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

After certification, what's next...

The video demonstration of the individuals and families application is available here.

The video demonstration of producer registration and account set up is available here.

IMPORTANT: PPACA—Small group renewals

Q. I have a client with a small group policy that renews on Jan. 1, 2014. This client would like to renew the policy on Dec. 1, 2013, so as to avoid the requirements of the Affordable Care Act. Can I do this?

A. No. According to New York State Insurance Law Section 3221(s) “an insurance producer … shall not permit the renewal of a small group policy that provides hospital, surgical or medical expense coverage that renews on or after Jan. 1, 2014, but before July 1, 2014, so as to renew the same policy prior to the policy’s annual renewal date for the sole purpose of evading the requirements of the Affordable Care Act….” In keeping with Section 3221(s), the New York Department of Financial Services has said that health insurance producers that steer small employer groups toward early renewal of coverage for the sole purpose of avoiding the requirements of the ACA may be in violation of the Insurance Law. Similarly, insurers who early renew coverage for small groups for the sole purpose of avoiding the requirements of the ACA also may be in violation of the Insurance Law.

New York Health Insurance Exchange

As of Feb. 17, 2014, 745,262 completed applications and 456,042 individuals enrolled.

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.

Most plans have envisioned them as a web-based system. 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 are mandated to have an exchange in place by Oct. 1, 2013. If a state fails to do so, the federal Department of Health and Human Services is 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.

In December 2012, New York received conditional approval from the U.S. Department of Health and Human Services for its blueprint application to operate a state-based exchange. This achievement means that HHS has determined New York has made significant progress and is on track with setting up its health benefit exchange. A copy of the letter sent to Gov. Cuomo is available at:
http://healthbenefitexchange.ny.gov/sites/default/files/12-14-12%20Conditional%20Approvel%20Letter.pdf.

The U.S. Department of Labor expects that the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for exchanges. The Department of Labor is considering providing model, generic language that could be used to satisfy the notice requirement. As a compliance alternative, the U.S. Department of Labor also is considering allowing employers to satisfy the notice requirement by providing employees with information using the employer coverage template ... which will be available for download at the exchange website as part of the streamlined application that will be used by the Exchange, Medicaid and the Children's Health Insurance Program.

President Obama’s announcement that large employers won’t have to offer insurance to employees until 2015 will have little effect on New York’s health-care exchange, according to New York officials. As part of PIANY’s work to educate members, and position you for success, PIANY was honored to host Joe Muldoon, director of broker relations for the New York State Health Exchange, in July 2013, who briefed association members on the ongoing establishment of the exchange, as well as the SHOP and individual certification process. A video of the program is available above and here. The PowerPoint slides of his presentation are available here.

In September 2013, Aetna announced that it will not participate in NY State of Health as originally planned. According to Reuters, the Empire State is one of five states where the company has withdrawn from the exchange (other states including Connecticut, Maryland, Ohio and Georgia).

Educating your clients

As the health exchange portion of the Patient Protection and Affordable Care Act goes into effect, agents obtaining certification to sell coverage have voiced concern that insureds may be confused or enticed to seek coverage through the exchanges elsewhere. PIA has created a customizable brochure that explains to your clients that they don't have to look anywhere else. If your agency is certified to guide them in making the right health-care decisions use this brochure, which is suitable for both commercial- and personal-lines clients, to make sure your business stays where you've worked so hard to keep it. For pricing and information, contact PIA's Creative Services Department at snewkirk@pia.org.

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

Agent/broker certification/registration

New York certification course providers
Broker certification steps for SHOP
PIANY health update—I'm now certified through SHOP, what's next?
Agent and broker training outline and summary

Health carrier information

NYSOH issuer by county (individual)
NYSOH issuer by county (small group)
NYSOH simplified Shop rates (individual)
NYSOH simplified Shop rates (family)
NYSOH small group plans by carrier by metal tier

Additional resources

Exchange

NY State of Health
The Official Health Plan Marketplace
nystateofhealth.ny.gov
(855) 355-5777

NYDFS announces 2018 health insurance rates in a continued robust New York market
New York State Department of Financial Services announces 2016 health insurance premium rates, including rates for NY State of Health
Health and dental plans to be offered through NY State of Health Exchange (Aetna has since pulled out of writing through the individual exchange.)
NY Health Benefit Exchange rep explains exchange to agents at PIA
Essential health benefits for the New York Health Benefit Exchange
Business plan of operations—New York Health Benefit Exchange
Update for agents and brokers: New York Health Benefit Exchange
New York Health Benefit Exchange Regional Advisory Committee meetings, May 2013
Fact Sheet: Helping consumers apply and enroll through the marketplace
CMS-9955-F: Patient Protection and Affordable Care Act; exchange functions: standards for navigator 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
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
NAIC consumer alert: State health exchanges: what you need to know to (re)enroll

SHOP

Miscellaneous

HealthCare.gov
New York Health Benefit Exchange: reducing health disparities
New York Health Benefit Exchange study: Healthy New York and the Family Health Plus employer buy-in
HHS Office of Disability update
Health insurance marketplace, July 9, 2013, HHS program
NAIC consumer alert: Understanding the exchange

Health Insurance Tool kit

After certification, what's next...

IMPORTANT: PPACA—Small group renewals

New York Health Insurance Exchange

Educating your clients

QuickSource documents

Ask PIAs

Common forms

Agent/broker certification/registration

Health carrier information

Additional resources

Exchange

Role of agents/brokers

Employee notices

FAQs

Navigators

Statute/regulation/news

SHOP

Miscellaneous

Back to the tool kit index

Health Insurance Tool kit

After certification, what's next...

IMPORTANT: PPACA—Small group renewals

New York Health Insurance Exchange

Educating your clients

QuickSource documents

Ask PIAs

Common forms

Agent/broker certification/registration

Health carrier information

Additional resources

Exchange

Role of agents/brokers

Employee notices

FAQs

Navigators

Statute/regulation/news

SHOP

Miscellaneous

Back to the tool kit index ​​​​​​​

Back to the tool kit index