The Mississippi Insurance Department and Health Insurance Exchanges
Mississippi Insurance Department
P.O. Box 79
Jackson, Mississippi · 39205-0079
What is an Exchange?
Essentially, an Exchange is a marketplace for major
medical insurance.
A one-stop shop for health insurance -- similar to
Travelocity, Expedia, and Priceline.
This is perhaps an underestimate in that the
Exchange:
Will be a massive undertaking
Will affect millions of Americans
Will provide many services beyond simply offering different
insurance products for sale.
2
What Do We Know About the Exchange?
Unfortunately, not much at this point.
The details are in the regulations, and most of
the thousands of pages of expected regulations
are not out yet.
3
We Are Not Completely In The Dark
The Affordable Care Act provides us with a foundation.
We know that:
By January 1, 2014, each state shall establish an American
Health Benefit Exchange to sell individual and small group
major medical policies.
By January 1, 2013, the Secretary of Health & Human
Services (HHS) will determine whether each state will have
an effective mechanism in place to run an Exchange by
January 1, 2014, and if not, then the Federal government
will step in to run the Exchange for the state.
Only qualified health plans offering essential benefits and
certified by the Exchange may be offered through the
Exchange.
4
Four Levels of Coverage Will Be Available
Bronze
– covers 60% of actuarial value of benefits
Silver
– covers 70% of actuarial value of benefits
Gold
– covers 80% of actuarial value of benefits
Platinum
– covers 90% of actuarial value of benefits
5
Subsidies and Tax Credits
Subsidies
will be available through the Exchange for
individual taxpayers whose household income falls between
100% and 400% of the Federal Poverty Level (FPL).
400% of FPL is approximately
$88,000
.
Therefore, a large portion of Mississippians will be eligible for some
level of federal subsidy.
This subsidy will equal the difference between a percentage
of household income and the second lowest cost
silver level
plan
available through the Exchange.
These subsidies will be paid by the
Federal government
directly to the insurer and will only be available through the
Exchange.
6
Individual Mandate
In 2014, unless exempt, all individuals must maintain
minimum essential coverage or pay a tax penalty.
This tax penalty starts out at $95 per year for each
covered family member, and eventually increases to
$695 per year for each covered family member for
2016 and beyond.
7
Establishment of the Exchange
The Exchange should be established as a not-for-
profit corporation, created to effectuate the public
purposes of the Act but with a legal existence
separate from that of the State of Mississippi.
8
Regulatory Authority
The Mississippi Insurance Department should have
regulatory authority over the Exchange and the authority to
promulgate regulations necessary for the implementation
and operation of the Exchange in accordance with this Act
and any other State and/or Federal law.
The Mississippi Insurance Department should have the
authority to enforce any State and/or Federal laws
concerning the Exchange. Further, the Mississippi Insurance
Department should have the authority to investigate the
affairs of the Exchange, examine the properties and records of
the Exchange, and require the Exchange to provide periodic
reporting to the Mississippi Insurance Department.
9
Duties of the Exchange
Implement procedures for the certification, recertification
and decertification of health benefit plans as qualified
health plans;
Provide for the operation of a toll-free telephone hotline to
respond to requests for assistance;
Provide for enrollment periods;
Maintain an Internet website through which enrollees and
prospective enrollees of qualified health plans may obtain
standardized comparative information on such plans and
enroll in such plans;
Assign a rating to each qualified health plan offered
through the Exchange and determine each qualified health
plan’s level of coverage;
10
Duties of the Exchange
Use a standardized format for presenting health benefit
options in the Exchange;
Inform individuals of eligibility requirements for the
Medicaid program under title XIX of the Social Security Act,
the Children’s Health Insurance Program (CHIP) under title
XXI of the Social Security Act or any applicable State or
local public program and if through screening of the
application by the Exchange, the Exchange determines that
any individual is eligible for such program, shall refer that
individual to that program so that he or she may be
enrolled in said program;
11
Duties of the Exchange
Facilitate the purchase and sale of qualified health
plans;
Establish a Small Employer Exchange through which
qualified employers may access coverage for their
employees, which shall enable any qualified employer
to specify a level of coverage so that any of its
employees may enroll in any qualified health plan
offered through the Small Employer Exchange at the
specified level of coverage;
12
Duties of the Exchange
Establish and make available by electronic means a
calculator to determine the actual cost of coverage after
application of any premium tax credit under section 36B of
the Internal Revenue Code of 1986 and any State or Federal
cost-sharing reduction;
Review the rate of premium growth within the Exchange
and outside the Exchange;
Determine and process any Federal or State tax credits or
other premium support payments for health insurance, as
may be established by law;
Create advisory committees to the Board consisting of
stakeholders relevant to carrying out the activities required
under this Act;
13
Duties of the Exchange
Meet the following financial requirements:
Keep an accurate accounting of all activities, receipts and
expenditures and annually submit to the Governor, the Department
and the Legislature a report concerning such accountings;
In carrying out its activities under this Act, not use any funds
intended for the administrative and operational expenses of the
Exchange for staff retreats, promotional giveaways, excessive
executive compensation or promotion of federal or State legislative
and regulatory modifications.
Meet the requirements of this Act and fully comply
with any and all requirements set by State statutory
and regulatory law.
14
Duties of the Exchange: Navigators
Select entities qualified to serve as Navigators in
accordance with State law and/or Department
regulation and enable Navigators to:
Conduct public education activities to raise awareness of the
availability of qualified health plans;
Distribute fair and impartial information concerning enrollment
in qualified health plans, and the availability of premium tax
credits under section 36B of the Internal Revenue Code of 1986
and any cost-sharing reductions;
Facilitate enrollment in qualified health plans; however, no
person shall receive any form of compensation as consideration
for the facilitation of enrollment of any person in a qualified
health plan through the Exchange unless that person is an
insurance agent that is duly licensed by the Department pursuant
to Mississippi Code Annotated §83-17-75;
15
Duties of the Exchange: Navigators
Provide referrals to duly licensed insurance agents to facilitate
enrollment in qualified health plans;
Provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman or any
other appropriate State agency or agencies, for any enrollee
with a grievance, complaint or question regarding their health
benefit plan, coverage or a determination under that plan or
coverage; and
Provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being
served by the Exchange.
16
Funding
The Exchange must be self-sustaining by
January 1, 2015.
The Exchange may charge assessments or
user fees to health carriers or otherwise to
generate funding necessary to support its
operations.
17
Screenshots
of
eHealthInsurance.com
and
GetInsured.com
18
19
eHealthInsurance.com
20
eHealthInsurance.com
21
eHealthInsurance.com
22
GetInsured.com
23
GetInsured.com
The Mississippi Insurance Department plays a vital role in overseeing insurance regulations, and Health Insurance Exchanges provide a marketplace for major medical insurance in a similar fashion to online travel booking platforms. While details about the Exchange are still emerging, the Affordable Care Act sets the groundwork for states to establish American Health Benefit Exchanges offering different coverage levels, subsidies, and mandating individual health insurance coverage.
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Presentation Transcript
Mississippi Insurance Department P.O. Box 79 Jackson, Mississippi 39205-0079
What is an Exchange? Essentially, an Exchange is a marketplace for major medical insurance. A one-stop shop for health insurance -- similar to Travelocity, Expedia, and Priceline. This is perhaps an underestimate in that the Exchange: Will be a massive undertaking Will affect millions of Americans Will provide many services beyond simply offering different insurance products for sale. 2
What Do We Know About the Exchange? Unfortunately, not much at this point. The details are in the regulations, and most of the thousands of pages of expected regulations are not out yet. 3
We Are Not Completely In The Dark The Affordable Care Act provides us with a foundation. We know that: By January 1, 2014, each state shall establish an American Health Benefit Exchange to sell individual and small group major medical policies. By January 1, 2013, the Secretary of Health & Human Services (HHS) will determine whether each state will have an effective mechanism in place to run an Exchange by January 1, 2014, and if not, then the Federal government will step in to run the Exchange for the state. Only qualified health plans offering essential benefits and certified by the Exchange may be offered through the Exchange. 4
Four Levels of Coverage Will Be Available Bronze covers 60% of actuarial value of benefits Silver covers 70% of actuarial value of benefits Gold covers 80% of actuarial value of benefits Platinum covers 90% of actuarial value of benefits 5
Subsidies and Tax Credits Subsidies will be available through the Exchange for individual taxpayers whose household income falls between 100% and 400% of the Federal Poverty Level (FPL). 400% of FPL is approximately $88,000. Therefore, a large portion of Mississippians will be eligible for some level of federal subsidy. This subsidy will equal the difference between a percentage of household income and the second lowest cost silver level plan available through the Exchange. These subsidies will be paid by the Federal government directly to the insurer and will only be available through the Exchange. 6
Individual Mandate In 2014, unless exempt, all individuals must maintain minimum essential coverage or pay a tax penalty. This tax penalty starts out at $95 per year for each covered family member, and eventually increases to $695 per year for each covered family member for 2016 and beyond. 7
Establishment of the Exchange The Exchange should be established as a not-for- profit corporation, created to effectuate the public purposes of the Act but with a legal existence separate from that of the State of Mississippi. 8
Regulatory Authority The Mississippi Insurance Department should have regulatory authority over the Exchange and the authority to promulgate regulations necessary for the implementation and operation of the Exchange in accordance with this Act and any other State and/or Federal law. The Mississippi Insurance Department should have the authority to enforce any State and/or Federal laws concerning the Exchange. Further, the Mississippi Insurance Department should have the authority to investigate the affairs of the Exchange, examine the properties and records of the Exchange, and require the Exchange to provide periodic reporting to the Mississippi Insurance Department. 9
Duties of the Exchange Implement procedures for the certification, recertification and decertification of health benefit plans as qualified health plans; Provide for the operation of a toll-free telephone hotline to respond to requests for assistance; Provide for enrollment periods; Maintain an Internet website through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans and enroll in such plans; Assign a rating to each qualified health plan offered through the Exchange and determine each qualified health plan s level of coverage; 10
Duties of the Exchange Use a standardized format for presenting health benefit options in the Exchange; Inform individuals of eligibility requirements for the Medicaid program under title XIX of the Social Security Act, the Children s Health Insurance Program (CHIP) under title XXI of the Social Security Act or any applicable State or local public program and if through screening of the application by the Exchange, the Exchange determines that any individual is eligible for such program, shall refer that individual to that program so that he or she may be enrolled in said program; 11
Duties of the Exchange Facilitate the purchase and sale of qualified health plans; Establish a Small Employer Exchange through which qualified employers may access coverage for their employees, which shall enable any qualified employer to specify a level of coverage so that any of its employees may enroll in any qualified health plan offered through the Small Employer Exchange at the specified level of coverage; 12
Duties of the Exchange Establish and make available by electronic means a calculator to determine the actual cost of coverage after application of any premium tax credit under section 36B of the Internal Revenue Code of 1986 and any State or Federal cost-sharing reduction; Review the rate of premium growth within the Exchange and outside the Exchange; Determine and process any Federal or State tax credits or other premium support payments for health insurance, as may be established by law; Create advisory committees to the Board consisting of stakeholders relevant to carrying out the activities required under this Act; 13
Duties of the Exchange Meet the following financial requirements: Keep an accurate accounting of all activities, receipts and expenditures and annually submit to the Governor, the Department and the Legislature a report concerning such accountings; In carrying out its activities under this Act, not use any funds intended for the administrative and operational expenses of the Exchange for staff retreats, promotional giveaways, excessive executive compensation or promotion of federal or State legislative and regulatory modifications. Meet the requirements of this Act and fully comply with any and all requirements set by State statutory and regulatory law. 14
Duties of the Exchange: Navigators Select entities qualified to serve as Navigators in accordance with State law and/or Department regulation and enable Navigators to: Conduct public education activities to raise awareness of the availability of qualified health plans; Distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under section 36B of the Internal Revenue Code of 1986 and any cost-sharing reductions; Facilitate enrollment in qualified health plans; however, no person shall receive any form of compensation as consideration for the facilitation of enrollment of any person in a qualified health plan through the Exchange unless that person is an insurance agent that is duly licensed by the Department pursuant to Mississippi Code Annotated 83-17-75; 15
Duties of the Exchange: Navigators Provide referrals to duly licensed insurance agents to facilitate enrollment in qualified health plans; Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint or question regarding their health benefit plan, coverage or a determination under that plan or coverage; and Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange. 16
Funding The Exchange must be self-sustaining by January 1, 2015. The Exchange may charge assessments or user fees to health carriers or otherwise to generate funding necessary to support its operations. 17
Screenshots of eHealthInsurance.com and GetInsured.com 18
