The builders of the District of Columbia Health Benefit Exchange program are holding detailed discussions about how the exchange managers ought to determine exactly what plans the exchange will sell.

D.C. Health Benefit Exchange Authority staffers, advisory panel members and commenters talk about some of the considerations in documents posted on the authority website.

In a batch of plan offering working group recommendations, for example, a working group notes that it is looking at questions about matters such as the number of plans that each participating issuer should be able to issue at each level of coverage, and whether the exchange should require that each plan that an issuer offers have “meaningful differences” from other plans sold through the exchange.

The working group also has been talking about whether issuers should be able to offer benefits other those included in the required essential health benefits (EHB) package.

The Patient Protection and Affordable Care Act (PPACA) requires the federal government and states to set up exchanges, or health insurance supermarkets, for individuals and small groups by Oct. 1, and for non-grandfathered individual and small plans to cover a standard EHB package.

In some cases, the working group says, the health insurance brokers and insurer representatives on the panel could not agree with the consumer and employer representatives on what position to take.

When the panel considered whether an exchange issuer ought to show that the plans it was offering through the exchange had meaningful differences, a majority of the broker and insurer reps opposed the requirement, while a majority of the employer and consumer reps supported the requirement, the working group says.

Some of the individual and consumer interest reps think that letting insurers offer too many different overly similar products through the exchange could lead to unnecessary confusion.

Insurer reps, on the other hand, “stated that there is no reason to place further restrictions on insurers,” the working group says.

PPACA and exchange rules likely already will lead to reductions in the number of plan designs that insurers offer in the District of Columbia, the working group says.

In some cases, however, all working group members, including the three health insurance brokers on the panel, could agree on a recommendation, the working group says.

When it comes to letting an issuer offer extra benefits, there was a unanimous recommendation from working group members that yes, insurers should be allowed to add benefits to EHBs,” the working group said. “Few concerns were expressed by members.”

Some working group participants originally wondered whether issuers could end up attracting or scaring off the sicker enrollees by offering extra benefits, but the panel members agreed that adding benefits that require a claim submission are unlikely to lead to antiselection, the working group says. 

“The working group was silent on whether other benefits, such as discounted or free gym memberships and wellness programs, should be permitted,” the working group says. “Members want to be clear to the board that the working group did not take a position on these other plan offerings.”

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