1 TPA – TPA Qualified TPAs will be certified by the Maryland Health Benefit Exchange (MHBE) to provide alternate online marketplaces for employers, brokers, and employees to compare, select, and purchase SHOP QHPs. Organizations interested in obtaining Program 1 certification must be able to demonstrate the capability to build and maintain an online retail shopping experience that meets the applicable standards and conditions established by the Affordable Care Act (ACA) and MHBE. Specifically, Program 1 organizations must have the ability to support both the employer choice and employee choice plan set-up and selection models. Additionally, companies interested in providing a Program 1 marketplace should indicate how their company’s approach will further the goals and objectives of the Maryland SHOP Exchange through innovative processes and techniques and ability to drive enrollment into SHOP QHPs. Program 1 is not currently envisioned as a stand-alone program and will include all the functional and technical requirements included in Program 2. Accordingly, all terms and conditions including performance metrics, service levels, and required technology and functions for Program 2 (described separately) will be adhered to by Program 1 participants. TPA Companies seeking certification for Program 1 must have an authorized company representative submit an application through Maryland Health Connection committing their organization to meeting all business and technical requirements of Program 1 as well as to the terms and conditions of the Program 1 business agreement if their company should receive certification. There is no application fee for the program. MHBE will determine whether to accept the company’s application based on the strength of the company’s capabilities, experience and expected innovations and contributions to enhancing and increasing participation in the Maryland SHOP Exchange. The estimated time from submission of an application to decision from MHBE about whether an organization can move to the certification process will be thirty (30) days. MHBE reserves the right to accept an organization’s application for certification as well as defer the applicant’s certification process by up to one year. The number of qualified applicants going through the certification process will be the driving force in any deferred application processes. TPA Companies seeking certification to participate in Program 1 must have an authorized company official sign a business agreement that commits them to meeting all business and technical
1 – TPA TPA Qualified TPAs will be certified by the Maryland Health Benefit Exchange (MHBE) to provide alternate online marketplaces for employers, brokers, and employees to compare, select, and purchase SHOP QHPs. Organizations interested in obtaining Program 1 certification must be able to demonstrate the capability to build and maintain an online retail shopping experience that meets the applicable standards and conditions established by the Affordable Care Act (ACA) and MHBE. Specifically, Program 1 organizations must have the ability to support both the employer choice and employee choice plan set-up and selection models. Additionally, companies interested in providing a Program 1 marketplace should indicate how their company’s approach will further the goals and objectives of the Maryland SHOP Exchange through innovative processes and techniques and ability to drive enrollment into SHOP QHPs. Program 1 is not currently envisioned as a stand-alone program and will include all the functional and technical requirements included in Program 2. Accordingly, all terms and conditions including performance metrics, service levels, and required technology and functions for Program 2 (described separately) will be adhered to by Program 1 participants. TPA Companies seeking certification for Program 1 must have an authorized company representative submit an application through Maryland Health Connection committing their organization to meeting all business and technical requirements of Program 1 as well as to the terms and conditions of the Program 1 business agreement if their company should receive certification. There is no application fee for the program. MHBE will determine whether to accept the company’s application based on the strength of the company’s capabilities, experience and expected innovations and contributions to enhancing and increasing participation in the Maryland SHOP Exchange. The estimated time from submission of an application to decision from MHBE about whether an organization can move to the certification process will be thirty (30) days. MHBE reserves the right to accept an organization’s application for certification as well as defer the applicant’s certification process by up to one year. The number of qualified applicants going through the certification process will be the driving force in any deferred application processes. TPA Companies seeking certification to participate in Program 1 must have an authorized company official sign a business agreement that commits them to meeting all business and technical
TPA-Integration-Package07242013.docx