Roles And Responsibilities Of Health Insurance Exchanges

Health Insurance Exchanges are scheduled to come into operation by 2014 under the Affordable Care Act of 2010

. Apart from being a distribution channel for selling commercial health insurances, these exchanges will be responsible for a medley of administrative and other functions. An insurance exchange will also operate as a platform for - availing federal tax credits and subsidies, ensuring compliance with Individual mandate and regulating the insurance market.

A successful health insurance exchange must offer high-quality, low cost plans that help in attracting new prospects and retaining existing customers. Not only this, the insurance exchanges will be responsible for a number of other functions as well as listed below all data transactions to and from an exchange must be performed in an efficient and secure manner; members need to be regularly apprised of all health plan related updates; a simple and easy to understand interface needs to be set up that helps consumers check their plan eligibility and easily apply for health plans and tax waivers. A few of these functions have been discussed in detail below:

Determining eligibility

The ACA instructs U.S. states to establish a single eligibility checker that can be used by users to determining their eligibility for different health plans and federal programs such as CHIP, Medicaid, SHOP exchange, HIX etc. In some U.S. states, programs such as Medicaid and CHIP etc. have different eligibility rules and are processed by separate eligibility engines. The health insurance exchange platform will feature a single portal for checking eligibility for plans.

Health carrier and plan selection

The federal government requires state insurance exchanges to include and offer only qualified health plans to their customers. Exchanges will need to operate as an impartial entity and set standards for plans that qualify as a high-quality plan. Only those plans that fulfill the laid out criteria should be allowed to participate in the exchange. Exchanges will need to operate as a quality regulator for health plans.

Enrollment

Individuals planning to buy insurance from an Insurance exchange will have access to a large number of health carriers and health plans. The health insurance exchange will need to have a set up in place that allows consumers to easily enroll for a health plan of their choice. Exchanges will need to remain careful against instances of adverse selections and will need to adopt measures to mitigate market risks.

The health insurance exchanges are one of the more radical measures introduced under the Affordable Care Act. Well-structured health insurance exchanges may prove instrumental in determining the success of the federally imposed health care reforms. The exchanges are expected to improve consumer access to health plans, regulate and lower the cost of health insurance and enhance the quality of healthcare options available to users. The state governments across the entire U.S. will play a vital role in not only setting up these insurance exchanges, but also standardizing the insurance markets to lower down the costs of health insurance plans.

by: Shaun Mike

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