In a newly released slide deck, CMS, the Centers for Medicare and Medicaid Services, offers tips to brokers who assist clients with Marketplace coverage. The slide deck is titled “Compliance with Marketplace Requirements: Considerations for Agents and Brokers.”
The guidance reflects concerns CMS has expressed regarding consumer complaints, including some about brokers. CMS is considering a program to advise individual brokers if they have received complaints or have reason to believe that a broker has not adhered to Marketplace rules. The program which is under review and has been described to NAHU would be advisory in nature and would not be reported to state regulators.
By instituting the best practices in the slide deck, brokers will head off the likelihood of some of the more egregious claims from consumers that they were enrolled in coverage without their knowledge. Chief among the best practices is the recording of consumer consent to help a person apply for financial help and enroll in a Marketplace plan.
Consumer consent is required to assist a consumer and should acknowledge “the functions and responsibilities” that a broker has in the Marketplace.
A record of consent should include:
- Consumer’s name
- Date of consent
- Identification of any brokers to whom consent is given.
The advice notes that a signed Broker of Record form from a state or carrier satisfies the consumer consent requirement.
A broker who wishes to speak with the Marketplace Call Center regarding a consumer’s application or with questions specific to a consumer must provide a separate authorization. This authorization can be valid for one call or up to 365 days. A consumer has to be on the phone with the broker for the initial contact to provide the authorization.
The guidance also cautions that brokers should never use their or their firm’s email address on behalf of a consumer. Mailing addresses must also be that of the consumer. If a consumer does not have an email address the broker can assist the consumer in establishing a personal email account. Consumers may enroll without an email in some instances but will need an email address to access online notices or to make changes to their HealthCare.gov account.
Brokers are also cautioned that creation of a HealthCare.gov account is limited to consumers or their legal representatives. A broker can assist in creating the account but the consumer must enter their own information. Also, brokers cannot log in to HealthCare.gov using the consumer’s HealthCare.gov account.
The presentation includes contact information for brokers to report suspected fraudulent activity. Examples of fraud and abuse identified by CMS include:
- A client reports they have been contacted by an individual seeking his personal and financial information
- A client, or colleague, submits false documentation to the Marketplace
- An agent or broker is enrolling consumers without their consent
- An agent or broker is assisting consumers without a valid health license or without completing Marketplace registration
- A registered agent or broker with a valid health license is assisting consumers but is not licensed in the state where the consumer lives
- An agent or broker has disclosed a consumer’s personally identifiable information
- Unauthorized changes were made to the client’s online application
- A consumer or insurance company is suspected of providing false or misleading information to the Marketplace.
The slide deck can be found here.