Health Care Exchanges Start Today! A broad-based working definition of the Health Care Exchange is an organized marketplace designed to help people shop for, and enroll in, health insurance coverage. The exchange is more than just the immediately visible web interface. Some commentators have analogized it to online shopping. However, there is substantially more going on in the background of an online exchange.
Some states took the opportunity to create and build health care exchanges from scratch; some partnered with the federal government; some rejected any active role in creating an exchange and opted to let the U.S. Department of Health and Human Services operate the exchange in their state; and others initially refused to cooperate at all. Connecticut’s health insurance exchange, known as Access Health CT, is a state-created, state-specific model.
“Qualified health plans” will continue to be sold through insurance agents in Connecticut. The plans are designed to be easily compared in terms of what is covered and what the overall value of the plans are. Individual and small group plans (exchange and non-exchange plans alike) must offer 10 essential health benefits. They are:
1.) ambulatory patient services;
2.) emergency services;
4.) maternity and newborn care;
5.) mental health and substance use disorder services, including behavioral health treatment;
6.) prescription drugs;
7.) rehabilitative services and devices;
8.) laboratory services;
9.) preventive and wellness services and chronic disease management; and
10.) pediatric services, including oral and vision care.
Metal tiers (platinum, gold, silver and bronze) represent a plan’s actuarial value. Actuarial value, as described on the Center for Consumer Information and Insurance Oversight site, represents “the percentage of total average costs for covered benefits that a plan will cover.” Platinum plans cover 90 percent, gold covers 80 percent, silver 70 percent and bronze 60 percent.
For more information, log on to the Access Health CT website at www.ct.gov/hix/site/, or give The Russell Agency a call at 888.926.3564.