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Guidance Issued on Health Insurance Exchanges and Summary of Benefits

The Department of Health and Human Services (HHS) on May 16 issued new guidance for states on health insurance exchanges. In addition, HHS in conjunction with the Departments of Labor and Treasury, released an additional set of frequently asked questions regarding implementation of the summary of benefits and coverage provisions included in the Patient Protection and Affordable Care Act (PPACA).

Health Insurance Exchanges

The HHS guidance includes an Exchange Blueprint states can use to demonstrate the health plan options their health insurance exchange will offer. The blueprint also explains the application process for states seeking to enter into a Partnership Exchange. If a state chooses to operate its own exchange or a Partnership Exchange, HHS will review and potentially approve or conditionally approve the exchange no later than Jan. 1, 2013, so it can begin offering coverage on Jan. 1, 2014. To see the state Exchange Blueprint, visit: http://cciio.cms.gov/resources/other/index.html#hie.

If a state chooses not to operate an exchange, HHS will operate a federally facilitated exchange (FFE). The new guidance also describes how HHS will consult with a variety of stakeholders to implement selected functions in an FFE and key policies organized by exchange function. To see the guidance on FFEs, visit http://cciio.cms.gov/resources/regulations/index.html#hie.

In addition, the department will conduct implementation forums in the coming months to work with states and stakeholders on building exchanges. Below are the locations and dates for the regional implementation forums:

  • Washington, D.C. – July 18
  • Chicago – August 2
  • Denver – August 10
  • Atlanta – August 15

More details on location and registration will be released in the coming weeks. For more information on the forums, visit http://cciio.cms.gov/resources/factsheets/index.html#hie

For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.

FAQs on Summary of Benefits and Coverage

Under PPACA, beginning on Sept. 23, health insurers and group health plans are required to provide a summary of benefits and coverage (SBC) to consumers. The most recent FAQs issued on SBC contain 14 FAQs to help stakeholders understand the new law. They also clarify under which circumstances a failure to fully comply with the requirements will not result in enforcement action.

The FAQs are available at: http://www.dol.gov/ebsa/faqs/faq-aca9.html.

For more information, visit www.dol.gov/ebsa/healthreform/.


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