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What Is a Health Insurance Exchange?

A health insurance claim form.
Health insurance.
Article Details
  • Written By: Malcolm Tatum
  • Edited By: Bronwyn Harris
  • Last Modified Date: 08 August 2014
  • Copyright Protected:
    2003-2014
    Conjecture Corporation
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A health insurance exchange is a platform that is used to help consumers identify healthcare plans that are available for purchase and that also are authorized to offer services in the jurisdictions in which those consumers reside. Platforms of this type may be provided by state or national health regulatory agencies or governmental departments that are charged with the responsibility of making sure all citizens have up to date and complete information on the healthcare insurance options available to them. This type of program is especially helpful if current laws and regulations require that all citizens have access to healthcare coverage that is considered affordable for various income brackets represented in the general populace.

There are two main functions provided by a health insurance exchange. One function is to make sure that citizens have easy access to a listing of insurance providers who meet the basic standards of ethics and scope of services considered acceptable by the jurisdiction. Individuals and families looking for viable healthcare plans can often use an exchange to rest assured that a given healthcare plan is authorized for delivery to people living within a given geographical area, and that the chances of the insurer failing to honor claims that are within the terms and conditions of those plans is kept to a minimum.

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Along with providing citizens with current information on healthcare providers who meet the minimum qualifications set by the state or national government, the health insurance exchange also works to make sure approved providers continue to meet those standards after inclusion in the listings. This involves periodic review of each provider to make sure no changes in terms or other factors have arisen that indicate a plan no longer meets minimum standards and should be removed from the listing. In addition, new plans may be added from time to time, providing consumers with additional options for health insurance.

The actual regulations that govern a health insurance exchange may vary from one jurisdiction to the next. This means that a provider may meet the standards set in one state health insurance exchange but not be eligible for listing in another state. In like manner, some providers may be included in a national health insurance exchange associated with one country but not meet the minimum standards for inclusion in a different nation. For consumers who are required by law to maintain health insurance of some type, taking the time to consider all options listed on the exchange, including the scope of coverage, the cost of the insurance premiums and the availability of physicians and healthcare facilities that accept a given insurance plan, will make it much easier to obtain coverage and lock in the highest quality of healthcare possible.

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