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How Web brokers can share their HealthCare.gov pipelines

By Allison Bell

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The Centers for Medicare & Medicaid Services (CMS) is continuing to proceed on the assumption that the Patient Protection and Affordable Care Act (PPACA) and the PPACA public exchanges will return for the 2016 open enrollment period.

CMS officials recently presented a webinar aimed at companies that want to serve as Web brokers for the exchanges that use the HealthCare.gov system for enrollment — and it included a discussion of how a Web broker can share its exchange system pipelineline with other agents and brokers.

CMS, a division of the U.S. Department of Health and Human Services (HHS), set up HealthCare.gov for the states in HHS administers the exchange program.

Companies must meet many regulatory requirements to act as Web brokers for the HHS-run exchanges. A Web broker must warn shoppers that its site is separate from HealthCare.gov, provide as much information as possible about all available “qualified health plans” (QHPs), and warn consumers when it’s providing fewer details than HealthCare.gov would.

If Web brokers want to give consumers premium tax credit estimates, they must use a HealthCare.gov tax credit tool to verify the estimates.

Web brokers’ sites must be accessible for people who have only a limited ability to use English, and for people who have disabilities.

But acting as a Web broker, may give a broker a chance to capture some of the premium revenue flowing into the PPACA exchange system, and Web brokers may be able to charge users’ service fees.

For more about what CMS officials said at the Web broker webinar, read on.

Dollar puzzle

1. Charging QHP buyers a separate service fee is complicated, but it’s possible. 

The HHS officials who set up the PPACA program have always expressed an interest in working with traditional health insurance agents and brokers, combined with complicated views on whether and how producers who sell QHPs ought to get paid.

At the webinar, officials said Web brokers should not offer financial incentives, such as rebates or giveaways, to QHP buyers.

They then said that Web brokers should not “charge consumers a separate transaction or service fee for enrolling in a QHP.”

The officials then reversed the command that Web brokers should not charge QHP enrollees a service fee, by adding, “Unless: Permitted under state law [and] the fee is reasonable and for a bona fide service of value that goes beyond the traditional assistance” provided by a HealthCare.gov exchange agent.

Web brokers that charge services for extra QHP help should clearly disclose the amount and reason for the fee and inform shoppers that they can apply for coverage through HealthCare.gov at no cost, officials said.

Someone reviewing paperwork

2. A Web broker that shares its HealthCare.gov QHP pipeline with other agents and brokers must make sure shoppers know which company is the official Web broker.

A producer who is using a Web broker’s pipeline must put the Web broker’s name and National Producer Number (NPN) on the initial shopper landing page, the QHP selection page, and any written QHP materials that can be printed from the website, officials said.

The information identifying the Web broker has to be as prominent as the disclaimers warning shoppers that a Web broker’s site is not HealthCare.gov.

See also: Getinsured.com signs exchange hub agreement

Shield

3. The Web broker has to help CMS police the other agents and brokers who are using the QHP pipeline.

A Web broker that wants to share QHP access must give CMS the producers’ contact information and verify that the producers are licensed in the right states and registered with HealthCare.gov.

A Web broker must cut off a producer if HHS ejects the producer from the exchange agent program.

If a Web broker lets a producer use its QHP pipeline, and the Web broker “has become aware” of a producer violating exchange agent standards, the Web broker is supposed to report the producer both to HHS and to the applicable state insurance departments.

See also: What if producers and FFEs break up?