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The Affordable Care Act and Health Benefits Exchange. 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 . - PowerPoint PPT Presentation
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The Affordable Care
Act and
Health Benefits Exchange
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.
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.
What are Insurance Affordability Programs (IAPs)?
• MAGI Medicaid • KCHIP• Advanced Premium Tax Credits (APTC)
to help pay insurance premiums
• APTC with Cost Sharing Reductions
(CSR) to help reduce out of pocket
costs
Health Benefits ExchangeAs 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”.
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.
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.
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
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
Who Can Assist?
“kynectors” will help individuals and small businesses apply for Qualified Health Plans and Insurance Affordability Programs on the Self-Service Portal.
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.
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
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
May interact with individuals at home or in person
Overseeing Agency
Kentucky Health Benefit Exchange
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:
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.
Roles and Responsibilities
kynector
Family Support worker
Insurance Agent
Customer Service Center (CSC)
Explain what a Health Insurance Plan is x x x xHelp consumers select a Health Insurance Plan xHelp understand Managed Care and choose an MCO x x x xHelp consumers understand which health plans are available to them
x x x xAddress issues concerning applications using the Worker Portal
xUnderstand the roles of other kynect stakeholders x x x x