The Georgia 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=georgia.
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.
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:
Office of Insurance and Safety Fire Commissioner
Two Martin Luther King, Jr. Drive
West Tower, Suite 704
Atlanta, GA 30334
www.oci.ga.gov/
Complaints: www.oci.ga.gov/consumerservice/complaintprocess.aspx
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 HEALH 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.
Georgia has established Blue Cross Blue Shield of GA 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.
Alliant Health Plans
Plan Website: http://www.alliantplans.com/visitors.php
Provider Enrollment: http://www.alliantplans.com/contact.php
Plan types offered: Individual, SHOP
Ambetter from Peach State Health Plan
Plan Website: http://www.pshpgeorgia.com/
Provider Enrollment: http://www.pshpgeorgia.com/for-providers/become-a-provider/
Plan types offered: Individual
Anthem Blue Cross and Blue Shield
Plan Website: https://www.bcbsga.com/health-insurance/georgia-health-plans/
Provider Enrollment: http://www.bcbsga.com/wps/portal/chpproviderbcbsga?content_path=provider/noapplication/plansbenefits/credentialing/notertiary/pw_ad031448.htm&rootLevel=3&label=Become%20A%20Network%20Provider&rootLevel=3&label=Become a Network Provider
Plan types offered: Individual
Assurant Health
Plan Website: http://www.assuranthealth.com/corp/ah/AHHome.htm
Provider Enrollment: http://www.assuranthealth.com/corp/ah/Providers/health-care-provider.htm
Plan types offered: Individual
Blue Cross Blue Shield of Georgia
Plan Website: https://www.bcbsga.com/health-insurance/home/overview
Provider Enrollment: http://www.bcbsga.com/home-providers.html
Plan types offered: SHOP
Blue Cross Blue Shield Healthcare Plan of Georgia
Plan Website: https://www.bcbsga.com/health-insurance/georgia-health-plans/
Provider Enrollment: http://www.bcbsga.com/wps/portal/chpproviderbcbsga?content_path=provider/noapplication/plansbenefits/credentialing/notertiary/pw_ad031448.htm&rootLevel=3&labe
Plan types offered: Individual
Cigna Healthcare
Plan Website: http://www.cigna.com/business/?WT.srch=1&gclid=CLWE_-aZksICFSgV7Aodt3gAKQ
Provider Enrollment: http://www.cigna.com/aboutcigna/contact-us/?WT.z_nav=health-care-professionals%3BTop-Nav%3Bcontact-us
Plan types offered: Individual
Coventry Health Care of Georgia, Inc.
Plan Website: http://chcgeorgia.coventryhealthcare.com/
Provider Enrollment: http://chcgeorgia.coventryhealthcare.com/services-and-support/providers/
Plan types offered: Individual
Humana Employers Health Plan of Georgia, Inc.
Plan Website: https://www.humana.com/individual-and-family/
Provider Enrollment: https://www.humana.com/provider/medical-providers/network/learn-more/
Plan types offered: Individual
Humana Insurance Company
Plan Website: https://www.humana.com/individual-and-family/products-and-services/medical-plans/
Provider Enrollment: https://www.humana.com/provider/medical-providers/network/
Plan types offered: Individual
Kaiser Foundation Health Plan of Georgia
Plan Website: http://thrive.kaiserpermanente.org/regions/georgia-health-care?kp_shortcut_referrer=kp.org/georgia
Provider Enrollment: http://www.kaiserpermanentejobs.org/default.aspx
Plan types offered: Individual, SHOP
Kaiser Permanente
Plan Website: https://healthy.kaiserpermanente.org/html/kaiser/index.shtml?region=GGA
Provider Enrollment: http://www.kaiserpermanentejobs.org/default.aspx
Plan types offered: SHOP
UnitedHealthcare
Plan Website: http://www.uhc.com/health_reform_guide.htm
Provider Enrollment: http://www.uhc.com/physicians/join_our_network.htm
Plan types offered: Individual