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The Affordable Care Act and Health Benefits Exchange.

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Presentation on theme: "The Affordable Care Act and Health Benefits Exchange."— Presentation transcript:

1 The Affordable Care Act and Health Benefits Exchange

2 What is the Affordable Care Act? The ACA put in place many reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law guarantees access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care.

3 What is the Affordable Care Act? The ACA also requires individuals to have health insurance coverage beginning in 2014 and introduces new Insurance Affordability Programs (IAPs) that provide tax credits and cost sharing reductions to eligible individuals.

4 What are Insurance Affordability Programs (IAPs)?

5 Health Benefits Exchange As part of the requirements of the ACA, individuals and small businesses have access to a Self Service Portal (SSP) to apply for IAPs and shop for and purchase affordable Qualified Health Plans (QHPs) through an Exchange. Kentucky’s Health Benefits Exchange is known as “kynect”.

6 What is kynect? kynect is essentially a marketplace. It will serve individuals, families and small employers and provide access to a range of health coverage options. Individuals can enroll in a Qualified Health Plan (QHP) or MAGI Medicaid on kynect. kynect will certify that all health plans sold meet federal requirements.

7 What is kynect? The kynect system will identify Insurance Affordability Programs for which the consumer may be eligible. QHPs are displayed in a “shop and compare” format based on price, benefits, quality, and other features.

8 What is kynect? Through kynect individuals can: Get answers to questions Compare health insurance plans Find out eligibility requirements for Medicaid, KCHIP, tax credits and Cost Sharing Reductions Enroll in Medicaid, KCHIP or an insurance plan

9 DCBS Roles & Responsibilities Explain what a Health Insurance plan is Help understand Managed Care and choose an Managed Care Option Address issues concerning applications using the worker portal Understand the roles of other kynectors

10 Who Can Assist? “kynectors” will help individuals and small businesses apply for Qualified Health Plans and Insurance Affordability Programs on the Self- Service Portal.

11 Who Can Assist? kynectors are entities that meet the federal requirements of the Navigator program: Maintain expertise in Exchange eligibility, enrollment, and programs Provide information services in a fair, accurate, and impartial manner Help with enrollment in health insurance plans Provide referrals to other agencies as needed, such as health insurance Consumer Assistance Programs or Ombudsman, State agency for complaints, questions, etc.

12 kynector Roles Role Responsibility Navigator (starting in 2015) In-Person Assistor (IPA) Certified Application Counselor (CAC) Personal advising Cannot guide an individual towards a given plan May offer personal guidance in regards to plans available Level of involvement Personal involvement, but no at-home visits May interact with individuals at home or in person Overseeing Agency Kentucky Health Benefit Exchange Kentucky Health Benefit Exchange, DMS, KHBE Designated Employees The three kynector roles of Navigator, IPA, and CAC have important differences in responsibilities:

13 The Role of Insurance Agents Health insurance agents represent an individual or small business in the solicitation, negotiation, or procurement of insurance policies. Agents have a duty to the individual or small business seeking coverage to match their insurance needs with proper products and options available.

14 Roles and Responsibilities kynector Family Support worker Insurance Agent Customer Service Center (CSC) Explain what a Health Insurance Plan is xxxx Help consumers select a Health Insurance Plan x Help understand Managed Care and choose an MCO xxxx Help consumers understand which health plans are available to them xxxx Address issues concerning applications using the Worker Portal x Understand the roles of other kynect stakeholders xxxx

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