Small businesses with up to 100 employees can purchase insurance through the exchanges. At least two multi-state plans will be offered in each exchange, and at least one offered by a nonprofit. The plans offered in the exchange must have a minimum set of standards in coverage, and past that minimum standard threshold the plans will feature four levels of coverage: bronze, silver, gold and platinum, varying in premium costs and benefits.

The Department of Health and Human Services (HHS) must develop criteria for the certification of health plans to be accepted in the exchanges. The criteria must include: marketing requirements (such as prohibiting marketing practices or benefit plans that discourage enrollment by individuals with significant health needs); a sufficient choice of providers; information to enrollees and prospective enrollees on the availability of in-network and out-of-network providers; and networks for essential community providers that serve predominately low-income, medically-underserved individuals.

Insurance reforms will be imposed upon the plans in the exchanges. Rating variations on insurance premiums in the exchanges will be limited to a 3 to 1 ratio for age and 1.5 to 1 for tobacco use. Insurers will be required to accept every employer and individual in the state that applies for coverage, and must renew or continue coverage at the option of the plan sponsor or the individual. Insurers cannot base eligibility for enrollment on health status, mental or physical illness, claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence) or disability. The plans may not apply any waiting period for coverage that exceeds 90 days.

For the small group (employer-sponsored) plans, the deductible under the plan will have a limit of $2,000 for a single individual and $4,000 for families.

Premium assistance will be provided for low-income eligible individuals and families to buy insurance in the exchange in the form of a tax credit, with the amount of the assistance dependent upon income between 100 and 400% of the federal poverty level.

Rural Health Boost

In other health reform news, HHS has announced $32 million in FY 2010 funding for programs in rural health care. The funds are being directed to seven programs:

--The Medicare Rural Hospital Flexibility Program, for improvements of health care quality in communities served by critical access hospitals;

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