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July 12, 2013 at 01:03 PM
The Obama administration has come up with a new batch of rules for the people who are supposed to help consumers and employers use the Patient Protection and Affordable Care Act (PPACA) health insurance exchange program.
The rules would let licensed insurance agents and brokers sell exchange coverage to consumers, as long as states let agents and brokers sell health insurance.
Because of a PPACA ban on “navigators,” or independent ombudsmen, getting compensation from health insurers, the rules would not let producers who were working as navigators get paid by carriers.
But, in the new final rule, “Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel; Consumer Assistance Tools and Programs of an Exchange and Certified Application Counselors” (CMS-9955-F), the U.S. Department of Health and Human Services (HHS) leaves open the possibility that some producers in some states might be able to work as exchange-paid navigators while collecting commissions for other types of insurance products, such as critical illness insurance or hospital indemnity insurance.
The final rule also includes sections on certified application counselors, in-person assistance personnel and non-navigator assistance personnel. All kinds of official exchange helpers would have to get 30 hours of training.
The rule, which is set to appear in the Federal Register July 17, is based on drafts released in January and April.
The regulations will apply directly to the “federal facilitated exchanges” (FFEs) run by HHS. States that are setting up their own, state-based exchanges can either use the HHS rules or develop their own guidelines.
In the past, HHS officials have said that they expect agents and brokers to continue to play an important role in the health insurance market in most states. Officials have included a similar statement in the preamble to the new regulations.
In a discussion of comments on the earlier regulation drafts, HHS talked about an apparent navigator program quirk that could give sellers of supplemental health products, such as a critical illness insurance, and edge over sellers of major medical insurance.
Navigators are not supposed to be able to sell exchange coverage or make official recommendations about the coverage, because they are not licensed agents or brokers.
