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California: Keep Tom, Dick and Harry out of group market

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Managers of Covered California — the California Health Benefit Exchange — are trying to control the number of different types of intermediaries that help employers use the state’s health insurance exchange (HIX) system.

California officials are fighting a federal proposal that would require all types of certified exchange helpers to serve both individual consumers and small employers.

Officials want to stick with encouraging licensed agents, licensed brokers, and certified Navigators to serve small employers.

Requiring all types of exchange helpers to serve small employers “would be both costly and duplicative of services provided today by agents,” California exchange officials said in a comment on draft exchange regulations developed by the Centers for Medicare & Medicaid Services (CMS).

Exchange managers included the comments on the draft in a batch of documents to be reviewed at a board meeting.

The Patient Protection and Affordable Care Act of 2010 (2010) requires CMS’ parent, the U.S. Department of Health and Human Services (HHS), to work with state regulators to set up exchanges, or health insurance supermarkets, for individuals and small groups in all 50 states and the District of Columbia by Oct. 1.

California is setting up its own individual exchange and Small Business Health Options Program (SHOP) exchange, rather than letting HHS provide exchange services for its residents.

The California exchange will be open only to employers with two to 50 employees. 

PPACA requires exchanges to offer users access to Navigators, or ombudsmen. The Navigators are supposed to be independent sources of information about how the exchange system works. Navigators cannot sell coverage or give users advice about which plans to buy.

HHS is going to let agents and brokers serve both individuals and employers that use the exchanges that HHS runs.

HHS is letting states choose whether to offer users of state-run exchanges access to agents and brokers.

Since PPACA was created, HHS has developed regulations that describe other types of exchange helpers, such as “in-person assisters” and “certified application counselors.”

HHS officials have suggested that in-person assisters will be paid workers who will work with individuals who need face-to-face help with filling out exchange plan paperwork.

Certified application counselors would be volunteers who would provide in-person assistance services.

States have been creating additional categories of exchange helpers.

Illinois, for example, is now offering grants for “in-person counselor” entities that will hire and employ “guides.”

In California, “Covered California intends to use certified agents to facilitate enrollment in the SHOP,” exchange officials said.

California will teach “non-Navigator assistance personnel” SHOP basics, but the state does not want to have to give those types of exchange helpers the kind of training they would need to complete a group plan enrollment, officials said.

In another document, on the Covered California program for recruiting, training and supervising in-person assisters. Thien Lam talks about the kinds of insurance that assisters should have.

California is using the term “assister” to refer to everyone other than Navigators who helps consumers and employers use the exchange system. In California, the term “assister” includes licensed agents and brokers as well as exchange enrollment helpers who do not have producer licenses.

Originally, exchange staffers had talked about requiring all “assister enrollment entities” to have general liability insurance and errors and omissions (E&O) coverage, Lam said in the presentation.

Members of the public who commented on that idea said individual assisters other than licensed producers would not qualify for liability insurance.

Because of that challenge, the exchange staff has decided that the “individual assister entities” that help with enrollment must have general liability insurance, auto insurance and workers compensation insurance.

The staff has decided that the individual assisters who work for the entities need not have their own general liability insurance, Lam said.

If HHS will let an exchange require an assister enrollment entity to have E&O coverage, Covered California will require California assister enrollment entities to have E&O coverage, Lam said.

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