Formerly called the “health benefits exchange,” the Health Insurance Marketplace (HIM) is a virtual insurance megamall that will operate in each state. It is an avenue for individuals, families, and small employers (with 50 or fewer employees) to shop for, select, and enroll in qualified private health plans that meet their specific needs. This type of marketplace may sound as if it already exists online; however, the plans offered through the HIM must meet certain regulatory requirements not currently required of plans. The HIM is also a place where individuals can determine eligibility for health insurance premium subsidies and cost-sharing reductions or for other state or federal public health programs such as Medicaid.
Arkansans can access the HIM via the Arkansas Health Connector at www.arhealthconnector.org. Enrollment for individuals, families, and employers in health care plans via the Arkansas Health Connector is scheduled to run from October 1, 2013 through March 31, 2014. Plan coverage will begin January 1, 2014. Individuals may also enroll via paper application, phone, or with the help of trained and licensed assistors.
The HIM has established tiers (bronze, silver, gold, and platinum), which are ways to categorize plans based on “actuarial value.” Actuarial value (AV) measures the relative generosity of the health plan’s coverage of essential health benefits. A plan’s AV indicates the share of medical spending paid by the plan rather than being paid out-of-pocket by the consumer (such as deductibles, coinsurance, co-payments, and out-of-pocket limits), measured across a covered population. The AV required by tier is as follows: bronze (60 percent), silver (70 percent), gold (80 percent), and platinum (90 percent). There are no annual or lifetime caps on expenditures for these plans, and beneficiary out-of-pocket costs for 2014 are capped at $6,350 for an individual and $12,700 for a family. Those totals include copayments and deductibles but not premiums.
The HIM will offer plans that cover essential health benefits including items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
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