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After the New York State legislature failed to pass exchange legislation, Governor Andrew Cuomo signed Executive Order 42 on April 12, 2012, to establish the New York Health Benefit Exchange. The Executive Order establishes the New York Health Benefit Exchange “within the Department of Health” and gives the Exchange authority to work in conjunction with the Department of Financial Services and other agencies to carry out requirements of the Affordable Care Act. On December 14, 2012, New York received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time and complying with future guidance and regulations.
Under the Affordable Care Act, all non-grandfathered individual and small-group plans must cover certain defined health benefits, or ‘essential health benefits’ (EHB). These benefits include: ambulatory patient services, emergency, hospitalization, maternity and newborn care, mental health, prescription drugs and more. Because New York has submitted a proposal and gained approval, the state will use the Oxford Plan (EPO) as the benchmark, contingent on future performance.
The New York Health Benefit Exchange within the Department of Health works with the Department of Financial Services to carry out ACA requirements and has conditional approval to create a state-based exchange. The state uses the Oxford Plan (EPO) as the essential health benefits benchmark.
For more information about setting up a private exchange solution in New York, contact a representative at GoHealth today.