne
Clients don’t know what they don’t know. What web solutions are right for them? How does WordPress come into the picture? How do you make sure you understand scope and timeline? What do you do if sometime changes?
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Accelerate your Kubernetes clusters with Varnish CachingThijs Feryn
A presentation about the usage and availability of Varnish on Kubernetes. This talk explores the capabilities of Varnish caching and shows how to use the Varnish Helm chart to deploy it to Kubernetes.
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Slack (or Teams) Automation for Bonterra Impact Management (fka Social Soluti...Jeffrey Haguewood
Sidekick Solutions uses Bonterra Impact Management (fka Social Solutions Apricot) and automation solutions to integrate data for business workflows.
We believe integration and automation are essential to user experience and the promise of efficient work through technology. Automation is the critical ingredient to realizing that full vision. We develop integration products and services for Bonterra Case Management software to support the deployment of automations for a variety of use cases.
This video focuses on the notifications, alerts, and approval requests using Slack for Bonterra Impact Management. The solutions covered in this webinar can also be deployed for Microsoft Teams.
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Transcript: Selling digital books in 2024: Insights from industry leaders - T...BookNet Canada
The publishing industry has been selling digital audiobooks and ebooks for over a decade and has found its groove. What’s changed? What has stayed the same? Where do we go from here? Join a group of leading sales peers from across the industry for a conversation about the lessons learned since the popularization of digital books, best practices, digital book supply chain management, and more.
Link to video recording: https://bnctechforum.ca/sessions/selling-digital-books-in-2024-insights-from-industry-leaders/
Presented by BookNet Canada on May 28, 2024, with support from the Department of Canadian Heritage.
Monitoring Java Application Security with JDK Tools and JFR Events
hCentive Health Insurance Exchange Platform
1. hCen ti v e
Technology Solutions to Simplify Healthcare
A Complete Guide to State Exchanges
All you need to know about the state health insurance platforms
Published by: hCentive
Date: 29 November 2010
2. hC ent iv e
Technology Solutions to Simplify Healthcare
Table of Contents
The Numbers Game
4
Patient Protection and Affordable Care Act
6
Timeline of the Act
7
Small Business Health Options Program (SHOP)
9
Timeline for Changes Impacting Employers
10
State Health Exchanges
10
Functions of a State Exchange
11
Structure of an Exchange
12
Operating an Exchange
12
Benefits of the Exchange
13
Eligibility
13
Timelines
14
Summary
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3. hC ent ive
Technology Solutions to Simplify Healthcare
Introduction
Health insurance has been, and continues to be, a highly debated issue in the United States. Every
aspect of the healthcare industry is under question, from the cost of healthcare to its availability. This
paper focuses on the changes mandated by the federally enacted Patient Protection and Affordable
Care Act which calls for dramatic changes in the way health insurance is sold in this country.
The Number Game
The U.S. is well known for its medical advances, but it also has the dubious distinction of being one of
the only developed nations that does not guarantee medical insurance for all its citizens. The U.S.
Census Bureau claims that there are about 50.7 million uninsured Americans, including 8.7 million
children. The U.S. also has the third highest per capita expenditure for public healthcare.
Furthermore, in 2007, nearly half of all personal bankruptcies were attributed to medical debt.
Health Insurance Coverage Status
Private
Medicare
2007
Medicaid
2006
1990
Other Government
Uninsured
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%
Source: US Census Bureau, Current Population Survey, 2008 Annual and Social Economic Supplement
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In 2000, the United Nation’s World Health Organization (WHO), ranked America’s healthcare system as
the highest in cost, first in responsiveness, 37th in overall performance, and 72nd in overall level of
health (among the 191 member countries of the UN). In addition, the Institute of Medicine of the
United States National Academies points out that around 18,000 unnecessary deaths are caused in the
U.S. every year and that the lack of medical care has resulted in the death of about 100,000 Americans
annually .
Employers still serve as the primary source for health insurance among most Americans, but due to
rising health care costs, many employers have limited or, in some cases, eliminated coverage for their
employees. This and the large number of unemployed have contributed to the rising number of uninsured Americans.
Health Insurance Status (Under 65 Years of Age)
Employer sponsored health
insurance
Non-group health insurance
Not Insured
Medicare
Medicaid
Military Health Care
Source: U.S. Census Bureau, Income Poverty and Health Insurance Coverage in the United States, 2007
These statistics represent some of the reasons for the passage of the Patient Protection and Affordable
Care Act.
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5. hCent ive
Technology Solutions to Simplify Healthcare
Patient Protection and Affordable Care Act
Health reform was a key issue during the Presidential
elections of 2008. While the Republicans
emphasized having an open-market competition rather than
government controlled, then Senator Barack Obama
campaigned for universal healthcare.
Obama also called for the formation of state based
Exchanges – a sort of market place – where
insurers could compete for consumers based on the
products, prices and services that they offer.
Reform finally culminated with President Obama signing into law on March 23, 2010 the Patient
Protection and Affordable Care Act. This legislation promised to change the business of health
insurance in the U.S. substantially – not just for consumers seeking to buy coverage, but also for
brokers, health insurance carriers, states and the federal government as well.
This law calls for the implementation of various health insurance provisions over a four-year period.
The goal is to make healthcare more accessible and affordable to all individuals irrespective of age,
income or health condition. The Act is an attempt to make health insurance more consumer-friendly
and eliminate any unfair advantages among insurers.
The Act intends to reform individual and group coverage plans and also changes the insurance laws
for health carriers selling medical insurance. The Act will be implemented in the following phases.
5
6. hCentive
Technology Solutions to Simplify Healthcare
Timeline of the Act
EFFECTIVE BY 2010:
No discrimination permitted against children with
pre-existing medical conditions
Insurance companies cannot drop people from
coverage unless there is a serious case of fraud
There would be no lifetime limit on insurance
coverage
Annual limits on insurance coverage would be
regulated
Insurance companies must set up a consumer appeals board
Information on health insurance must be provided online
Qualified small businesses will get tax credits if they provide coverage at work
Seniors hitting the prescription drug coverage “donut hole” (the coverage gap in drug spending
in which seniors pay 100% of the costs) are given a one-time rebate check of $250
Preventive healthcare such as mammograms and flu vaccines will be available free of cost
$15 Billion will be allocated to the Prevention and Public Health Fund to encourage Americans
to live healthy lifestyles
Adults with pre-existing medical conditions can access affordable healthcare through a high risk
pool program
Children can stay on their parents’ coverage until the age of 26
A $5 billion federal fund will ensure that early retirees have access to affordable coverage
New incentives encourage more primary healthcare providers to work in underserved areas
Insurance companies must justify unreasonable rate hikes
Medicaid will be expanded to accommodate more people from low-income brackets
Rural healthcare providers are paid to ensure that they continue serving these communities
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EFFECTIVE BY 2011:
Seniors who fall in the coverage gap receive a discount of 50% on Medicare Part D prescription
drugs
Free preventive services provided to seniors
The Department of Health and Human Services (HHS) must submit a national strategy to
improve the quality of healthcare in government sponsored programs like Medicaid, Medicare
and CHIP
The Community Care Transition Program must ensure that high risk Medicare beneficiaries do
not undergo unnecessary readmissions
Community Health Centers are constructed and expanded.
Insurance companies must spend 80% (80% for small group and individual markets and 85% for
large groups) of their premium dollars on healthcare services
EFFECTIVE BY 2012:
A Hospital Value-Based Purchasing Program is established that offers financial incentives to
hospitals to improve the quality of care
Physicians are incentivized to join Accountable Care Organization
Electronic health records are created to reduce paperwork and administrative costs
CLASS, a voluntary long-term care insurance program will provide cash benefits to disabled
adults
EFFECTIVE BY 2013:
More funding to state Medicaid programs to provide preventive services
Primary care physicians will be paid 100% of Medicare payment rates
Additional funding to ensure children not eligible for Medicaid are covered
EFFECTIVE BY 2014:
Health insurers can’t discriminate on the basis of pre-existing health conditions or gender of the
beneficiary
No annual dollar limits on the amount of coverage an individual might receive
Individuals participating in clinical trials will be ensured coverage
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Tax credits are provided to lower income individuals applying for medical insurance
Each state must create Exchanges for individuals to shop easily for health insurance
Small businesses providing coverage to workers will receive increased tax credits
Individuals and families that can afford insurance will be encouraged to buy their own insurance
Workers can use the employer’s insurance fund to receive affordable coverage for themselves
EFFECTIVE BY 2015:
The payment of physicians will depend on quality and not volume. This will encourage physicians to focus on providing quality healthcare
Small Business Health Options Program (SHOP)
The reform legislation also calls for the creation of
the Small Business Health Options Program
(SHOP) that would act very similar to exchanges,
but is designed primarily for small employers.
Both the exchanges and SHOP would act very
much like Expedia or Travelocity but for
consumers and small employers buying health
insurance.
SHOP will prohibit health insurance companies from underwriting or pricing insurance based on
health status, gender or claim experience1. The SHOP pool must comply with the ratings rules and
minimum benefit packages set for the program.
The SHOP provides tax credits for small business owners to make healthcare coverage affordable.
To obtain these credits, the employer has to pay a minimum of 60% of the premium. The tax credits
available are:
$1000 for each employee who receives self-only coverage
$2000 for every employee who receives family coverage
$1,500 for each employee who receives health insurance coverage for 2 adults or 1 adult and 1
or more children through the employer
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Technology Solutions to Simplify Healthcare
Bonus tax credits will be provided to those employers who exceed the 60% threshold and contribute
more towards their employee health insurance:
$200 for each employee who receives self-only health insurance coverage$2000 for $400 for
each employee who receives family health insurance coverage through the employer
$300 for each employee who receives health insurance coverage for 2 adults or 1 adult and 1 or
more children through the employer
However all tax credits depend on the number of workers employed by the firm:
10 or fewer full-time employees
100%
More than 10 but not more than 20 full-time employees
80%
More than 20 but not more than 30 full-time employees
60%
More than 30 but not more than 40 full-time employees
40%
More than 40 but not more than 50 full-time employees
20%
More than 50 full-time employees
0%
SHOP program tax credits are also subject to the percentage of year factor, determined by the
number of months during the taxable year in which the employer paid or incurred qualified employee
health insurance expenses.2
Timeline for Changes Impacting Employers
2011: Penalty for incorrect spending within Flexible Savings
Account will increase from 10% to 20%
2013: Medicare tax will increase to 2.35% for individuals earning
above $200,000 and for couples earning more than $250,000
Contribution to Flexible Savings Account will be limited to $2500
per year
For those with annual income of more than $200,00O, hospital tax
will increase by 0.9 percentage points
2014: Companies with more than 50 employees will have to provide coverage at work or pay penalty of $2,000 per employee
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Americans without any form of medical insurance must pay an annual fine of $95. This amount will
increase in subsequent years
2016: : States will have to open SHOP to facilitate bulk buying of health insurance by small business
employers.
Both Exchanges and SHOP will be administered by individual states. The federal government will
only administer an Exchange or a SHOP if a state refuses to create one.
State Health Exchanges
A state health Exchange is an insurance market place.
An Exchange is a multi-carrier shop and an
information kiosk. The Affordable Care Act requires
state Exchanges to provide health insurance
information in a manner that is easy to comprehend
for consumers.
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Functions of a State Exchange
In addition to being a market place for insurance products, Exchanges will have five crucial
functions:
1. Foster competition among insurers to ensure that
the consumers get the best rates and services. All
the costs and services would be listed in a manner
that will make comparison across plans easy.
2. Exchanges also are required to provide transparent
and authentic information about plans,
premiums, coverage, benefits, and the like.
3. For those who do not have access to any sort of assistance, Exchanges will facilitate enrollment in
plans and the payment of premiums. They will serve as portals where applicants can check their
eligibility for plans and subsidies.
4. By purchasing health plans from Exchanges, individuals can retain their coverage even when
between jobs.
Exchanges must adhere to the following regulations:
Inspect policies to ensure that they adhere to the standards set by the government and are in the
best interest of the consumers
Have no power to decide premiums but can ask carriers to justify rate hikes. If they are unsatisfied
with a carrier’s explanation, they have the right to not display that carrier’s products.
The Exchanges will provide resources so that people who do not have access to the Internet can
get information through mail and community announcements.
Must use standard forms, definitions and marketing materials. Individuals should have the option
to enroll online, over the phone, by mail or in person.
States must operate call centers to ensure efficient customer service.
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The Exchanges will have five categories of health plans depending on the expenses. Other than
providing the essential health benefits, the following different benefit categories will also include a:
1. Bronze Plan: 60% of the costs with HSA out-of-pocket limits
2. Silver Plan: 70% of the costs with HSA out-of-pocket limit
3. Gold Plan: 80% of the costs with the HSA out-of pocket limit
4. Platinum Plan: 90% of the costs with the HSA limit
5. Catastrophic Plan: For those below the age of 30 and are exempted from the mandatory purchase
of health policy.
Though the Act leaves it to the states to decide upon the form and medium of the Exchanges, most
states, barring a few, will eventually govern their own health insurance Exchanges.
Structure of an Exchange
The Act directs every state to have a state-based health
insurance Exchange as health insurance rules vary from
state-to-state. A state Exchange will also give a greater
sense of ownership to its citizens.
The Exchanges will be funded by federal dollars. The Act
also has provisions calling for the federal government to
create and administer an Exchange if any state refuses to
do so.
There is a possibility that, at some later date, all state
health insurance Exchanges will be integrated into a
single national Exchange. This would reduce the administrative costs associated with the Exchanges.
A national Exchange also would ensure that consumers are not deprived of coverage even when they
change their state of residence.
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Operating an Exchange
Administrating a state based Exchanges that operate on federal dollars and adhere to both federal
and state regulations will require collaboration by federal and state governments.
Since Exchanges will be funded largely by the
federal government, each state’s Exchange will be
audited by federal agencies to ensure compliance
with federal health insurance regulations.
Since states will administer the Exchanges, it is
important that state governments and their
respective insurance departments form an
Exchange Board to oversee operations.
The effective management of the Exchanges will
ensure that consumers reap the maximum benefits
when purchasing health insurance.
Benefits of the Exchange
Advocates of the Act and its mandated Exchanges point to the following benefits:
Standardized benefits make comparisons across
plans easier.
Provides for access to federal subsidies and information about eligibility for government sponsored
programs
Consumers can retain their employee sponsored
coverage even when they change jobs
Allows convenient access to the cheapest plans
Beneficiaries do not have to worry about the authenticity of their coverage, as only those plans that
comply with the Affordable Care Act and are sold by insurance companies that have the license to
do so, will be exhibited on the Exchanges.
Employers will enjoy more flexibility and choices while providing group coverage to their
employees
Affordable plans and non-denial to any applicant will ensure that more people have access to
medical coverage.
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Eligibility
Not everyone can sell or purchase a plan through an
Exchange. Both buyers and sellers must meet certain
eligibility criteria before they can operate on an
Exchange platform.
For Buyers: Initially, Exchanges will be limited to
unemployed individuals, those self-employed or
employers with fewer than 100 employees.
Health insurance carriers: Only those health
insurance companies with acceptable rates, who
spend no less than 80% of their premium dollars on
health care expenses for their members and who
comply with the federal guidelines will qualify to
showcase their products on an Exchange platform.
Exchanges will provide consumers with a broad selection of health insurance options. However, with
increased options comes, in some cases, confusion. It will be important that states also provide
support – including call centers -- for consumers participating in the Exchanges.
Timelines
Though Exchanges don’t become fully
operational until January 1, 2014,
implementation has already begun. The following
outlines the mandated implementation plan
2010
States develop informal databases capturing the issues that will affect the formation of Exchanges
and the drafting of grant applications.
The Department of Health & Human Services (HHS) establishes interoperable standards and
protocols for enrollment in the HHS program
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Technology Solutions to Simplify Healthcare
2011
States begin to apply for federal grants for: A) HIT enrollment standards & protocols and; B) development of health benefit Exchanges
Develop strategic plans to integrate the Affordable Act within the realms of the Exchanges
Grants from the HHS become available for planning and developing standards for compiling and
providing enrollees with summary of benefits
2012
Establish Health Benefit Exchanges
Develop, issue, and review RFPs for IT and infrastructure
States seek and receive final approval from HHS for Health Benefit Exchanges
Develop and implement ‘plans of operations’
Select audit firms to assess system of internal controls, key processes and systems
Select vendors for outreach, marketing, advertising and develop strategy and materials
Develop and issue RFPs for
a) Navigators
b) Call Centers
c) Financial systems/ Subsidy Reconciliation
State implements federal eligibility and subsidy determination guidelines
2013
IT/ Website developed and implemented
HHS approves that a state is willing and able to implement the Exchange by January 1, 2014
Begin development of QHP (Qualified Health Plan) RFP specifications
HHS to provide loans to assist Co-Ops
Select QHP and begin implementation
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Marketing and outreach campaign
Full Enrollment Systems Testing
Begin selling health plans
2014
Health Benefit Exchange becomes fully operational
Summary
The state based health insurance Exchanges are one of the most important aspects of the healthcare
reforms of 2010. The Act sets certain guidelines that every Exchange has to adhere to and yet leaves
enough flexibility for states to accommodate their individual preferences and regulations. More
importantly, the Act provides a platform for consumers to cost effectively and more easily purchase
health insurance.
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