x - DCBS Training Branch

Report
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)?
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”.
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 SelfService 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
The three kynector roles of Navigator, IPA, and CAC
have important differences in responsibilities:
Role
Responsibility
Personal
advising
Level of
involvement
Overseeing
Agency
Navigator
(starting in
2015)
Cannot guide an
individual towards
a given plan
Personal
involvement, but
no at-home visits
Kentucky Health
Benefit Exchange
In-Person
Assistor (IPA)
Certified Application
Counselor (CAC)
Cannot guide an
individual towards
a given plan
May interact with
individuals at home
or in person
May offer personal
guidance in regards to
plans available
May interact with
individuals at home or
in person
Kentucky Health
Benefit Exchange
Kentucky Health
Benefit Exchange,
DMS, KHBE Designated
Employees
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
Family
Customer
Insurance
kynector Support
Service
Agent
worker
Center (CSC)
Explain what a Health
Insurance Plan is
Help consumers select a
Health Insurance Plan
Help understand Managed
Care and choose an MCO
Help consumers
understand which health
plans are available to them
Address issues concerning
applications using the
Worker Portal
Understand the roles of
other kynect stakeholders
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x

similar documents