Navigating the New Health Care Benefits
The new federal health reform calls for each state to implement and administer a Health Insurance Exchange. Maryland was one of the first in line to seek and receive federal approval to begin designing its program in March 2010.
Maryland is establishing two exchanges; one for small business group health insurance policies and another for individual policies.
The federal health care act additionally requires each exchange to establish Navigator entities. These entities will provide the link and the expertise to guide uninsured families and individuals to the best health policy for their needs.
The Maryland Health Benefit Exchange Navigator Advisory Committee is charged with establishing the criteria for selection of the organizations to serve as Navigator entities. The committee anticipates community based organizations already involved with social and health services will compete for state grants to operate as a Navigator entity.
Some of the types of community based organizations the federal guidelines permit include, but are not limited to, unions, chambers of commerce as well as almost any nonprofit involved with the community health and social services and faith-based nonprofits.
Government agencies dedicated to health care such as health departments, which do not receive compensation from an insurance company, would be eligible to serve as a Navigator Program as well.
Every entity operating the Navigator program must have at least one certified Navigator professional on staff. Maryland differentiates between a Navigator entity and a Navigator professional. The advisory committee is charged with establishing the certification standards for the Navigator professionals as well.
Certified professional Navigators provide advice and counseling on the steps to be taken to select the proper policy from the exchanges. Considerations in helping select the proper policy include family financial information to determine eligibility for health insurance subsidies. Other considerations might include how the family’s physicians fit into the best selection of available plans.
Health care practices and clinics, hospitals, industry professionals and insurance brokers cannot be Navigator entities. The standards prohibit anyone who receives any type of remuneration from health insurance payments from working as a Navigator.
The health benefit exchange navigators are prohibited from discussing products outside of the exchange and will not be licensed insurance agents.
Licensed health insurance brokers can take the Navigator certification program and thus will be able to enroll participants in policies outside the public health market or within the Maryland exchange but no one who receives health insurance payments can function as a Navigator.
Educational standards and Navigator entity selection criteria must be submitted in a report to the Maryland Legislature by the end of 2012. The committee is currently seeking public input as it develops the report.
Once the criteria are established, the winning Navigator entities will be awarded grants from the Maryland Health Benefit Exchange to compensate the community outreach. This will include the expense to hire and train a professional as the entity’s Navigator.
Maryland expects more applicants seeking accreditation as a Navigator Entity than available funds will support and thus anticipates selection of the Navigator entities to be made on a competitive basis.
There are a few other states also leading the way toward incorporation of the new federal health care reforms into their governments. Among them, Maryland is leading the pack in its incorporation of insurance brokers in the partnership.