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Health Benefit Exchange Board Continues Progress on Establishing Rules for Competitive Insurance Market

Friday, March 22, 2013
Insurers must show a “meaningful difference” in plans.

The DC Health Benefit Exchange (HBX) Authority today continued its work to establish a competitive insurance market for individuals, families, and employers in the District of Columbia by approving policies regarding the number and type of plans that will be available in 2014, and clarifying that applied behavioral analysis (ABA) to treat autism is a covered habilitative service.

“These decisions ensure that the residents and businesses of the District of Columbia will have a robust marketplace with unprecedented information to help them choose the best quality health plan to fit their needs and budgets,” said Mohammad N. Akhter, M.D., Chair of the Executive Board. “I am pleased that parents of children with autism will know their sons and daughters will get the needed care to help them thrive.”

Under the standards adopted today, insurers participating in the DC Exchange will be able to offer as many qualified health plans as they want. Residents purchasing coverage on the web-based Exchange portal will be able to decide how many plans they want to consider in making side-by-side comparisons when choosing coverage.

The Board also voted to require all participating insurers to offer at least one standardized policy that has the same benefits and cost-sharing so that consumers can make direct apples-to-apples comparisons. These “standardized benefit plans” will be offered during 2014 open enrollment for coverage beginning in 2015.

To make sure consumers can make an informed choice among plans, the Board asked the DC Department of Insurance, Securities, and Banking (DISB) to review all policies offered on the Exchange to guarantee there is a “meaningful difference” among an insurer’s policies.

In addition, the Board adopted a definition of habilitative services that includes coverage of applied behavioral analysis for the treatment of autism spectrum disorder. Habilitative services are one of 10 categories of essential health benefits that must, by federal law, be covered by all policies sold in 2014.

The rules adopted by the Board are the product of considerable public input. They were discussed in public by working groups made up of more than 60 people representing consumer and patient advocates, employers, insurers, brokers, providers, and others from the DC community. A three-member committee of the Board held an additional public meeting and made recommendations to the Board that were approved today.

“We are making tremendous progress in our efforts to build a marketplace that reflects the needs of District residents and employers,” said Mila Kofman, J.D., the authority’s executive director. “We couldn’t have gotten this far without the input and support of the diverse stakeholders who are truly building the DC Exchange from the ground up.”

For more information about the approved policies, visit