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Government unveils rules for state Health Insurance Exchanges Posted: July 14th, 2011

By Maryalene LaPonsie

One major provision of federal health care reform, the individual health insurance mandate, is scheduled to go into effect in 2014. At that time, all residents of the United States will be required to maintain medical coverage or face fines at tax time.

To help individuals find affordable health insurance, Health Insurance Exchanges will be created by every state and the U.S. territories. This week, the Department of Health and Human Services (HHS) published a framework to guide states in the creation of exchanges. Among the required elements of the Health Insurance Exchanges:

  • Search function capabilities
  • Standardized comparison information on available health plans
  • Ability to apply and enroll in qualified health insurance policies
  • Navigation program to assist individuals and small businesses searching for medical insurance
  • Accessible information for those with limited English proficiency, disabilities or low literacy levels

To be included in a Health Insurance Exchange, a health insurance policy must be certified as a "qualified health plan." Before certifying policies, Health Insurance Exchanges must ensure minimum coverage standards are met, and the health plans must be of interest to individuals and small businesses.

In addition to providing access to medical insurance, the state-run exchanges will help applicants determine whether they are eligible for government programs such as Medicaid or the Children's Health Insurance Program (CHIP). Applicants will also be provided information on advance premium tax credits or other available cost-sharing reductions.