Your resource for health-care reform, insurance health exchanges/certification and more

New Jersy Health Insurance Exchange

An exchange is, in its simplest form, a portal where a consumer can find information about, compare and contrast health plans. It would offer consumers information on coverages, premiums, deductibles and position them to purchase health coverage.

Exchanges are an integral part of the federal health-care reform measures signed into law through the Patient Protection and Affordable Care Act. All states were mandated to have an exchange in place by Oct. 1, 2013. If a state failed to do so, the federal Department of Health and Human Services was directed to step in and provide exchange services in the state

Exchanges are not a brand-new idea, and are not being created solely at the behest of the new health-care law, and are not associated with any particular political ideology. Indeed, both Massachusetts and Utah created state health exchanges prior to the PPACA in 2006 and 2007, respectively.

The PPACA does not direct states to form exchanges in any specific manner. They may be stand-alone state agencies, divisions of an existing state agency, such as a Department of Health or Department of Insurance. They also may be formed as an independent quasi-public entity.

Gov. Chris Christie gave formal notice to the federal Department of Health and Human Services that New Jersey is opting to put in place a federally administered exchange for plan year 2014. In a letter to HHS Secretary Kathleen Sebelius, the governor affirmed his administration’s commitment to protecting high-quality health-care for New Jerseyans, cooperating with the federal government as an exchange comes online in New Jersey and detailed the many steps taken to improve the excellence in care for all the state’s residents.

Two courts reach different decisions on PPACA subsidies

In a recent ruling that affects the Patient Protection and Affordable Care Act, the U.S. Court of Appeals for the District of Columbia decided that the government can’t give subsidies to anyone buying insurance on the federal exchanges. The federal government has made subsidies available, in the form of tax credits, to people with annual incomes of up to 400 percent of the federal poverty level, or $94,200 for a family of four. In another ruling, a panel of three judges in Virginia reached the opposite conclusion hours later, arguing that, while the language of the law is ambiguous, the IRS had the discretion to write rules for the PPACA.

What this means for agents: If the Washington ruling stands, more than five million people who have signed up for health insurance under the PPACA may not be able to afford the coverage without the tax credits. This ruling also may have an effect on the individual mandate portion of the PPACA. Under the PPACA, individuals are required to purchase insurance or pay a fine. However, individuals can apply for a hardship exemption if health insurance premiums would exceed 8 percent of their household income, a scenario that is more likely if individuals do not have access to subsidies.

QuickSource documents

QS90691—Health-care reform—insurance exchanges FAQ
QS90746—Q&A on health-care exchanges

Ask PIAs

900354-00—Exchanges—broker compensation
900358-00—Producer health exchange certification

Common forms

EBSA’s government-approved model notice (for those with a health plan)
EBSA’s government-approved model notice (for those without a health plan )
Application for health coverage and help paying costs (short form)
CMS forms list
Data change request form and best practices for data change requests
Supplement A to data change request form
State authorization of QHP data change request
2014 Enrollment and payment data template submission certification form
December enrollment and payment data template

Agent/broker certification/registration

Federal SHOP and individual exchange certification training; second portion of certification: https://portal.cms.gov/
Registration process for agents and brokers (Sept. 13, 2013)
Registration process for agents and brokers (Sept. 27, 2013)
General questions about agent/broker registration
CMS FAQ #1—Operational tips for completing agent and broker registration for the Federally Facilitated Marketplace registration
Agent and broker training outline and summary
Agent and broker training and registration process for the FFM: quick reference guide
Registering to participate in the Federally Facilitated Marketplace for the 2015 plan year

Additional resources

HealthCare.gov
Federal health insurance marketplace training (in the organization field, the phrase needed is MARKETPLACE)
Fact Sheet: Helping consumers apply and enroll through the marketplace
CMS-9955-F: Patient Protection and Affordable Care Act; exchange functions: standards for navigators and non-navigator assistance personnel; consumer assistance tools and programs of an exchange and certified application counselors
HHS, SBA and IRC joint website on health-care changes for employers
Frequently asked questions about private exchanges
CMS bulletin to marketplaces on availability of retroactive advance payments of the PTC and CSRs in 2014 due to exceptional circumstances
NAIC consumer alert: Insured, but no proof: what to do if you haven't received your proof of insurance coverage
Resources for agents and brokers in the health insurance marketplace
Plan management for plan year 2015
Qualified Health Plan notices and question-and-answer session for issuers
Qualified Health Plan application resubmission tips
CMS bulletin on affordable exchanges guidance
NAIC consumer alert: State health exchanges: what you need to know to (re)enroll
CMS Bulletin #14: Guidance for issuers on 2015 reenrollment in the federally-facilitated marketplace

SHOP

Miscellaneous

HealthCare.gov
New Jersey Individual Health Coverage Program carriers
HHS Office of Disability update
Health insurance marketplace, July 9, 2013, HHS program
IRS completes health penalty rules for noncompliance
NAIC consumer alert: Understanding the exchange
CMS health insurance casework system for issuers (Dec. 19, 2013)

Health Insurance Tool kit

New Jersy Health Insurance Exchange

Two courts reach different decisions on PPACA subsidies

QuickSource documents

Ask PIAs

Common forms

Agent/broker certification/registration

Additional resources

Role of agents/brokers

Employee notices

Department bulletins/news

FAQs

Navigators

Statute/regulation

SHOP

Miscellaneous

Back to the tool kit index

Health Insurance Tool kit

New Jersy Health Insurance Exchange

Two courts reach different decisions on PPACA subsidies

QuickSource documents

Ask PIAs

Common forms

Agent/broker certification/registration

Additional resources

Role of agents/brokers

Employee notices

Department bulletins/news

FAQs

Navigators

Statute/regulation

SHOP

Miscellaneous

Back to the tool kit index ​​​​​​​

Back to the tool kit index