Health Insurance Exchange and Multi-state plans
–The Exchange shall require health plans to submit information, which inlcudes claims payment policies and practices, financial disclosures, enrollment and disenrollment data, data on denied claims and rating practices, information on cost-sharing and out-of-network payments, and enrollee rights under the program.
–All information provided should be in plain language which is readily understandable by the layman.
–Multi-state plans can be offered through the exchange, at least two in each state, and they are overseen by the Office of Personnel Management. At least one of those companies should be non-profit. The companies will negotiate a medical loss ratio, a profit margin, the premiums to be charged, and any other terms and conditions of coverage.
–Multi-state plans must offer essential benefits, but they can offer additional benefits. If they do, the state is responsible for paying for the additional benefits on behalf of those for whom they are responsible.