Private Health Insurance Exchange announced for State Bar members.

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Private Health Insurance Exchange announced for State Bar members.

Georgia Bar Journal | December 2013 | Volume 20| Number 3 (this article has been edited to update certain dates)

By: Georgia Bar Journal Staff

Jan. 1, 2014, will mark the enactment date for many key features of the Patient Protection and Affordable Care Act. Open enrollment in state and federally run public exchanges has already begun around the country, establishing a new marketplace for individuals and small businesses to purchase coverage. The new law also transforms the health insurance market for individuals, requiring carriers to guarantee coverage without exclusions for pre-existing conditions and mandating coverage meet certain criteria.

Because Georgia opted out of building a state-run exchange, the federal government is operating the public exchange in Georgia. The website HealthCare.gov, managed by the U.S. Department of Health & Human Services contains information on how the Affordable Care Act will affect you. One tool on this site, Find Insurance Options, will help you find health insurance options through a series of question-and-answer prompts. The other, Timeline, tells what’s changing and when. Since Oct. 1, the site has provided information about all the plans available in your area and offered a self-enrollment process, directly through the website, or by calling a toll-free phone hotline.

Through your membership in the State Bar of Georgia, you now have access to a private exchange offered by Member Benefits Inc., the recommended broker of the State Bar for health insurance. The private exchange is an online marketplace where members and their employees, can compare and purchase products and services from insurance providers that compete for business within the exchange.

Unique decision support technology within the exchange is backed by licensed benefits counselors that specialize in working with association members. Member Benefits also takes additional steps to provide assistance for members and their staff in accessing reduced costs through the public exchange in the event that you qualify. Also included in the exchange are specially priced ancillary product options such as dental, vision, disability, life and more.

The exchange consists of two components:

The Individual Marketplace provides members and small firms (less than five employees) with the ability to create and manage their own individual benefits portfolio comparable to those currently offered by large employers. Decision support tools, recommendation algorithms, educational videos, and provider search tools guide participants through the process and assist in choosing a plan that meets their families’ needs.

The Small Employer Exchange, available to groups with five to 49 employees, includes many of the features of the Individual Marketplace and allows employers to compare individual health plans with their current group plan. Employers then setup and manage a fixed-dollar healthcare allowance for its employees. Employees then use that money to purchase insurance through the exchange, making individual, cost-based decisions about the type of health, dental, and other ancillary benefits that best meets their unique needs. This model allows employers to set their annual benefits budget, helping them cope with ever-increasing health care costs. Likewise, employees have more choices than before and the ability to secure the coverage they need. Additional features such as benchmarking tools, mobile apps, payroll integration, online enrollment, reporting, and administration tools, allow employers to fully manage their employee benefits online through one portal. The exchange also consolidates the transfer of monies between the employer, employee, and each insurance provider, significantly streamlining the administrative burden on small businesses.

Employers with 50 or more employees may also have options available. Since different guidelines apply under PPACA for these groups, custom arrangements may need to be considered for participation in the private exchange.

The exchange is scheduled to open in mid-January. Members and small groups interested in participating can contact Member Benefits at 1-800-282-8626 or visit www.gabar.memberbenefits.com