As mandated by the Patient Protection and Affordable Care Act of 2010, each state is required to establish a Health Insurance Marketplace by January 1, 2014. Health Insurance Marketplaces are a new way for certain consumers to buy health insurance. They will offer a choice of different health plans for those who buy their own individual and/or small group coverage, certify health plans that participate, and provide information to help consumers better understand their health coverage options. IBC will participate in the federally facilitated Health Insurance Marketplace for Pennsylvania by providing various commercial products that are covered under your current Professional Provider Agreement and will be reimbursed in accordance with your payment rates for commercial products.
These commercial products will be available beginning January 1, 2014, and will include tiered provider network products. These tiered network products will have benefit designs with different member cost-sharing by tier and will offer members a lower out-of-pocket cost (e.g., copayment) when they select a provider in the preferred benefit tier. The following provider types will be designated to one of three tiers: primary care physicians, specialists, acute care hospitals, home health, sleep study centers, dialysis centers, and ambulatory surgical centers. To the extent applicable, these providers will receive a letter in August notifying them of their tier assignment.
Look for more information about these new products in future editions of Partners in Health UpdateSM.