Many Patient Protection and Affordable Care Act (PPACA) health insurance exchange (HIX) agencies have started posting answers to questions from insurers, brokers and the general public on their websites.
Managers of the Nevada Silver State Exchange have added a set of answers to carrier questions to the Q-and-A supply.
PPACA requires states and the U.S. Department of Health and Human Services (HHS) to set up exchanges, or Web-based health insurance supermarkets, in all 50 states and the District of Columbia by Oct. 1.
Nevada is setting up its own exchange and lining up insurers willing to provide the “qualified health plans” (QHPs) to be sold through its exchange.
Carrier representatives asked about topics such as the mechanics of how premiums will get from the customers to the exchanges; how someone will verify whether applicants for various types of plans are eligible for the coverage they are seeking; and what will happen when something goes wrong.
Carriers asked, for example, how customers will pay any “per member, per month” (PMPM) fees that they must pay.
“The exchange will deduct the PMPM fee from the premium payment before sending payment to the carrier,” exchange managers said. “All exchange PMPM fees must be built into QHP rates.”
That answer holds both for individual plan rates and for the Small Business Health Options Program (SHOP) small-group rates, managers said.
Carriers also asked about customers who fail to pay their premiums, or fail to pay as much as they are supposed to pay, by the end of the grace period.