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HHS declares final rule on Health Insurance Exchanges

Last month, the US government Department of Health and Human Services (HHS) released the final rules on the health insurance exchanges – the online marketplaces for comparing health plans and purchasing health insurance.

The new released rule includes guidelines for setting and operating health insurance exchanges and pre-requisites for health plans to be eligible for participating in an exchange.

The final rule combines aspects of two earlier rules on health Insurance exchanges that had been issued separately in July and August, last year. 

One of the rules published in July 15, 2011 proposed a framework with an aim to assist states in setting up health insurance exchanges. The other rule released on August 17, 2011 laid down standards for health plans to be deemed Qualified Health Plans (QHPs) – plans eligible to participate in state health insurance exchanges. 

After the proposed rules were declared, HHS invited US citizens from across the country to share their views and suggestions. The Center for Medicare and Medicaid Services (CMS), held a national eligibility conference that was attended by various states and even hosted conference calls and webinars to seek public input and propositions on declared rules.

The health insurance exchanges as proposed by the Affordable Care Act would be web-based portals that would serve as marketplaces for purchasing insurance. Exchanges are expected to facilitate the insurance purchasing process for consumers and are expected to aid them in searching and easily enrolling for private health plans. The exchanges would also serve as a medium to check and apply for small business tax credits and federal subsidies. 

HHS which has already received more than 24,781 comments on the recently proposed rules still seeks more inputs from the public on various aspects of the declared rule – best options for determining eligibility for exchange participation, roles of agents and brokers in assisting individuals, CHIP & Medicaid. The final rule establishes standards for the following:

•Establishment and functioning of a health insurance exchange

•Health plans that are qualified to participate in an exchange

•Determining eligibility of an individual to enroll in insurance plans offered through an exchange and in insurance affordability programs

•Enrolling in health plans through health insurance exchanges

•Determining employer eligibility for participating in SHOP exchanges. 

The final rule holds cost-factors as central to the health insurance exchange implementation. Cost is the most common challenge cited by most states in successful implementation of health insurance exchanges. The federal HIX plan and implementation grant money has helped ease out some of the initial financial burdens for some states. 

The defined rules are expected to provide greater clarity to state health insurance exchange implementers and is hoped to ease out some of the administrative and functional doubts related to the insurance exchanges. State exchange supervisors may find it easy to filter out plans that do not meet the defined criteria of qualified health plans. Set standards would also help in easily determining eligibility of an individual for any applicable federal subsidy or an employer looking to purchase group insurance for his/her employees through the exchange. 

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Author is a well known authority on health insurance Exchange in the US. He is currently looking to expand his expertise in Health Exchange and health insurance exchange available.

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