Milestone: Define the health plan selection strategy of the Exchange
A strategy for determining which health plans will be offered in the Exchange helps the state assure that plan selection will be aligned with overall goals for the Exchange and will ensure a competitive, consumer-friendly marketplace.
*Full name: Define the health plan selection strategy of the Exchange.
*Relevance to the ACA:
The ACA specifies that states may certify plans that meet the Secretary’s criteria for certification and that the Exchange determines are in the interest of “qualified individuals and employers.” This allows the Exchange additional discretion over the plans it selects to offer. Sections relevant to plan selection include:
§1311 - Requires Exchanges to implement procedures for certifying, recertifying and decertifying health plans in the Exchange.
§1312 - Requires insurers to create a single risk pool inside and outside the Exchange for each market (individual and small group). Provides state flexibility to merge these markets, continue state benefit requirements, and continue operating a market outside the Exchange.less