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PPACA agency explains brokers to assisters

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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.

See also: How the PPACA exchange program still infuriates agents

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. 

Client meeting

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.”

See also: Complicated young adults: How do you get them covered?

Parity scale

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.”

See also: Feds: HHS exchange agent who fibs could owe $250,000 fine 

Moat

3. Assisters must take steps to avoid actual or potential conflicts of interest.

Officials told assisters not to promote links or widgets connecting consumers with specific Web brokers at their offices or enrollment tables or on their websites.

Assisters must also refrain from hosting or reserving space for agents or brokers at their service locations, whether or not the producers would be paying for the space.

Assisters must not use a Web broker’s site when helping consumers with the exchange application process, unless the assisters are using the Web broker’s site as a reference tool to supplement the HealthCare.gov site.

“HealthCare.gov should always be the primary website you use to perform these assister functions,” officials say.

See also: When exchange users die: 3 do’s and don’ts

Chooser

4. If consumers ask for help with finding agents or brokers, assisters should use objective criteria to narrow the number of choices.

Officials suggest that assisters could help consumers screen producers based on criteria such as location, ability to help with Medicaid enrollment, or ability to speak Spanish.

See also: 5 exchange plan re-enrollment stories 

Shark

5. Assisters should be careful about how they relate to producers at enrollment events.

Officials give three scenarios to illustrate how the guidelines might work in practice.

One features an enrollment event at a local food bank.

You notice that the event’s guest list includes several health insurance agents from the area. The food bank comments that these agents reached out to them to see if they could participate to advertise their services.

You know that not all agents and brokers from the community will be attending, and do not want to appear biased towards those who are.

Assisters could attend that event without violating the HHS conflict-of-interest rules, officials say. But officials note that the assisters should not use help from the producers in place of their own assister services, by, for example, helping consumers complete applications, and then having consumers see producers for help with selecting QHPs.

Assisters could send a consumer to a producer only if “the consumer specifically asks to be assisted by that agent or broker,” officials say.

See also: Sluggish exchange plan users could face big 2016 tax bills

Image: NOAA photo/Walter Heim