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Private exchange firms seek PPACA exchange links

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The government has set up the Patient Protection and Affordable Care Act (PPACA) public health insurance exchange (HIX) system.

Private companies are setting up private health insurance exchange systems.

In many cases, the public HIX and private HIX worlds are converging. The PPACA exchanges usually use private exchange system vendors to build and run their exchange systems.

Now the private exchange companies are expanding efforts to connect with the public exchange system.

The managers of the, and retail health insurance sales sites are just three of the retail vendors that have been certified as “Web broker entities,” and the managers of the Quotit quotation and enrollment systems for brokers have also gotten certified.

Towers Watson, a big private exchange organizer, was talking about seeking Web broker entity status more than a year ago, and it actually signed a Web broker entity agreement in August 2013. It and the retail Web brokers have started the Association of Web-based Health Insurance Brokers (AWHIB).

An exchange system developer, hCentive, announced that it had achieved Web broker entity status in October.

Robin Babu, the director of exchanges at another company, PlanSource, said in an interview that his company — which provides the systems powering Utah’s highly regarded, pioneering Avenue H Small Business Health Options Program (SHOP) exchange — is evaluating the Web broker entity certification process.

See also: His company scares public exchange managers.

PlanSource wants the private exchanges it runs for large and midsize employers to be able to automate the process of helping workers who are not eligible for an employer-sponsored major medical plan to apply for public exchange plan coverage.

Babu said the managers of his company have been involved with health insurance and electronic benefits sales systems for about 25 years. Its OneMarket Exchange program and PlanSource Advantage administration platform program have relationships with companies such as Aetna, Anthem, Assurant, Guardian, Lincoln and the Standard.

The managers of the public exchange went through well-publicized struggles to get up and running.

“We have been through that before,” Babu said.

What could convergence of the public exchange and private exchange worlds mean for benefits agents and brokers? For some ideas, read on.


1. Everyone wants a slice of your ancillary benefits business.

The PPACA public exchanges The U.S. Department of Health and Human Services (HHS) has said that state-based PPACA public exchanges can generate revenue by sending users to ancillary benefits sales partner websites, as long as the public exchange sites warn the consumers that the consumers are leaving the public exchange sites.

Some state exchanges have already talked about setting up partnerships with ancillary benefits marketers.

Babu said PlanSource could set up that kind of system for Avenue H with the flip of a switch.

 Blue flowchart

2. You may find that you start to care more about exchange platform compatibility than insurer brand names.

Managers of the public exchange programs have talked openly, and at length, about the folly of trying to send a family multiple bills for multiple products purchased through a public exchange.

Of course, employers and workers are no more fond of getting multiple bills than public exchange plan users are.

See also: HCA on PPACA: Let Exchange Plans Handle Billing.

You, and your clients, may find themselves choosing carriers that are “almost right” — if the almost-right carriers have products on the same exchange system that the clients’ other carriers use, and the exchange system will send just one simple bill. 

Another challenge, for you, may be avoiding deals that somehow lock you into using the wrong systems. Exchange system preferences could change quickly. 

 Two people behind a computer

3. You will still be a live human in a flesh-and-blood office.

The public exchange had all that money and all that publicity — and they are finding that getting rid of brick and mortar, and flesh and blood, is a lot harder than most exchange starters had imagined.

Covered California, for example, recently reported in an executive director’s presentation that 46 percent of its business is coming from certified exchange agents this year, up from 39 percent last year. Only 29 percent of that state-based public exchange program’s enrollees are coming in by buying coverage on their own, through the Web, down from 41 percent last year.

See also: What H&R Block says about PPACA.

CORRECTION: Robin Babu’s name was spelled incorrectly in an earlier version of this article.