Health insurance exchange

Creating competitive marketplaces for greater access and coverage

A health insurance exchange (HIX), or health benefits exchange (HBE), is an online marketplace for purchasing and enrolling in various health plans.

In the U.S., the Patient Protection and Affordable Care Act requires all states to implement health insurance exchanges for citizens and small businesses by January 1, 2014, or use the Federally Facilitated Marketplace (FFM). CGI is performing state-based exchange implementation work in six states, and is building the FFM to be used by states not currently creating their own exchanges. The FFM Is distinct from the Federal Data Services Hub being developed for the Centers for Medicare & Medicaid Services by another IT provider.

Because exchanges must provide many different functions, the soundest approaches bring together expertise and best practices in federal and state health programs, commercial insurance, data exchange, portals, e-commerce over the cloud, and financial management. CGI brings all of this expertise to the table, along with direct experience in developing sustainable HIX programs. We also have a dedicated group of subject matter experts tracking best practices for state HIX and integrated eligibility systems across the United States.

CGI’s extensive portfolio of HIX solutions includes:

  • CGI Health Insurance Exchange360® (HIX360) for state-based exchanges, addressing both individual and small business requirements and using CGI’s secure government cloud
  • Support for state-partnership exchanges using components of our HIX360 solution and providing guidance for effective use of the FFM while transitioning to a state-based exchange
  • For states moving toward integrated eligibility systems (IES) to modernize their determination and enrollment processes, CGI is integrating our HIX360 solution with an IES solution
  • Sustainability models based on our successful multi-state consortium for EHR incentive payments.

CGI also offers services and guidance to health insurers, including Consumer Operated and Oriented Plans (CO-OPs).