MANAGED CARE August 2011. ©MediMedia USA
Small businesses and individuals may soon be able to approach their state’s insurance exchanges, created through the ACA, and contract with private, not-for-profit organizations that sell health insurance products like HMOs or PPOs. Called CO-OPs (Consumer Oriented and Operated Plans), these organizations are made up of a board of members and are designed to offer quality, affordable, and consumer-friendly health plans in every state.
These CO-OPs will be subject to the same rules as other insurers, with a few exceptions. CO-OPs will:
- Give enrollees a say in the health plan. Members elect the board of directors, a majority of whom must be enrolled in the CO-OP.
- Use profits to benefit enrollees by offering lower premiums, robust benefits, high quality health care, and expanded coverage.
- Educate enrollees about the plan and give enrollees a choice in how the health plan is administered.
The Centers for Medicare and Medicaid Services proposed standards for CO-OPs in July. Eligible organizations interested in establishing a CO-OP will be able to apply for a portion of the $3.8 billion in repayable loans made available under the ACA to fund start-up and capitalization costs. The proposed rules can be found at www.ofr.gov/inspection.aspx [1].