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October 18, 2017 at 12:51 PM
Public health insurance exchange plan issuers should try to work with agents and brokers to clear up compensation problems related to missing National Producer Numbers (NPN), according to HealthCare.gov managers.
(Related: The NIPR Has Your Number)
Representatives from HealthCare.gov, the federal government’s web-based health insurance supermarket program talked, a little, about producer compensation last week, during a webinar aimed at producers who may sell the plans available through HealthCare.gov for 2018.
HealthCare.gov’s own staff calls HealthCare.gov “the Marketplace.”
“If you have reason to believe that your NPN (or agency/brokerage NPN) should have been included on a Marketplace enrollment transaction, but was not, you may contact the respective [exchange plan] issuer directly to discuss the situation,” HealthCare.gov managers say in a webinar slidedeck.
The HealthCare.gov team thinks an exchange plan issuer “would issue compensation if it is determined from the issuer’s or your records that you did in fact assist the consumer, but the NPN was erroneously left off of the enrollment,” HealthCare.gov managers say in the slidedeck.
“Such records may include a consent form from the consumer, an issuer’s broker of record form, or similar documentation to demonstrate that the consumer was your client for the enrollment in question,” the managers say.
The HealthCare.gov managers do not offer to help producers resolve disputes with the coverage issuers over problems with collecting fees or commissions.
The exchange managers note that the federal government does set agent compensation levels for the Medicare Advantage program, but not for the Affordable Care Act public exchange program.
State insurance regulators and state-based Affordable Care Act public exchange programs may set their own, state-specific exchange plan producer compensation standards, but, otherwise, exchange plan producer compensation levels are something for producers to negotiate with the coverage issuers, HealthCare.gov managers say.
HealthCare.gov managers posted the webinar slidedeck on a semiprivate technical support website.
HealthCare.gov Basics
Health insurance agents, brokers, issuers and dot.coms talked about setting up menu-based, and, later, web-based health insurance supermarkets for individuals and small employers for decades.
(Image: Allison Bell/TA)
In some cases, business groups, state governments and dot.coms set up small exchange programs, but they ran into problems with antitrust concerns, and with the difficulty of dealing with medical underwriting obstacles.
In 2009, when Democrats in Congress were writing the legislation that created the Affordable Care Act, they developed the public exchange provisions to serve as a market-oriented alternative to having government agencies offer Medicare-like “public option” plans throughout the country.
A public exchange program is supposed to give consumers a simple ways to shop for coverage from private health insurers online, and to use the ACA premium tax credit subsidy and cost-sharing reduction subsidy to hold down their share of the health insurance premium bills.
Originally, Democrats in Congress assumed that most states would set up their own public exchange programs. The U.S. Department of Health and Human Services set up HealthCare.gov to run the health insurance supermarkets in states that were unwilling or unable to handle the job themselves.
The Centers for Medicare and Medicaid Services, an arm of HHS, runs HealthCare.gov. The Center for Consumer Information and Insurance Oversight is the CMS division directly in charge of HealthCare.gov.
