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Filed Under:Health Insurance, Individual Health

California exchange seeks dental, vision plan bids

The California Health Benefit Exchange has posted solicitations for health insurers and managed care companies that want to write dental or vision coverage through the state's new exchange programs.

Notices of issuers' intent to bid on the solicitations are due Wednesday.

The actual bids are due noon March 1. The exchange hopes to get contracts signed by June 1.

Each solicitation includes a similar set of questions covering how a bidder would handle "marketing and outreach activities."

The exchange asks a bidder to describe the agent-oriented marketing materials it now provides for the individual and small group market, provide samples of ads the bidder has published in agent publications or trade publications, and list the criteria the bidder uses for appointing agents to sell individual and small group products.

"How many active, appointed agents do you have?" the exchange asks. "Does your vision plan have relationships with general agents? If so, please list the general agents with whom you contract."

The exchange also asks a bidder to describe current agent compensation and override schedules and any agent cash or in-kind bonus programs.

In a section on "cooperation with the exchange," the exchange asks each bidder to describe its plans to help the exchange with marketing and outreach efforts, such as running training programs and producing brochures and other collateral materials.

The Patient Protection and Affordable Care Act of 2010 (PPACA) requires state and federal agencies to set up exchanges, or Web-based health insurance supermarkets, by Oct. 1, with the coverage sold through the exchanges to start taking effect by Jan. 1, 2014.

Initially, the exchanges will be open to individuals and small groups. 

PPACA requires the carriers that sell coverage through exchanges to include dental and vision benefits for children in their basic benefits package, or "essential health benefits" (EHB) package.

PPACA lets exchanges offer richer dental and vision benefits and dental and vision benefits for adults through supplementary plans that exchange major medical coverage customers can buy on a voluntary basis.

States can set up their own exchanges or turn the job over to the U.S. Department of Health and Human Services. A state that runs its own exchange can choose to let any qualified carrier sell any qualified plan through the exchange, or it can be an "active solicitor" and try to use the bidding process to actively encourage plans to offer better, cheaper coverage.

State law calls for the California exchange to "selectively contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality," the exchange says in its solicitations.

The California exchange will accept bids from any organization licensed to sell dental or vision plans in the state, or from coalitions of licensed issuers, the exchange says.

"The successful bidders must be ready and able to accept enrollment as of Oct. 1, 2013," officials say.

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Nichole Morford

Nichole Morford
Managing Editor

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