Health Care Reform: Recent News & Events

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CMS issued FAQs March 29, 2013 addressing whether health insurance Exchanges (now called Marketplaces) can sell stand-alone vision and other ancillary insurance products (such as life and disability insurance) on the Exchange.

The answer is "No, An Exchange only may offer qualified health plans (QHPs), including stand-alone dental plans, to qualified individuals and qualified employers, due to sections 1311 and 1312 of the Affordable Care Act."  However, CMS will allow "separate state programs that share resources and infrastructure with a State-based Exchange" to sell ancillary insurance products which are not QHPs.

That is, a state can establish other, separate state progrrams to offer these non-QHP ancillary benefits.

The FAQs provide that an Exchange may provide information about vision plans and other ancillary products on its website or through its call center, including information on how to purchase these products and even provision of a link to a page where consumers could add the products to their shopping baskets and purchase these products along with QHP products.

Exchanges also would have to inform consumers that these ancillary products are not eligible for premium tax credits or cost-sharing reductions.

Additionally, CMS requires that certain criteria must be met before Exchange information technology infrastructure can be "re-used" by these other separate state programs to sell non-QHP ancillary benefits:

1. The agency or program facilitating the coverage must be legally and publicly distinct from the Exchange, and the non-Exchange program facilitating the coverage must be responsible for non-Exchange activities.
2. Federal funds must not be used to support non-Exchange activities. Further, Exchange user fees and assessments may not be used to support non-Exchange activities. Exchange funds should not be co-mingled with the funds used to support these other separate state programs.
3. To the extent that an Exchange resource is used for non-Exchange purposes, the cost of using the resource must be paid by the other, non-Exchange state program. An appropriate portion of the costs of rent, maintenance, etc., must be charged to the other, non-Exchange state program.

The FAQs provide several examples of how appropriate allocations of costs might be charged:

• If Exchange website programming and information technology infrastructure (such as servers or coding for website applications) are used to support the website of the other state program that facilitates enrollment in non-QHP insurance coverage:  the websites themselves would need to be clearly identified as distinct, e.g., the “state Exchange website” and the “other non-Exchange state program website.”
• If the Exchange call center also supports other non-Exchange state programs, each program would need to have  different phone numbers and different scripts for the call center operators.   The non-Exchange state program would have to pay for the development of the differing scripts, maintenance of separate phone numbers, and associated staff time.

CMS apparently has not updated its terminology to refer to Exchanges as "Marketplaces," at least not in the March 29 FAQs.