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On July 11, HHS Sec. Kathleen Sebelius released the much-anticipated, 200+ page proposed framework that states will use in developing and running insurance exchanges. More than any other provision of the reform law, exchanges will forever change the way individuals and small businesses purchase health insurance … and how insurers sell it. While the transition to a nationwide network of state exchanges is an enormous opportunity for health insurers, rules developed by HHS and state exchange boards will determine exactly how viable this new market will be. 

HHS on July 11 proposed giving states enormous flexibility to develop rules that work best for their markets, including determining which insurers can participate and how restrictive exchanges will be with enrollment periods and premium rate increases.

The new rules are complex and critically important for all stakeholders. That’s why, on Aug. 24, we’ve assembled a powerhousepanel of experts to walk you through the proposed reg and help you understand the likely impact on health insurers, brokers/agents, employers and providers. You’ll get all the details about:

• Rate hikes:The reform law requires exchanges to consider rate hikes in determining whether an insurer can participate. Will they also consider prompt claims payment history and the depth of provider networks?
• Participation: While HHS could make certification requirements uniform across all exchanges, it also might allow each exchange to determine its own standards. Will insurers that don’t participate be able to thrive outside of the exchanges?
• Family rating categories: HHS is considering “uniform family rating categories,” which it contends will increase competition among health insurers based on price and quality. How would such a system work, and how would it impact employers and health plans?
• Certification, recertification and decertification: What hurdles will insurers face in becoming a “qualified health plan?” How difficult will it be to maintain certification? 
• Federal involvement: Some states want a model that combines a state-designed and -operated exchange with federally designed and operated business functions, such as eligibility and enrollment. How would this model impact health insurers?
• Network adequacy:How much influence will exchanges have on provider networks? How will hospitals and physicians be affected?
• Agents and brokers: Will states require that navigators meet licensing or certification requirements to sell coverage through an exchange? Who will compensate them, the insurer or the exchange?
• Exchange boards: Health insurers want a seat at the table when states develop rules for their exchanges, but consumer groups don’t want health plans to be allowed on boards. How much influence are health insurers likely to have on exchange boards?