Consumer Reps: Navigators and Producers Can Share Exchange Business

Agents who receive commissions from health insurers should not serve as health insurance exchange navigators, but exchanges could pay agents to send consumers their way, consumer representatives say in a new comment letter.

The Patient Protection and Affordable Care Act of 2010 (PPACA) clearly prohibits anyone who wants to participate in the new navigator program from receiving commissions from health insurance carriers, the reps say in a letter to the leaders of the Exchanges Subgroup at the National Association of Insurance Commissioners (NAIC), Kansas City, Mo.

“That said, an exchange can contract with producers separately to bring them enrollees,” the reps say.

Existing health exchanges in Utah and Massachusetts already do that, the reps say.

“Further, there is nothing to prevent an exchange from contracting with producers – either on a [per member per month] or commission basis, to bring in small groups,” the reps say. “Whether it’s an employer-choice or employee-choice model, small business owners and employees will likely continue to rely on producers to understand their options and recommend benefits. In fact, the need for producers may be greater in an employee choice model, in which each individual employee may need help choosing coverage.”

The NAIC provides funding for the reps to help them represent consumer interests in NAIC proceedings.

PPACA, Exchanges and Navigators

PPACA opponents are trying to block implementation of part or all of the act.

If the act takes effect as written, state-supervised health insurance exchanges will help low-income and moderate-income individuals use federal tax credits to buy health insurance through a one-stop shopping process. The exchanges will also sell coverage to small employers.