Health insurance exchange and eligibility
Providing a competitive health insurance marketplace
The U.S. health industry continues to see an unprecedented level of programs to encourage health IT adoption, including Electronic Health Record (EHR) incentive programs, Health Information Exchanges to connect critical patient health information and Health Insurance Exchanges, a major component of the Patient Protection and Affordable Care Act (ACA) which seeks to increase the number of U.S. citizens covered by health insurance by 34 million.
Health Insurance Exchanges create marketplaces for individuals and small business to purchase and enroll in various health plans, helping to reduce the overall cost of care. Tied closely to these initiatives are changes in Medicaid eligibility rules to expand coverage. Efforts are underway to modernize and streamline rather cumbersome eligibility determination and enrollment processes. States are focused on planning and implementation efforts for their Health Insurance Exchanges as well as changes to Medicaid eligibility to help consumers more easily navigate their options.
CGI Health Insurance Exchange360®
To help states meet their unique Health Insurance Exchange needs, as well as ACA requirements, we developed CGI Health Insurance Exchange360®, an end-to-end set of consulting, business and technology services that include:
- Health Insurance Exchange Portal providing plan feature and price comparisons
- Eligibility screening and verification
- Enrollment and purchasing
- Interfaces through the Federal Data Services Hub to IRS, Homeland Security and Social Security Administration. Interfaces will also include gateways to state systems as needed.
- Health plan management
- Financial management including premium billing/tax credits
- Customer service center
- Education and outreach
- Member management
- Administration and reporting
- Infrastructure and hosting services
- Program management
CGI is leveraging practical experience from our extensive work with high-profile public and private sector health insurance programs, including: Medicare, Medicaid and numerous complex private sector plans; ACA planning and prototyping efforts for the IRS; and work on integrated state eligibility systems. Our experience also includes:
For states - CGI is performing exchange implementation work for California, Colorado, Hawaii, Massachusetts, Kentucky and Vermont. Read the news release on our work for the Colorado Health Benefit Exchange
For the federal government - CGI is bulding the federally facilitated health insurance exchange (FX).
- CNBC coverage of CGI's health insurance exchange work with the State of Vermont (video)
- Healthcare IT Connect Interview with CGI's Melissa Boudreault on Strategic IT Considerations of Health Insurance Exchange Implementation: Part I and Part II
Health insurance exchanges giving you a headache?
Trust us: IT is not the issue.
Rather than focusing on technology alone, states should take a more holistic, enterprise-wide approach. CGI's Melissa Boudreault, nationally recognized thought leader in health insurance exchanges, and Holli Ploog, expert in health and human services solutions for the state healthcare market, offer a unique perspective on best practices for building sustainable HIX solutions.