Federal Health Care Reform
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.
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 Jul 30, 2013, CMS released the following Frequently Asked Questions document about the Federally Facilitated SHOP Program: https://www.regtap.info/uploads/library/SHOP_FAQ3_073013_5CR_080913.pdf
On September 4, 2013, CMS released a supplement to the Frequently Asked Questions regarding QHP Issuers and Agents and Brokers.
CMS is holding a series of webinar outreach meetings for agents and brokers to provide information about the federal Marketplace. More information can be found at http://marketplace.cms.gov/newsevents/newsevents.html. The following is the CMS presentation shared during a webinar outreach meeting: CMS PowerPoint Presentation for Agent/Broker Outreach Meetings on the Health Insurance Marketplace.
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: https://marketplace.medicarelearningnetworklms.com
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: https://portal.cms.gov/
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: http://www.cms.gov/CCIIO/programs-and-initiatives/health-insurance-marketplaces/a-b-resources.html
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.