Determining Health Benefit Designs to be Offered on a State Health Insurance Exchange

Under the Affordable Care Act, all states must either develop or participate in a health insurance exchange, which must give consumers complete and easy-to-understand information about health insurance options. Since this requirement was modeled after Massachusetts’ health reform law, many are turning to Massachusetts officials for learnings from the last five years.

The series’ third installment reveals several key lessons in developing the part of the Massachusetts’ exchange serving unsubsidized, individual purchasers—known as Commonwealth Choice. This experience includes developing—through a public procurement process—specific health insurance products that allow for easy comparison on the basis of quality, benefits, provider networks, cost-sharing, and premiums.

This toolkit series, released by the Robert Wood Johnson Foundation and the Blue Cross Blue Shield of Massachusetts Foundation, provides examples, templates, and lessons from Massachusetts. Each toolkit includes a written narrative and a variety of source documents, including examples of organizational structures, job descriptions, requests for proposals, etc.