Health insurance exchange rules finalized

15 March 2012

The U.S. Department of Health and Human Services (HHS) released new rules for health insurance exchanges that outline the minimum standards states must meet in establishing and operating their exchanges. The rules also outline the minimum standards for health insurers and employers. A health benefits exchange is a marketplace where individuals and small groups could compare health plan benefits and costs, as well as purchase insurance products; it is a key component of health reform implementation.

The rules give states flexibility in the design and operation of their exchanges, enabling states to build exchanges that work for their residents. Through the rules, starting in 2014, exchanges will include information on certifying qualified health plans, operating a Web site for comparing plans, running a toll-free hotline for consumer support, providing grants to "navigators" to assist consumers, determining eligibility of consumers and helping consumers enroll.
 
In 2011, Sec. of Health and Human Resources William A. Hazel Jr., M.D. indicated that the McDonnell administration did not think that legislation was necessary this session to create a benefits exchange in Virginia. Sec. Hazel said that the administration was planning for an exchange and awaiting federal guidance. Gov. Bob McDonnell indicated that he wants Virginia to operate its own exchange, but only if the U.S. Supreme Court upholds the federal mandate that all individuals purchase health insurance under the Affordable Care Act (ACA). If Virginia has not received conditional approval for an HBE from the U.S. Department of Health and Human Services (HHS) by the end of 2012, HHS will implement a federally-run exchange in Virginia in 2013.

The rule is effective 60 days after publication in the Federal Register. Click here for more information or click here for the full text of the health exchange rule from the Federal Register.