Mental health and substance abuse services, including behavioral health treatment, are one of the essential health benefits required to be provided by Qualified Health Plans. The Behavioral Health Subcommittee reviews and makes recommendations on policy issues related to the provision of mental health and substance abuse services under the Kentucky Health Benefit Exchange.
Beginning in 2014, pediatric dental and vision services are one of the essential health benefits required to be provided by Qualified Health Plans. The Dental and Vision Subcommittee reviews and makes recommendations on policy issues related to the provision of dental and vision services under the Kentucky Health Benefit Exchange.
The Kentucky Health Benefit Exchange is required to provide culturally and linguistically appropriate outreach and educational materials to the public regarding eligibility and enrollment options, program information, benefits, and services available through the Exchange, the Insurance Affordability Programs, and the SHOP (Blueprint Section 2.3.pdf). The Education and Outreach Subcommittee reviews and makes policy recommendations related to education and outreach programs and activities by the Exchange.
Under the ACA, states are required to establish and operate a Navigator program to provide educational materials and assistance to individuals and small businesses accessing the new online health insurance marketplace. (Click here to learn more about Navigator requirements and duties.) The Navigator/Agent Subcommittee reviews and develops policy recommendations relating to specific aspects of the Navigator program, including performance standards, conflicts of interest standards, financial compensation and sustainability, training and certification, as well as delineating roles for Navigators and agents.
Qualified Health Plans
Only “qualified health plans” that meet both federal and state requirements will be offered by the Kentucky Health Benefit Exchange. (Click here to learn more about the ACA definition of a qualified health plan (QHP) The Qualified Health Plan Subcommittee will review and make policy recommendations relating to certification and other plan management issues for Qualified Health Plans.
Small Employer Health Options Program
Under ACA requirements, the Kentucky Health Benefit Exchange must establish a Small Employer Health Options Program (SHOP). The SHOP is designed to assist qualified employers and facilitate the enrollment of qualified employees into qualified health plans that are both of high quality and affordable. The Small Employer Health Options Program Subcommittee reviews and makes policy recommendations on specific aspects of the SHOP, including enrollment and eligibility, employer choice requirements, and group participation rules.