Utah and the Department of Health and Human Services (HHS) this past week agreed to a fourth model for what the Patient Protection and Affordable Care Act (PPACA) once called insurance exchanges but are now dubbed health insurance marketplaces.

Under the new model, Utah will continue to operate its Avenue H Program, an exchange for employers with up to 50 eligible full-time employees (working at least 30 hours a week), while HHS will set up an exchange solely for individual health insurance consumers in the state.

Most insurance marketplace arrangements are either solely state or federal run. A third arrangement allows for joint operation, but Utah's is the first instance — breaking new ground — in which separate exchanges will be operated.

Avenue H is a defined contribution model, in which employers contribute a set amount for their employers, who then get to choose from three insurers. If employees choose a high-deducatible health plan, they can invest the difference in a Health Savings Plan (HSA).