Search all of NY.gov

• What is Health Care Reform?
• Benefits for Specific Groups
• Questions and Answers
• Find Health Insurance
• Timelines and Events
• Grants
• Health Benefit Exchange
• Submitted Comments
• Updates
• Research and Resources
• Partnership for Coverage: New York's Health Reform Experience
• Contact Us
• Home

Health Benefit Exchange

Establishment

On October 26, 2012, New York submitted its Blueprint application to HHS for approval to operate a state-based health benefit exchange. NYS submitted a Declaration Letter on July 9, 2012 and an updated Declaration letter on November 14. The Blueprint submission was in advance of the November 16th deadline set by HHS. HHS expects to formally approve applications and make certification decisions by January 1, 2013. Click here to view the Blueprint application documents.

On October 1, 2012, NYS formally submitted its selection of an Essential Health Benefits benchmark plan to Health and Human Services.  New York has selected the benefits of the State's largest small group plan, Oxford EPO, as the benchmark plan.  In addition to the selection of a benchmark plan, the state has indicated the coverage areas in which benefits will be supplemented in order to meet ACA requirements.  View the letter to HHS.  For more detail on the benefits covered by the Oxford EPO plan, see Exhibit 3 of the final Milliman report.

On September 25, 2012, NYS submitted a series of documents to HHS in advance of the state's in-person design review scheduled for October 9th and 10th in Bethesda, MD. The sections covered during the design review correspond with requirements of the State's Exchange Blueprint Application due November 16, 2012. A copy of the Blueprint application can be found here. NYS submitted a Declaration Letter in July.

On July 9, 2012 Governor Cuomo submitted a declaration letter to the Centers for Medicare & Medicaid Services confirming New York's intent to establish a State-based Health Benefit Exchange consistent with the Affordable Care Act. The letter indicates the State's intent to perform advance premium tax credit and cost sharing reduction eligibility determinations and designates Donna Frescatore, who will serve as the Executive Director of the New York Health Benefit Exchange, as the primary point of contact for the State's Exchange Blueprint Application.

On April 12, 2012, Governor Cuomo issued Executive Order #42 to establish a statewide Health Exchange. The Executive Order established the New York Health Benefit Exchange within the Department of Health.

The establishment of the New York Health Benefit Exchange was included in the Governor's 2012-13 Executive Budget Proposal. Information on the Governor's Budget Proposal is available on the Governor's website and the NYS Division of the Budget website. The bill text relating to the Exchange is included in Part E of the Health and Mental Hygiene Article VII Legislation.

On June 23, 2011, the Assembly passed the Governor's Program Bill (A8514/S5849) which would create the New York Health Benefit Exchange. The Bill is awaiting action in the State Senate. The following resources regarding the Bill are available:

• Bill Text
• Bill Memo

Consultant Work

• Essential Health Benefits for the New York Health Benefit Exchange (Milliman, Inc) (PDF)
  This report identifies the issues around the selection of the essential health benefits (EHB) benchmark and discusses the implications that the EHB choice will have on consumers, businesses, and the state. The report examines the implications of the EHB choice on mandated benefits and the policies offered to the individual and small group markets both in and out of the exchange. Finally, the report estimates the cost impact on services covered by the health insurance policies of small businesses relative to the selected benchmark plan.
  • Additional information regarding the Essential Health Benefits (EHB) report by Milliman, Inc is posted with the August 2, 2012 stakeholder meeting materials on the Timelines and Events page.
• Benefit Standardization Study for the State of New York (Wakely Consulting) (PDF)
  This report describes the small group products available in New York today, how these products align to the requirements of the ACA, and presents options for consideration to standardize products within the Exchange.
• Business Plan of Operations New York Health Benefit Exchange (Wakely Consulting) (PDF)
  This report lays out the work processes and the steps that must be completed in order for the New York Health Benefit Exchange to start taking applications for coverage on October 1, 2013.
• The Role of Producers and Other Third Party Assistors in New York's Individual and SHOP Exchanges (Wakely Consulting) (PDF)
  This report explores the critical interactions that third party assistors have with buyers and sellers of insurance in the New York market and presents various models for incorporating and compensating producers and other intermediaries in the New York Health Benefit Exchange.
• Risk Adjustment and Reinsurance under the ACA New York State Recommendations (Wakely Consulting) (PDF)
  This report provides recommendations for New York's approach to addressing the ACA's risk adjustment and reinsurance requirements and implementing these programs. Risk adjustment is the method of adjusting premium rates for differences in underlying morbidity of a health plan's membership. Reinsurance describes methods for protecting health plans against high cost individuals.
• March 2012 Urban Institute Report: The Coverage and Cost Effects of Implementation of the Affordable Care Act in New York State (PDF)
  • Urban Institute NY State Savings Estimate Memo (PDF)
  • Additional information regarding the March 2012 Urban Institute report is posted with the February 2, 2012 stakeholder meeting materials on the Timelines and Events page

Stakeholder Involvement

• The New York Health Benefit Exchange has established Regional Advisory Committees pursuant to Governor Cuomo's Executive Order No. 42 to provide advice and make recommendations on the establishment and operation of the Exchange, including recommendations about relevant regional factors. Information about these Committees is available on the Regional Advisory Committees page.
• Materials from stakeholder meetings regarding the Exchange are posted on the Timelines and Events page.
• The Exchange is soliciting comments on a proposal to define how quality and customer satisfaction ratings are displayed for Qualified Health Plans (QHPs) available in the Exchange beginning in 2014. The ratings described in this proposal are similar to those currently used in New York and have the benefit of real world application. We are seeking input on this proposal and, in particular, are interested in suggestions for how the display of these ratings can be made most effective for consumers. Those who wish to submit comments on this proposal should send comments to exchange@health.state.ny.us by Friday, September 28th. All official comments submitted will be publicly posted to this website after September 28th.
  • HBE Quality and Satisfaction Ratings Proposal (PDF)

Grants

New York has received the following grants to plan and develop a Health Insurance Exchange in the State. Information on each grant, including RFPs for contracts funded by grant awards, is available on these pages:

• Exchange Planning Grant
• Early Innovator Grant
• Exchange Establishment Grant

Questions, Answers and More Information

• March 2012 Exchange Frequently Asked Questions (PDF)
• The Questions and Answers page includes an Exchange section
• Exchange reports written by New York researchers are posted on the Research and Resources page

Last updated: October 2012. Privacy Policy