Now that you’ve enrolled in a health plan through NY State of Health, you may have some questions about how to use your health plan coverage. Here are some resources with answers to the questions you may have:
On December 16, 2011, the U.S. Department of Health and Human Services (HHS) released a bulletin on the essential health benefits. The purpose of this bulletin is to provide information and solicit comments on the regulatory approach that HHS plans to propose to define essential health benefits under the Affordable Care Act. This primer document describes the key features of the essential health benefits described in the bulletin.
On September 14, 2011, the U.S. Department of Health and Human Services (HHS) issued a request for information regarding the Basic Health Plan option. This option permits States to enter into contracts to offer one or more "standard health plans" providing at least the essential health benefits to eligible individuals in lieu of offering such individuals coverage through the Exchange. Comments were due to HHS by October 31, 2011.
On July 15, 2011, the U.S. Department of Health and Human Services (HHS) issued a proposed rule to implement the Exchanges, which will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.
On July 15, 2011, the U.S. Department of Health and Human Services (HHS) issued a proposed rule on the reinsurance, risk corridors, and risk adjustment programs. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Exchanges are implemented, starting in 2014. Comments were due to HHS by October 31, 2011.
On August 17, 2011, the U.S. Department of Health and Human Services (HHS) issued a proposed rule regarding specific Exchange functions, including eligibility determinations for Exchange participation and insurance affordability programs and standards for employer participation in SHOP. Comments were due to HHS by October 31, 2011.
On August 17, 2011, the Internal Revenue Service (IRS) issued a proposed rule on the health insurance premium tax credit. These proposed regulations provide guidance to individuals who enroll in qualified health plans through Exchanges and claim the premium tax credit, and to Exchanges that make qualified health plans available to individuals and employers. Comments were due to IRS by October 31, 2011.
On August 22, 2011, the U.S. Department of Health and Human Services, the U.S. Department of Labor, and the U.S. Department of the Treasury issued a proposed rule on the summary of benefits and coverage and the uniform glossary. These proposed regulations relate to the disclosure of the summary of benefits and coverage and the uniform glossary for group health plans and health insurance coverage in the group and individual markets under the Patient Protection and Affordable Care Act.
On July 20, 2011, the U.S. Department of Health and Human Services (HHS) issued a proposed rule that would implement the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the Exchanges. Comments were due to HHS by September 16, 2011.
Despite the ACA’s recognition that effective enrollment and consumer assistance is an essential component of health reform, important design questions about the Navigators and CAPs remain unanswered and must be resolved for New York to move forward: What should be the core functions of Navigators and CAPs in New York? How should New York structure and administer its Navigators and CAPs to maximize integration and avoid duplication of efforts? How should New York leverage existing enrollment and consumer assistance resources into the Navigators and CAPs?