State Health Insurance Exchanges
Reform Article #4 - Burning Health Care Reform Questions:
What Should I Know about State Health Insurance Exchanges?
You probably have heard that individuals and companies will be able to purchase health insurance through state exchanges in 2012. While this situation is evolving — with only 14 states passing legislation to create an exchange to date — here is what you should know now as a restaurant owner.
Who Can Buy Coverage on an Exchange?
Two groups will qualify. The first is people with income of up to 400 percent of the federal poverty level. In 2011, that would be $73,240 for an individual and $89,400 for a family of four. They will receive a premium credit to buy health care there. The second is companies with fewer than 100 employees. (This will expand to 100 or more employees in 2017.)
What Benefits Will Exchanges Offer?
The goal of each state exchange is to help these two groups to find and compare affordable, quality health insurance options. The exchanges are expected to offer two benefits.
Lower Costs:
This should happen as exchanges educate consumers on their choices and costs, “pool” the purchasers (so small businesses get the buying power of larger companies), and increase competition among private insurance plans that want to serve these customers.
One-stop Shopping:
The exchanges should make purchasing easier by providing people and businesses with tools to compare benefits, pricing and quality. Exchange users will also have access to a wide range of customer assistance benefits — including information about prices, quality, and physician and hospital networks—to help them make the best choice for themselves, their families and their employees.
How Will Exchanges Work?
So far, four different models have emerged:
- Information aggregators deliver bare-bones capabilities to meet legislative requirements. Enrollment transactions are passed on to each health plan’s website.
- Retail-orientation creates a retail shopping experience with lots of service capabilities. It offers a wide range of products that vary by price, design and the amount of assistance to consumers.
- Guided exchanges use a competitive selection process to limit the number of carriers, whose products may be standardized. This may be a short-term approach for states that are short on funding.
- Market curators offer a robust end-to-end consumer experience — including shopping, enrolling and extensive customer service — while limiting the number of carriers through a competitive selection process.
One thing that is certain, is that enrollment in state exchanges will begin in October 2013.
Health Care Education Resources for Restaurants
There are many moving pieces to this legislation, which will continue to evolve over the next year and a half (and probably well beyond that). The National Restaurant Association is committed to helping you get the facts about health reform as new rules are defined and implemented. Please visit the NRA Health Care Knowledge Center at www.restaurant.org/healthcare to stay informed on other changes as they occur.
In addition, UnitedHealthcare and the National Restaurant Association have created the Health Insurance Options Center. If you would like individualized assistance with evaluating your options for health insurance, speak to our dedicated restaurant team at 800-293-0105 or visit www.restauranthealthcare.org.
UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., or their affiliates. The content provided is for informational purposes only. This communication is not intended, nor should it be construed, as legal or tax advice. Please contact a competent legal or tax professional for legal advice, tax treatment and restrictions. Federal and state laws and regulations are subject to change.
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