Deadline Nears for Health Exchange Setup with New Rules in Play

In preparation for the 2014 launch of mandatory health insurance exchanges, states must report their readiness status to the federal government by December 31, 2012. States are currently in the process of laying the groundwork for the establishment of consumer friendly health insurance “marketplaces” that allow customers to easily compare the prices and benefits of health insurance plans. If a state us unable to prove they have made acceptable progress towards that goal they risk federal takeover of the preparation process.

The newly released rules involve specifications on how the exchanges should be formed and how they will operate. Under the new orders, states are allowed to decide a on a variety of details involving how their exchanges will operate including who will oversee the exchange (non-profit organization or public agency), how plans are to be selected, and whether or not to delegate some functions to the federal Department of Health and Human Services.

States may also choose to either operate multiple exchanges throughout a state or to participate in a regional exchange with other states. So-called secret shoppers are to be placed under the purview of states, which have the authority to police insurers to ensure compliance. Exchanges are also mandated to run a website that eases the task of plan comparison and to operate a customer support hotline.

State exchanges must conduct regular public outreach programs to educate the consumers about the existence and operation of the exchanges. The responsibility for explaining eligibility requirements for qualified health plans falls on the exchanges who must act to determine and disperse the information to consumers. Finally, one enrolled, individuals must be allowed to switch from plan to plan at any time for reasons such as marriage, birth, or adoption.