The role of agents, brokers, and web-brokers in regard to health insurance exchanges was clarified to some degree by a release May 1st from Health & Human Services. While the information relates mostly to federally-facilitated exchanges and state-federal partnership exchanges, it still leaves a number of questions unanswered for state-based exchanges.
Exchange Registration:
In states where Federal exchanges or state-federal partnership exchanges exist, agents and brokers seeking to operate in exchanges must register with the Center for Medicare and Medicaid Services (CMS) through an online registration process available sometime during the summer of 2013.
Agents and brokers will be required to provide identification information, undergo an exchange training course, and agree to comply with federal and state exchange laws. Federally-facilitated and partnership exchanges will not offer any state-specific training, and states will continue to govern their own licensing and continueing education requirements.
Broker Interaction:
There will be two main ways that brokers and agents can interact with consumers in regards to exchanges – through the insurance company or directly through the exchange. This will apply to both individual exchanges as well as Small Business Health Options Program (SHOP) exchanges. Going to the insurance company, agents and brokers will be redirected to the exchange website using exchange credentials obtained upon completion of exchange registration.
Agents and brokers will then assist consumers with their exchange eligibility applications. Once the consumer is deemed qualified for the exchange, the agent and broker will be redirected back to the issuer’s website to assist with plan comparison, selection, and enrollment. For Federal exchanges and state-federal partnerships, agents and brokers are not required to display or facilitate enrollment into all Qualified Health Plans.
On the exchange, consumers will login to the exchange website, and create an account. Agents and brokers can assist with the application process, but are prohibited from creating a consumer’s username and password. After a consumer completes their eligibility application, all available plans will be displayed, and the agent or broker can assist the consumer in selecting a product. The consumer will also be required to enter an agent’s exchange credentials to indicate they were assisted by the agent in choosing their plan.
Commissions:
Health and Human Services will not be issuing commission rules or schedules for agents or brokers for Federal exchanges or state-partnership exchanges, though it does not plan on prohibiting states from doing so in state-based exchanges.
Previously, Health & Human Services has issued rules preventing issuers from offering different compensation rates for health plans sold inside or outside of exchanges.
The full text of the guidance can be found here.
Contact Heather Matias Ainesworth for group quotes and other information relating to health care reform.