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Health Insurance Exchanges under the Patient Protection and Affordable Care Act in North Dakota

On the 23rd of March, 2010, the Patient Protection and Affordable Care Act or PPACA was signed into law. As its name suggests, this mandate hopes to bring down the cost of health care and to have every citizen insured against sickness, preventive care and other medical concerns.

The state of North Dakota has been very responsive in meeting the new legislation. To start with, the North Dakota Insurance Department (NDID) gathered and analyzed information to study the state of health insurance exchanges in North Dakota. On the 1st of July, 2011, the United States Department of Health and Human Services (HHS) declared North Dakota's rate review process efficient in all markets. Another review by the HHS on the 30th of December of the same year states that North Dakota's external review process is of standard and complies with the temporarily allowed process. Finally on the 28th of September, 2012, North Dakota sent its Essential Health Benefits (EHB) benchmark plan to Secretary Kathleen Sebelius of the HHS. This is based on the Sanford Health Plan, the recommended benchmark plan by NDID. Once approved to take effect on January 1, 2014, it will be the framework used to manage healthcare in the state of North Dakota.

The benchmark plan is beneficial to the residents of North Dakota for several reasons. First of all, it aims to not only run the health care services, but to provide the best possible system for accessing excellent medical professionals. The customers are likewise given the option to choose their medical provider.

Not only that, the benchmark plan provides comprehensive benefits to ensure that the customer's health care needs are addressed. The extensive benchmark plan includes coverage for Family Planning and Family Planning Services such as consultations and pre-pregnancy planning; Allergy Care; Diagnostic Testing and Treatment of Hearing Illness or Injury, among others. Not only this, it has made mandatory amendments for the North Dakota Commercial Group Policy, such as removing the lifetime dollar limits to essential health benefits; extending the coverage of adult benefits to include coverage for a dependent offspring who has not yet reached his 26th birthday; and changing the policies for pre-existing conditions, preventive services, and emergency treatment.

North Dakota further enhances its program by adding a separate plan for minors. This is the North Dakota Children's Health Insurance Plan or CHIP, which includes pediatric and dental benefits. This is the Healthy Steps Children's Health Insurance Program, which was created by the North Dakota Cent Code Legislature way back in 1999 to provide health care support to children from low income families. The CHIP Vision includes Routine Eye Exam for Children once every year as part of its preventive vision services. The plan includes coverage for a pair of reading glasses every other year. There is also the possibility of claiming post-operative refractive examinations if the aforementioned benefits were not availed; otherwise this can be claimed on the next benefit period. The Children's Health Insurance Plan likewise includes coverage for various dental services, which fall under four categories: diagnostic, preventive, restorative and endodontics. Examples of services included in the CHIP Dental are routine dental examinations twice during a benefit period, full mouth survey once every three years, prophylaxis four times during a benefit period, sealants on undecayed molars for a lifetime maximum of two sealants per qualified tooth, restorative veneers once every five years, and root canal therapy.

The Department of Health and Human Services has yet to make a final ruling on state plans including this one. Although ideal, there is no guarantee that benefits and coverage stated here will be rendered mandatory when the Health Care Reform takes effect on January 1, 2014. Hence, the North Dakota Insurance Department continues to study the health insurance marketplace and its options. It is keeping its 1-800 line (1-800-247-0560) open and its email ( up for questions. North Dakota residents may also log on to the North Dakota Insurance Department's website at for updates on the health insurance exchange and the current developments regarding the Affordable Care Act.

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