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Federal Health Care Reform

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Information for Agents and Brokers

This website provides very general information about the Affordable Care Act. For the most complete and up-to-date information about the health care reform law, visit the federal website www.hhs.gov/healthcare.

Effective March 6, 2013, the North Carolina General Assembly enacted Senate Bill 4 (Session Law 2013-5), which determined that North Carolina will have a federally facilitated Health Insurance Marketplace (formerly also known as a health benefit exchange).

The federal government anticipates that agents and brokers will play an important role in educating consumers and assisting them in selecting an individual qualified health plan (QHP) in the new federally facilitated Health Insurance Marketplace. They also anticipate that agents and brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs) available in the federal Marketplace.

Below is new information from CCIIO issued in June 2014, concerning annual training requirements for agents and brokers participating in the Federally-facilitated Marketplace (FFM) and Federally-facilitated Small Business Health Options Program (FF-SHOP). If a producer completes training in July 2014, will it apply to July 2014-July 2015?

In July 2014, CMS will launch FFM agent/broker registration for the 2015 plan year, and release the new training curriculum for the FFM for the individual market and FF-SHOP. Marketplace training it required for agents and brokers participating in the FMM for the individual market; training is encouraged for agents and brokers who wish to participate in the FF-SHOP Marketplace, but not required.

Marketplace training is just one part of FFM registration for agents and brokers.

Agents and brokers who wish to participate in the FFM (for both the individual market and FF-SHOP) must complete all registration requirements for the 2015 plan year. Agents and brokers who completed FFM registration for the 2014 plan year must complete registration renewal for the 2015 plan year and future plan years. This chart explains the different FFM registration requirements, which vary by market type (FFM for the individual market, the FF-SHOP, or both) and whether the agent/broker completed FFM registration for plan year 2014.

Agents and brokers who completed 2014 plan year registration may assist consumers with special enrollment periods (SEP) until September 30, 2014, when their FFM agreements expire. Once agents and brokers complete FFM registration for plan year 2015 (whether registering for the first time or renewing), they will be able to assist consumers with:

  • Any plan year 2014 SEPs
  • Plan year 2015 open enrollment (November 15, 2014, to February 15, 2015)
  • Any plan year 2015 SEPs after open enrollment, until November 12, 2015 (when the plan year 2015 FFM agreements expire)

During summer 2015, CMS will inform agents and brokers about the registration renewal process for the 2016 plan year. For more information, visit the CMS agent and broker resources page on the CCIIO website.

On May 1, 2013, the Centers for Medicare and Medicaid Services (CMS) issued guidance on the Role of Agent and Brokers in the Health Insurance Marketplace.

On September 4, 2013, CMS released a supplement to the Frequently Asked Questions regarding QHP Issuers and Agents and Brokers.

CMS has released several publications that Agents and Brokers may find helpful:

 

The following is the CMS presentation shared during a webinar outreach meeting:

Agents and brokers will be able to enroll qualified individuals in QHPs through the federal Marketplace. Agents and brokers must register with the federal Marketplace, complete training, and adhere to privacy, security and other federal requirements before helping qualified individuals enroll in coverage through the federal Marketplace. Agents and brokers will be able to assist qualified employers/employees with enrollment in SHOP; registration and training is strongly encouraged however, it is not required. All agents and brokers in North Carolina must be licensed for Accident and Health or Sickness line of authority and comply with North Carolina state laws including appropriate agent appointments to QHP issuers. Although there are North Carolina Continuing Education providers that may offer courses to educate agents and brokers on the Affordable Care Act rules and regulations, only the federal government registration and training will allow agents and brokers to enroll qualified individuals in QHPs through the federal Marketplace.

CMS has indicated that Part I agent/broker training is available now through the following portal:

Part II of agent/broker registration process for the federal Marketplace has also been officially launched by CMS. In Part II, agents/brokers who wish to serve in the individual market may now complete identity proofing on the CMS Enterprise Portal:

Please note:

Prior to completing Part II of the registration process, agents/brokers need to have completed Part I—the training/testing that is available at https://Marketplace.MedicareLearningNetworkLMS.com.  After completion of Part I, agents/brokers should allow 48 business hours for their training/testing results to be transmitted to the CMS Enterprise Portal where Part II occurs.  Please ensure that you allow sufficient time for your training/testing results to reach the CMS Enterprise Portal, or you will get an error message when you try to complete Part II.

For agents/brokers who are mid-registration, please be reminded of these useful links that should be useful to you during that process:

For questions related to the FFM registration process, agents/brokers may submit email inquiries to: FFMProducer-AssisterHelpDesk@cms.hhs.gov

Instructions from earlier CMS webinars may be useful as agents/brokers complete the registration process. Those instructions, and other information, may be found on CMS's webpage:

Additional Health Insurance Marketplace training and presentations

Proposed federal regulation found here provides some additional information for agents and brokers, including the proposed federal standards that agents and brokers must meet to assist in enrolling qualified individuals and employers/employees in the QHPs available through the federal Marketplace. (Reference pages 37045, 37046, 37047 and 3708.)

Navigators will also play a role in the federal Marketplace as the federal government anticipates there is a lot of work to be done in educating and enrolling qualified consumers. Navigators are to be selected and trained by the federal government to assist consumers with enrollment. It is anticipated that the navigators will be primarily safety net organizations in North Carolina that will be able to reach consumers that may not have access to traditional health insurance avenues. Licensed agents and brokers are eligible to apply to be navigators, however, during their term as navigators, individuals and entities are not permitted to receive any direct or indirect consideration from a health insurance issuer connected to the enrollment of individuals and employers/employees into QHPs or non-QHPs.

The federal government will also provide assistance to North Carolina consumers for questions, concerns, and complaints about the federal Marketplace. Additional information for North Carolina consumers is located here.