Because insurance offered in the Exchange will be paid for by individuals, businesses, federal tax credits, and possibly states, establishing billing procedures and responsibilities is critical to Exchange operation and to minimizing administrative costs.

*Milestone details:

*Full name: Develop enrollee billing procedures and allocate responsibilities among the Exchange, employers (for the SHOP exchange), and qualified insurance plans.

*Relevance to the ACA:

The ACA contains both requirements and options for premium payments and credits. Relevant sections include:

§1312- Allows, but does not require, individuals enrolled in a qualified health plan through the Exchange to pay their premiums to the plan.

§1401- Establishes a refundable premium tax credit for individuals with incomes at or below 400% FPL. The Secretary of HHS also is required to issue regulations for how the tax credit coordinates with the advance payment program and for any reconciliation procedures.

§1412- Establishes the advance premium tax credit and procedures. An Exchange has the authority to request advance determination of the tax credits from the Secretary of HHS. The Secretary of HHS then must notify the Exchange and the Treasury of the determinations, and the Treasury must send the advance payments to the insurer. This section also provides that states have the flexibility to provide additional premium or cost-sharing assistance to or on behalf of individuals enrolled through the Exchange.