Health Insurance Exchanges – Employer Coverage Tool

The Affordable Care Act (ACA) calls for the creation of state-based competitive marketplaces, known as Affordable Health Insurance Exchanges (Exchanges), for individuals and small businesses to purchase private health insurance. ACA requires the Exchanges to become operational in 2014. According to the Department of Health and Human Services (HHS), the Exchanges will allow for direct comparisons of private health insurance options based on price, quality and other factors, and will coordinate eligibility for premium tax credits and other affordability programs.

On April 30, 2013, HHS released three simplified and shortened versions of Exchange applications that will be used by individuals seeking to enroll in health insurance coverage through an Exchange in 2014. HHS has also included an Employer Coverage Tool that Exchanges will use to verify employer-sponsored coverage.

• The application for individuals who are applying for affordability programs is five pages long and will be used by single adults who are not eligible for employer-sponsored coverage.
• The application for individuals who are not applying for affordability programs is also five pages long and can be used by anyone who is not eligible for premium tax credits, cost-sharing reductions, Medicaid or CHIP coverage.
• A longer, 12-page application for those who are applying for affordability programs is also available for families and single adults who are offered coverage through an employer. The Employer Coverage Tool can be found in Appendix A (at the bottom) of this application.

These applications will be used in states with a federally facilitated Exchange (FFE). States that are operating their own Exchanges will have the option of using these applications or developing their own.

Enrollment in the Exchanges for eligible individuals and small businesses is expected to begin on Oct. 1, 2013.

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