Close Close

Industry Spotlight > Broker Dealers

3 PPACA exchange group plan gotchas

Your article was successfully shared with the contacts you provided.

The U.S. Department of Health and Human Services (HHS) has had such a hard time starting the Small Business Health Options Program (SHOP) plans that it claims it can’t provide enrollment estimates — even for other federal agencies.

Analysts at the Urban Institute reported this summer that one challenge for the managers of the Patient Protection and Affordable Care Act (PPACA) exchange system is winning the hearts of benefits brokers.

But the Centers for Medicare & Medicaid Services (CMS), the HHS agency in charge of the exchange program, still includes challenges to broker love in a new HHS exchange SHOP presentation. Some brokers may refuse to do business with the SHOP plans on principle, because of opposition to the Patient Protection and Affordable Care Act (PPACA) and the PPACA exchange system, but some parts of the presentation might irk even brokers who have a positive or neutral attitude toward the exchange program.

To read more about what’s in the presentation, read on.

No paper

1. Employers can’t apply for SHOP coverage through an HHS-run on paper.

Small employer benefits managers who tried to sign up for SHOP coverage a year ago might prefer to work with quiet, dependable, steady paper. They might flash back to horrific memories of entering complicated employee census information by hand, then watching as the enrollment website froze and ruined al of the work.

But HHS is not offering any concessions for those traumatized by

“No paper applications will be distributed or accepted,” officials say.

See also: Inside the war room

Brokers can't use paper

2. Insurers sometimes give agents and brokers a little more flexibility than they give Joe Shmo Online Consumer. Not the SHOP system.

Your small employer clients can’t apply for SHOP coverage on paper, and you can’t, either.

The employers that already have HHS SHOP plans (we don’t know how many there are, but we assume there are too many to fit in a van) can’t renew existing SHOP coverage by working directly with the insurer.

The employer has to place renewal orders through If you’re helping the employer, you have to get the job done online, too. 

See also: Inside the war room

Disclaimer: Brokers might be bad

3. makes sure to remind employers that you could be an impostor or some other type of crook.

The HHS exchanges don’t warn would-be users that the site they believe to be might be a spoofed site set up by hackers in Bulgaria, but they do make sure to remind employers that you might not be licensed, that you might not be in good standing with insurance regulators, and that you’ll have access to the employer’s business and employee information.

See also: NAIC panel develops navigator licensing framework