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CMS updates exchange plan agent advice

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Any health insurers that want to sell “qualified health plans” (QHPs) through the federal exchanges in 2015 should keep tabs on agents’ and brokers’ business names.

QHP issuers also ought to make sure that exchange agents and brokers agree not to discriminate.

Officials at the Center for Consumer Information and Insurance Oversight (CCIIO), the arm of the Centers for Medicare & Medicaid Services (CMS) that oversees the Patient Protection and Affordable Care Act (PPACA) public exchanges, have included those thoughts in a draft version of a QHP program guide aimed at health insurers.

CCIIO completed a similar QHP program guide for 2014 back in April.

The 2014 guide and the draft 2015 would apply directly only to the insurers selling QHPs through the exchanges run by the U.S. Department of Health and Human Services (HHS), not to the issuers of QHPs at state-based exchanges.

Last year, for example, guide drafters suggested in parentheses that the HHS-run exchanges might work with Web brokers as well as traditional agents and brokers. This year, drafters refer to QHPs’ “affiliated agents, brokers, and Web-brokers.”

“CMS strongly suggests that agents and brokers not use ‘Marketplace’ or ‘Exchange’ in the name of their businesses or websites,” officials write.

CMS and HHS officials have been talking about the need for exchanges and QHPs to attract healthy young consumers, but officials say in the new draft guide that QHPs cannot discriminate based on disability, age or health needs.

CMS is recommending that QHPs’ agreements with agents and brokers include a statement emphasizing that the QHP does not discriminate.

In some cases, if CMS gets a consumer complaint about the marketing activities of an agent, broker or Web broker, “CMS may take the necessary enforcement action against the issuer or agent,” officials say.

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