If your company provides employer clients and their qualified beneficiaries’ COBRA or direct bill administration, you’ve been operating a health benefit exchange for many years now.  If you think about the services provided; the daily interactions you have with employers, members, carriers, brokers and government, you will see the service is nearly identical with the core operational requirements of Health Benefit Exchanges under the PPACA. 

In the COBRA world, an active employee is EXCHANGING their employer sponsored and subsidized group health coverage for individual insurance coverage.  When the individual obtains full time employment they exchange the COBRA continued coverage for employer sponsored insurance.  Often times, the individual drops their COBRA continued coverage and replaces it with either short term medical, individual health insurance, Medicare, Medicaid, CHIP or some high-risk pool coverage.  This churning of insurance coverage parallels the PPACA’s model for Health Benefit Exchanges.

Operationally, COBRA administrators receive information about an individual, communicate eligibility and enrollment information, receive and process elections, bill and process monthly payments, apply premium reduction subsidies, reconcile, remit and report to agency stakeholders. 

This entire process is built to profitably operate for less than 2.8% of monthly premium.    As a COBRA administrator operating at scale for many employers and thousands of individuals, your model is mature, tested, and sustainable.  Your team knows how to deliver quality service that complies with a strict set of federal regulations, handle complex client requirements, manage millions of dollars in custodial cash (including premium subsidies), disburse allocated premiums, and real time stakeholder reporting. 

Several media and government sources look to the Massachusetts Connector as the blue-print for building and managing a PPACA Health Benefit Exchange.  It is our contention that the better blue-print is the business you run and the service you provide clients and members each and every day.  Get out there and share your story and value with as many Directors of Insurance and elected officials as possible.  We sure are!

Below is a Benaissance produced graphical representation of how a COMPLETE EXCHANGE is configured utilizing our core technology for powering a state(s) operated Health Benefit Exchange.