The Patient Protection and Affordable Care Act has mandated each state in the country establish a health insurance exchange that will make purchasing coverage faster and more efficient for individuals and employers. The exchanges will offer insight into health insurance products, services and frequently asked questions, while offering an online store through which coverage can be purchased.
Many states have struggled to meet recent deadlines regarding the mandate, unable to decide upon essential health benefits that must be offered by all health insurance plans available through the exchange. The federal government’s healthcare reform law outlined some basic benefits that must be covered by the plans, but more detailed explanations have been left in the hands of the states. Some governments are finding this to be a burden, while others are openly embracing the project.
Maryland and Utah have already selected their state employee health coverage that will act as the benchmark for the essential benefits in the exchange. The benchmark plan offers 10 categories of care, including emergency services and prescription drugs that must be covered by the insurance plans. The two states were among 21 others that have selected a benchmark plan for the exchanges, while eight states are still selecting their essential benefits and three are refusing to select a benchmark at all. A remaining 17 states have not indicated what they will do regarding the exchange mandate. Maryland and Utah are the only two states that are using their state employee health plan to act as the benchmark for all other coverage offered.
According to the U.S. Department of Health and Human Services, each state can select one of four different options when determining a benchmark. The state can go with an established state employee plan, select one of the three largest small-group plans active in the state, the largest HMO plan in the state or one of the federal employee plans. From there, insurance providers in the state must meet the benchmark requirements when submitting plans to the online shopping portal.