GetInsured and MAXIMUS Chosen for NJ’s Health Insurance Exchange

On Jan 7, 2020

The New Jersey Department of Banking and Insurance announced the selection of GetInsured, a health insurance marketplace platform provider, to develop and operate the technology platform for New Jersey’s State-Based Health Insurance Exchange (HIX), and MAXIMUS to operate the consumer assistance center for the state. The selection is a key step in the effort to transition to a State-Based Exchange for Plan Year 2021 to improve health coverage access for New Jersey residents and allow the state greater control over its health insurance market.

“We made it a priority in New Jersey to ensure families have access to the health coverage and care they deserve by creating a State-Based Exchange that is tailored and efficient for our residents. We took a first step this year by moving to a State-Based Exchange on the Federal Platform, which allowed us to increase our investment in outreach to New Jersey residents at a time when the federal government was cutting costs. We now begin the work of establishing the technology platform and consumer assistance center for New Jersey’s State-Based Exchange that will allow us to best serve the health coverage needs of our residents into the future,” said Department of Banking and Insurance Commissioner Marlene Caride.

“We look forward to collaborating with our partners in New Jersey and, together, providing residents with greater access to comprehensive, quality healthcare at a fair and reasonable cost,” said Chini Krishnan, CEO and co-founder of GetInsured. “Thanks to current technology, it is easier than ever for states to ensure the health enrollment needs of their residents are met, and as we move into 2020, we expect more and more states will move to create their own state-based marketplace.”

“We are proud to support New Jersey as the state transitions its Qualified Health Plans (QHPs) from the Federally Facilitated Marketplace (FFM) to its own State-Based Exchange. We are dedicated to constantly improving the citizen experience so that consumers can easily connect to the right services and health plans. Our innovative approach is focused on seamlessly supporting consumers through multi-channel engagement and helping the state achieve its programmatic goals,” said Bruce Caswell, Chief Executive Officer of MAXIMUS.

Governor Phil Murphy signed legislation in June of 2019 to establish a State-Based Exchange in New Jersey operated by the Department of Banking and Insurance, to be funded by an assessment on premiums. The assessment was previously paid to the federal government to utilize the Federally Facilitated Exchange (FFE).

As part of its transition to a State-Based Exchange, New Jersey began operating a State-Based Exchange on the Federal Platform in September of 2019, which allowed the state to increase investment in outreach and enrollment efforts focusing on reaching uninsured and underinsured residents. New Jersey will operate a State-Based Exchange for the Open Enrollment Period in November of 2020. Until that time, consumers will continue to shop for and enroll in Marketplace coverage, available through Special Enrollment Periods, on HealthCare.gov.

GetInsured and MAXIMUS were selected through a competitive bidding process. The base term of the contract for GetInsured is for a period of five years, with a total cost of $39.8 million. After the first year of setup, the GetInsured contract calls for maintenance and operations costs of approximately $7.6 million for the year in 2021. The base term for the contract for MAXIMUS is three years, with a total cost of $17.8 million. Under the MAXIMUS contract, the maintenance and operations costs will be approximately $7.1 million for 2021. The technology platform and consumer assistance center will be funded by the assessment on premiums paid by carriers in accordance with state law. Under the law, funding from the assessment will also be used to support outreach, enrollment, and other means of supporting the exchange, including efforts that can increase market stabilization and that may result in a net benefit to policyholders.

The state previously sent over $50 million a year to the federal government to utilize the Federally-Facilitated Exchange. The operation of a State-Based Exchange will give the state control over the open enrollment period, cut by the federal government from three months to six weeks, and access to data that can be used to better regulate the market, conduct targeted outreach and inform policy decisions. It will also allow the state to dedicate funding towards outreach and enrollment efforts which have been significantly reduced at the federal level, in order to improve access to coverage for New Jersey residents.

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