Background

The “Patient Protection and Affordable Care Act” and “Health Care and Education Reconciliation Act of 2010” were signed into law by the President of the United States in March of 2010. The two laws are collectively referred to as “Affordable Care Act (ACA)”

The ACA create new competitive private health insurance markets - called Health Insurance Exchanges (HIX or Exchanges or Marketplace) - that provides millions of Americans and small businesses access to affordable coverage and the same insurance choices as members of Congress.

The ACA allows each State the opportunity to establish an Affordable Insurance Exchange called the “State Based Exchanges” (SBE). Not all state decided to establish their own SBEs, hence the ACA established Federally Facilitated Exchanges (FFE or FFM) in any state that did not have an SBE. Since then several States have transitioned from “FFM” to their own “SBE” or vice versa.

FFE Issuer or Qualified Health Plan

FFE Issuer or a Qualified Health Plan is an Health Insurance Company that offers products to the general public via the Exchanges. Centene is an FFE Issuer or a QHP that offers its health insurance product in the Exchanges.

A Health Insurance Company that wishes to be a QHP on the exchanges have to undergo an rigorous certification process that ensure each potential QHP meets the minimum standards established in the Exchange and is in the interest of the qualified individuals and employers.

The Health and Human Services (HHS) will carry out all the plan management activities

• QHP Certification

• QHP Monitoring and Oversight

• Issuer Account Management

• Recertification and Decertification

Trading Partner Profile

Once certified as a QHP, the QHP must complete a trading partner agreement, exchange profile information and establish connectivity in order to send and/or receive transactions from the FFE.

Data Service Hub (Hub)

The Hub is a single interface for the States and Federal Partners (e.g. CMS, SSA) for information exchange in support of Health Exchange Information. The Hub will serve as the gateway for enrollment transactions between FFE and QHP. The FFE Issuers will connect to the Hub via CMS Enterprise File Transfer (EFT) System.