HB 5409 Summary

• Establishes MiHealth marketplace as a nonprofit corporation to operate a health insurance exchange offering qualified health plans to individuals and small employers through the Small Business Health Options Program (SHOP)

• Creates a 7-member board appointed by the governor (5 members with Senate advice and consent), Senate majority leader, and House speaker to govern the marketplace, with the insurance commissioner serving as a nonvoting ex officio member

• Marketplace must certify health benefit plans as qualified health plans, maintain an internet website for plan comparison and enrollment, provide a toll-free helpline, and establish procedures to screen and enroll eligible individuals in Medicaid or MIChild

• Marketplace may charge assessments or user fees to health carriers to fund operations and must publish average costs and administrative expenses on its website; no state funds authorized for use by marketplace

• Marketplace must comply with federal Patient Protection and Affordable Care Act requirements, contract with the Office of Financial and Insurance Regulation to certify plans, and perform duties related to premium tax credits, cost-sharing reductions, and individual responsibility exemptions