Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

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1 1 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

2 Copyright No part of this consumer report may be reproduced or transmitted in any form without the written permission of the author. This electronic book is optimized for viewing on a personal computer screen, but is optimally organized so that it can be printed out and assembled in a traditional book form. Since this electronic book is optimized for viewing on a personal computer screen, the type used is larger than that of which is traditionally utilized in printed books. Disclaimer This report was diligently researched and compiled with the intent to provide information for persons wishing to learn about the landscape of health insurance reform and the opportunities they present. Throughout the making of this consumer report, every effort has been made to ensure the highest amount of accuracy and effectiveness for the techniques suggested by the author. The report may contain contextual as well as typographical mistakes. No information provided in this report constitutes a warranty of any kind; nor shall readers of this report rely solely on any such information or advice. All content, products, and services are not to be considered as legal, medical, or professional advice and are to be used for personal use and information purposes only. This report makes no warranties or guarantees express or implied, as to the results provided by the strategies, techniques, and advice presented in this report. The publishers of this report expressly disclaim any liability arising from any strategies, techniques, and advice presented in this report. The purpose of this consumer report is to educate and guide. Neither the publisher nor the author warrant that the information contained within this consumer report is free of omissions or errors and is fully complete. Furthermore, neither the publisher nor the author shall have responsibility or liability to any entity or person as a result of any damage or loss alleged to be caused or caused indirectly or directly by this report. Safe Harbor Notice Certain statements in this presentation relate to future results that are forwardlooking statements as defined in the Private Securities Litigation Reform Act of This presentation contains statements involving risks and uncertainties, including statements relating market opportunity and future business prospects. Actual results may differ materially and reported results should not be considered as an indication of future performance. Factors that could cause actual results to differ are not included. 2 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

3 Contents The Role of Agents and Brokers... 4 Registration and Training Three Options to Assist Consumers... 5 Issuer-Based Pathway... 5 What Does This Mean For HPA?... 5 Marketplace Pathway... 6 What Does This Mean For HPA?... 6 Web-Brokers What Does This Mean For HPA?... 7 About the Author... 8 About Health Partners America Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

4 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces On May 1, 2013, the Center for Consumer Information and Insurance Oversight (CCIIO), which is part of CMS, issued some guidance on the role of agents, brokers, and Web-brokers in Health Insurance Marketplaces, including their ability to sell subsidized plans and earn a commission. The Role of Agents and Brokers The much-anticipated guidance begins by saying that CMS will work with agents and brokers to assist consumers in completing the eligibility application, comparing and selecting qualified health plans (QHPs), and enrolling consumers through the Marketplace in states that have opted for a Federally-facilitated or State- Partnership exchange (a combined total of 33 states). States that are creating their own exchange will develop their own rules. Federally-facilitated Marketplaces, including State Partnership Marketplaces, will not establish a commission schedule or pay commissions directly to agents or brokers. Instead, brokers will be paid by the carrier, as they are today, and the commission will be the same for plans sold through the exchange and similar plans sold in the outside market, which is definitely good news. States setting up their own exchange may establish their own rules for compensating agents and brokers, by direct compensation from the Marketplace, or by having issuers pay commissions. Registration and Training Beginning this summer, brokers will be able to register online with CMS so that they may assist qualified individuals with Marketplace coverage. They will be required to complete an online training course and will receive an active Federally-facilitated Marketplace 4 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

5 user ID which, along with the agent s national producer number (NPN), will be essential for the broker to receive compensation from the carrier. Three Options to Assist Consumers The guidance outlines three ways in which brokers will be able to enroll consumers in Marketplace plans, which allow individuals to apply for a premium tax credit. Each of these options permits brokers to assist their clients throughout the year with adds, deletes, and other service issues. ISSUER-BASED PATHWAY Agents who use the carrier s website to assist consumers can continue doing so according to the guidance. They would start the process by logging in to the carrier s website and will be securely redirected from the issuer s agent website to the Marketplace website to complete the subsidy eligibility application, using his or her Federally-facilitated Marketplace user ID to access the Marketplace website. Once the eligibility determination is made, the agent will be securely redirected to the issuer s website to assist the consumer with plan comparison, plan selection, and enrollment. While there is no requirement that an agent using the issuerbased pathway to display all Qualified Health Plans (QHPs) or to facilitate enrollment into all QHPs, CMS expects the broker to inform the consumer that he is providing information for certain QHPs with which he has a business relationship, but that the consumer could directly access the Federally-facilitated Marketplace website, where additional QHP information and choices are available. WHAT DOES THIS MEAN FOR HEALTH PARTNERS AMERICA? This process is very similar to the process HPA partners currently 5 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

6 use to sell plans through their private exchange, whether they sell those plans directly or route their health insurance leads to the call center to follow up on. This new and welcomed guidance means that we can continue to help our clients by recommending the plans that make the most sense with no requirement to show plans that we don t feel are a good fit. MARKETPLACE PATHWAY An agent will also be able to help individuals and employers enroll directly on the Federally-facilitated Marketplace and SHOP websites using the Marketplace pathway. After the consumer creates his or her own Marketplace username and password, the agent or broker will then work with the consumer to complete the eligibility application. The consumer will be prompted to enter the agent or broker s Federally-facilitated Marketplace user ID and NPN on the application to indicate that the agent or broker assisted the consumer. Once the eligibility determination has been made, the broker will be able to assist the consumer in choosing a Qualified Health Plan. All of the QHP options will be displayed, and the consumer will once again be asked to enter the broker s ID number to indicate that the agent or broker assisted the consumer with plan selection and enrollment. WHAT DOES THIS MEAN FOR HEALTH PARTNERS AMERICA? The Marketplace pathway ensures that HPA partners as well as the fulfillment center will be able to assist clients in states that do not permit Web-brokers to sell subsidized plans. This is an important fallback plan but is less important given the issuer-based pathway which is now available. WEB-BROKERS CMS refers to agents or brokers who enroll consumers through public-facing websites as web-brokers, and, to the extent 6 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

7 permitted by a state, this will be another option for consumers seeking to enroll in QHPs through the Marketplaces for individual products. Unlike agents who are assisting clients one-on-one by signing them up through the carrier s website, web brokers would be required to display all QHPs available through a Marketplace, irrespective of compensation or appointment arrangements. CMS is developing the capability to support integration between the Web-broker s website and the Federally-facilitated Marketplace s website using secure redirect and application programming interface mechanisms. The application programming interface will allow a qualified individual to initiate his or her shopping experience on the Web-broker s website, connect securely to the Federally-facilitated Marketplace website to complete the eligibility application and determination process, and return securely to the web-broker s site to compare plans and select a QHP. The guidance says that Web-brokers may offer additional tools or decision support that the consumer can use to navigate or refine the display of QHPs. Web-brokers may also offer the consumer the ability to search for additional products or services after he or she has completed the QHP plan selection and enrollment, but the qualified plans must be displayed separately from non-qhps and the QHP shopping experience must be free from advertisements or information of other insurance-related products. WHAT DOES THIS MEAN FOR HEALTH PARTNERS AMERICA? HPA has long said that we intend to get established as a Webbroker in any states that permit this option, and the guidance from CMS makes it clear that this will be a possibility. HPA partners utilizing the fulfillment center will be provided with a public-facing website that displays all QHPs in the format prescribed by CMS. In states where enrollment through Web-brokers is not permitted, the call center will still be able to help individuals enroll directly through the carrier s website, as they do today. 7 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

8 About the Author Eric Johnson is the award winning Director of Education with Health Partners America. He spends much of his time studying the health reform legislation and translating it into terms everyone can understand. A recognized leader in the health insurance industry, Eric is a past president of the Fort Worth Association of Health Underwriters and a regular contributor to Benefits Selling Magazine and BenefitsPro.com. He is also a two-time recipient of the National Association of Health Underwriters William G. Wetzel Award for Excellence in Public Speaking and a national instructor for NAHU s Consumer Directed Health Care certification course. A Texas native, Eric was born and raised in Houston, graduated from the University of Texas at Austin, and currently lives in the Dallas-Fort Worth area. 8 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

9 About Health Partners America Since 2007, HPA has been providing game-changing training and soft-ware for financial professionals. They have been solving the American health care crisis by using smarter insurance solutions through innovative plan designs using defined contribution plans and private exchanges. Private Exchange Broker Blueprint is the latest software innovation that walks financial professionals through how to setup profitable Private Exchanges for employers of any size. Their concepts that are built on the solid structure of the tax law have been implemented hundreds of times by a small number of highly successful agents who began selling and implementing defined contribution solutions to businesses over four years ago. Learn more at Keep up to date by visiting our resources section: If you re interested in joining the groundswell of benefit advisors, General Agents, Field Marketing Organizations and brokers profiting from this new landscape, please join us for our next free webinar where we reveal The Proven Step-by-Step System to Understand, Present and Sell Private Exchange Solutions. Dates and times change weekly; visit our web site at to see the next one that s right for you. 9 Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces