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Additional Benefits of the State Health Insurance Exchange


Additional Benefits of the State Health Insurance Exchange

The Patient Protection and Affordable Care Act make it compulsory for all states to have health insurance Exchange by the year 2014. There are certain guidelines that these Exchanges have to follow to be eligible for federal funding. However, the health reforms have only drafted a basic skeleton. The details have been left to individual states so that they can mold it according to the state specific regulations and the needs of the residents.

However, there are certain add-ons that would certainly make Exchange a better insurance market place. Though these features are not compulsory according to the federal insurance regulations, most of the Exchanges are expected to incorporate it on their insurance platforms.

One such feature would be some sort of decision support mechanism. The Exchange will be a multi-carrier kiosk which means innumerable number of health plans. The consumer might be spoilt of choices but this unlimited number of choices could also lead to a lot of confusion about picking the right plan. This is where the decision support mechanism will come into a play. Based on the basic information provided by the resident and a perhaps a few additional questions, the Exchange will recommend a few plans across carriers. The resident can then pick a health plan from the shortlisted options.

Another such add on would be the direct transaction between the health insurance company and the consumer. A consumer would be able to pay for his medical coverage directly to the insurance company. This will result in the faster processing of applications, the consumer would be able to get his coverage faster and the fear of scams by the middlemen would be eliminated. The consumer will be able to purchase or renew his policies whenever he wants, at his convenience of date, time and place.

The online portal would also ensure that there is a single, integrated system that can automatically carry the customer from enrollment at the exchange, to ID card generation, and to post-sale service. Since customers are using the internet, they would expect instantaneous results. And with so many insurance companies trying to outdo each other, the competition to provide faster and better service will only get intensified.

Since the new regulations will prohibit the insurance companies from charging more for those who have pre-existing conditions or deny them coverage completely, insurance companies will soon have to come up with new tools to know the health status of the applicants. This would include tools such as health risk assessments, personal health records, behavioral analytics, etc. The more the insurance company takes the general well-being of its client, the better are its chances of staying away from remunerating their huge medical bills.

Health Exchange across the fifty states will have the same basic structure. However, it is these add-ons and how effectively they are amalgamated into the platform that will form the essential distinguishing factor.

The state administrators will try to incorporate the maximum basic and additional features so that for the residents of that state, buying health plan from the Exchange is a truly pleasurable and hassle-free experience.