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You may be a HealthCare.gov "A/B"

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Managers of the HealthCare.gov public exchange system refer to “agents and brokers” a lot more often in their new exchange instruction manual than they did in the old manual.

In an old version of the manual, published in 2013, exchange managers said at the start that the manual applied to “agents and brokers (A/B),” but they never used the terms “agent” or “A/B” anywhere else in the manual. The managers included one diagram showing how an exchange plan issuer’s or Web broker’s website might connect with HealthCare.gov systems.

In the new update, the Federally facilitated Marketplace (FFM) and Federally facilitated Small Business Health Options Program (SHOP) Enrollment Manual, exchange managers use the term “agent” or “agents” 17 times; “broker” or “brokers” 60 times; and “A/B” 49 times.

See also: CCIIO: Producers critical to small-group exchanges

The exchange managers have included a table showing A/B’s how to get their National Producer Numbers (NPNs) into HealthCare.gov systems; information about how the SHOP exchange division can interact with A/B’s; many references to how A/B’s fit in at various stages of the individual or small-group enrollment process; and a discussion of the “limited circumstances” in which A/B’s may be able to charge “an additional fee” for a “bona fide service of value that goes beyond the traditional assistance provided by an A/B.”

If an A/B does charge an extra fee for highly valuable extra services, the A/B must clearly disclose the amount of the fee and reason for the fee on its website, and tell consumers that they can apply for exchange plan coverage through HealthCare.gov without paying the additional fee, officials say.

The new manual applies only to the Patient Protection and Affordable Care Act (PPACA) exchanges that use the HealthCare.gov enrollment system. State-based, state-run exchanges have their own enrollment systems and their own operating rules.

The U.S. Department of Health and Human Services (HHS), which prefers to call the exchange system “the Marketplace,” set up HealthCare.gov system and opened it up for business on Oct. 1, 2013.

Officials at the Center for Consumer Information & Insurance Oversight (CCIIO), the HHS division that runs HealthCare.gov, prepared both the old exchange manual and the new update.

In addition to talking about the role of A/B’s in the HealthCare.gov exchange system, officials talk about many other aspects of exchange operations. In one section, for example, officials have added procedures explaining what the exchange, consumers, A/B’s and others should do when enrollees lose their coverage due to various types of errors.

Some of the major types of mistaken disenrollments covered include those resulting from A/B errors, exchange errors, issuer errors and “erroneous death notifications.”

The insurers that issue exchange plans can fix some disenrollment errors on their own, but not disenrollments related to mistaken reports of death.

When former enrollees who were thought to be dead prove to be undead, the enrollees have to talk to the exchange to provide proof of being alive, officials say.

See also: 6 signs you are a sales zombie

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