The agency that runs the public exchange system in the HealthCare.gov states has given navigators, certified application counselors (CACs) and other nonprofit assisters a webinar on how to work with insurance agents and brokers.
Officials at the Center for Consumer Information and Insurance Oversight (CCIIO), the arm of the U.S. Department of Health and Human Services (HHS) in charge of managing the Patient Protection and Affordable Care Act (PPACA) programs that affect the commercial insurance market, developed the webinar to help explain HHS legal requirements to the assisters.
Producers have argued that they usually know more about the market than newly trained assisters; that they usually carry professional liability insurance; and that they must abide by strict, complicated business rules that do not always apply to exchange assisters.
CCIIO has given its perspective on the matter in a written version of the presentation posted on the Web.
For a look at what CCIIO is telling the assisters about you, read on.
1. In states with HHS-run exchanges, producers do not necessarily have to tell consumers about all available QHPs.
Officials have told the nonprofit exchange assisters that, in most cases, assisters must sell all exchange qualified health plans (QHPs) to all people who seek help, and that they are prohibited from receiving consideration directly or indirectly from a health plan.
Producers are licensed and regulated by states, and they can make specific recommendations about enrollment in plans, officials say.
Producers “typically get payments, or commissions, from health insurers for enrolling a consumer into an issuer’s plans,” and some “may only be able to sell plans from specific health insurers,” officials say.
“There is no federal requirement that agents or brokers help all persons who ask for their assistance,” officials say. “The extent to which agents and brokers owe particular duties to consumers usually depends on whether any such duties have been established under state law.”
2. Exchange assisters have to avoid favoring some producers over others.
Officials told assisters that they cannot endorse specific producers, refer consumers to specific producers, accept consideration of any kind from producers, or use the services of producers “as a substitute for performing any of your federally required duties.”