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Delaware: Exchange plan applications due June 30

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The Delaware Health Benefit Exchange is getting ready to take applications from carriers that want to use it to sell coverage.

The Web-based health insurance supermarket hopes to start accepting certification applications from “qualified health plans” (QHPs) March 28 and close the application process June 30.

The Delaware exchanges hopes to get final QHP approvals from the U.S. Department of Health and Human Services (HHS) by early September.

Carriers can submit their applications through the HHS Health Insurance Oversight System (HIOS) website.

Crystal English and Linda Nemes, Delaware regulators, talked about the exchange plan application process recently during a workshop held for prospective exchange coverage issuers. 

The Patient Protection and Affordable Care Act (PPACA) calls for states and federal agencies to work to provide exchange services, or Web-based health insurance supermarkets, for eligible individuals and small businesses in all states by Oct. 1.

A state can run its own exchange system, let HHS provide exchange services for its residents, or work with HHS to run a partnership exchange. The exchange program will run separate markets for individuals and small groups.

Delaware is joining with HHS to set up a partnership exchange. Delaware will take charge of exchange plan and consumer relations. It will let the government run a reinsurance program that is supposed to protect health insurers that attract unusually high-risk enrollees.

The state has a population of about 898,000, including 100,000 uninsured residents and 193,000 Medicaid enrollees, according to a written version of the presentation English and Nemes gave. Officials have estimated that the Delaware exchange could serve about 35,000 people.

The top three goals are improving access to affordable health insurance for Delaware residents; achieving financial stability without hurting carrier selection or the cost of coverage in the commercial insurance market; and helping small employers buy coverage for their employees.

The fourth goal is to “implement a model that harmonizes with the broker community.”

Delaware exchange managers are hoping that exchange plans will serve the entire state and offer provider networks that meet Medicaid and state Department of Public Health standards.

A plan must provide at least one full-time primary care provider for every 2,000 patients, and at least one primary care provider office within a 30-minute drive of each member’s place of residence. The network providers must meet state appointment access standards. 

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