With just four months remaining until businesses must begin their first open-enrollment period for benefits under federal affordable health care guidelines, no one, not even the state’s insurance commissioner, knows how it will look.

With federal agencies rolling out new rules in recent weeks, the Iowa Insurance Division has been scrambling to put together its health insurance exchange.

“What we’re building here is accommodating an entirely new process,” said Iowa Insurance Commissioner Nick Gerhart. “The fact is, the plans that are going to be offered in the post-(Patient Protection and Affordable Care Act) world, if you will, are new plans. They have different benefits and other new mechanisms. ... We’re still reviewing the products…”

“We have to have our recommendations to the Centers for Medicare and Medicaid Services by July 31,” Gerhart said. “So I sure hope the carriers, if they’re going to play, do it before then.”

Gerhart said he personally has contacted each of the major insurers in the state. However, he still doesn’t have a clear picture of which ones may participate.

“I think everyone’s still weighing their options,” he said. “I’m confident that we’re going to have carriers in the exchange, and I’m confident we’ll have a couple of options that will have statewide capacity. But right now, I just don’t know who it’s going to be.”

FAQs on exchanges

What will Iowa’s health exchange do?

Iowa’s exchange essentially will provide a screening mechanism for individuals and employees of small businesses to first determine whether they’re eligible for Medicaid or the Healthy and Well Kids in Iowa (hawk-i) program, which provide free or low-cost coverage to low-income families. If a family’s income is higher than those programs’ limits, they’ll be sent back to a federal portal in which participating insurance companies will offer private-sector health policies along with federal tax subsidies to help them pay the premiums.

Will Wellmark Blue Cross and Blue Shield participate?

Wellmark, which holds the majority of market share in the group and individual health insurance markets in Iowa and also operates in South Dakota, said recently it expects to hold off on any announcement regarding Iowa exchange participation until closer to the state’s deadline of June 30.

What other companies might participate?

UnitedHealth Group Inc., the biggest U.S. health insurer, earlier this year indicated that it likely would focus on a limited number of markets as the new exchanges start. UnitedHealth said it expects to participate in 10 to 25 or more of the marketplaces. A nonprofit cooperative based in Des Moines, CoOportunity Health, was formed last year with the assistance of a $112 million federal loan and is expected to offer health coverage on the exchange.

Who are the exchanges for?

The exchanges will apply only to individuals needing insurance and to small businesses with fewer than 50 employees whose workers need coverage. Large companies, those with 50 or more employees, and self-insured groups that continue to offer health coverage will not have to worry about the exchanges this year. However, a large company will face a per-employee penalty next year if it does not offer coverage or its plan is deemed to not be affordable under the federal guidelines. Or, a large employer may decide to not provide coverage, pay the penalty and let their employees shop for their own insurance on the exchange.