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HHS Unveils Proposed HIX Rules

Cheryl Clark, for HealthLeaders Media, August 15, 2011

According to an HHS statement, the three proposed rules accomplish three goals:

1. Exchange Eligibility and Employer Standards. Detail the standards and process for enrolling in qualified health plans and insurance affordability programs as well as basic standards for employer participation in the Small Business Health Options Program, or SHOP.

These standards will be designed to be fast and easy, and will minimize burdens on states because they will use electronic data to verify applicant information. "In most cases, this will allow for a near real-time eligibility process so that individuals can receive an eligibility determination and enroll in a plan in a single session," according to an HHS statement.

They also will avoid paperwork redundancy by combining information for various programs that best suit an individual's needs and simplifies redetermination process for annual renewals without disruption.

2. Health Insurance Premium Tax Credit. Lay out regulations how individuals and families can receive tax credits to offset their premiums and defray insurance costs for middle class Americans.

Taxpayers with household incomes between 100% and 400% of the federal poverty level will be eligible for tax credits to offset premium costs if they are not eligible for other healthcare coverage. The credits will be paid in advance to the insurance company providing the plan. When the Affordable Care Act is fully phased in, according to a report from the Congressional Budget Office, these credits could average in excess of $5,000 a year.

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