The Whitehouse defines a health Exchange as a ‘marketplace that will offer affordable high-quality health insurance options. It will provide relief to families who have no insurance or do not get adequate insurance at work and cannot afford to buy it in the costly individual or small group market. It is also for small businesses that cannot afford small group health insurance. It is one-stop shopping that will enable you and your family to find a plan that is right for you.’
This sums up the basic purpose behind establishing a health Exchange. However providing affordable healthcare is not the only reasons why millions of dollars are being invested in these state based online platforms. The Exchange will have several other functions as well, each of which is a step towards bringing more regulations to the health insurance sector.
The functions of a state health insurance will include:
1. Foster competition among the insurers that will ensure that it is the consumers who get the best rates and the maximum services. All the costs and services would be listed in an organized manner that will make comparison across plans easier for the consumers.
2. An Exchange is also required to provide transparent and authentic information about plans, premiums, coverage, benefits, and the like.
3. For those who do not have access to any sort of assistance, the Exchange will facilitate enrollment in a plans and payment of premiums. It could serve as a portal where applicants can check their eligibility for plans and subsidies.
4. By purchasing health plans from the Exchange, the beneficiary would be able to retain his coverage even when he is between jobs. Delinking employment from the Exchange would ensure that people have access to medical policies no matter at their employment status is.
5. The Exchange will play a key role in the implementation of the healthcare reforms by bringing in more regulations.
6. Will have to inspect policies to ensure that they adhere to the standards set by the government and are in the best interest of the consumers
7. Though it has no power to decide premiums but it must ask carriers to justify the hike in rates. If the Exchange is unsatisfied with the explanation, it has the right to ban a carrier from displaying its products on the insurance platform.
8. The Exchange will provide resources so that people who do not have access to the Internet can get information through mails and community announcements.
9. Must use standard form, definitions and marketing materials. The residents should have the option to enroll online, or over the phone, by mail or in person.
10. A dedicated call center, which will be an integral part of the Exchange, will provide relevant information and clarify the doubts of residents, navigators, agents, health insurance companies and anyone who calls up to know more about health insurance plans and health insurance Exchange.
Though the federal government initially wanted to form a national exchange, it was finally agreed to set up individual Exchanges for each state. However, these states may soon be interlinked which will the residents more freedom of portability and more options of health plans to choose from.