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HIV and Enteropathy
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Texas State Insurance Exchange
Exchange:
The Texas Insurance Exchange (Marketplace) is the Federally-Facilitated Marketplace.
The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).
General information about the Federally-facilitated Marketplace can be found at: https://www.healthcare.gov/marketplace/individual/#state=texas.
Learn more: Background
Patients:
The Federally-facilitated Marketplace is essentially a marketplace for individuals to shop for health insurance if they do not already have insurance coverage from another source. If individuals have insurance from another source such as employment, retirement benefits, or spousal benefits, they do not need to obtain it from the Marketplace.
HIV Providers:
Providers must contract with each of the Qualified Health Plans offered in the marketplace individually to participate fully in the Federally-facilitated Marketplace.
This process is similar to enrolling in insurance or managed care organization provider networks. See below the list of insurers participating in the Federally-facilitated Marketplace, and information about contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.

Learn More
: Health Reform & My Practice
Reporting Problems

The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them. If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state office of insurance:

 

333 Guadalupe
Austin, TX   78701

800-578-4677

 

www.tdi.texas.gov/

 

Complaints: http://www.tdi.texas.gov/consumer/complfrm.html
 

Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

 
Qualified Health Plans Participating In the Exchange:
Below is a list of the Qualified Health Plans that have publically announced that they will offer plans in the Federally-facilitated Marketplace.
Texas has established Blue Cross Blue Shield of TX as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates.
Aetna
 
Aetna
 
Ambetter from Superior Health Plan
 
Blue Cross Blue Shield of Texas 
 
Cigna Health and Life Insurance Company
Provider Enrollment: http://www.cigna.com/healthcare-professionals/join-our-network
 
Community Health Choice
 
CommunityFirst
Plan Website: http://www.cfhp.com/
 
Firstcare Health Plans
 
Humana Health Plan of Texas, Inc.
 
Humana Insurance Company
 
Molina Healthcare of Texas
 
Scott & White Health Plan
 
Sendero Health Plans
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