Marketplace Broker Training Different for New and Returning Brokers

Brokers who pursue federal marketplace training this year will pursue a different path if they are new to the marketplace or renewing their registration.

A returning broker who can use the streamlined refresher training is one who was registered for the marketplace in 2017. To ensure eligibility for refresher training a broker should confirm that their NPN appears on the Agent and Broker FFM Registration Completion List for plan year 2017. This list is available here.

A new broker is one who is completing marketplace training and registration for the first time. A new broker is also one who may have participated in the marketplace in a prior plan year but did not complete registration and training for the 2017 plan year. New brokers are required to complete the full individual marketplace training for plan year 2018.

CMS has a presentation slide deck that new brokers should review in advance of attempting to register for the federal exchange. They will find this deck particularly helpful as it walks through creation of the CMS Enterprise Portal account and other required steps. The deck is available here.

The slide deck also contains instructions for brokers who wish to use an approved vendor for training. Vendors are required to offer five continuing education credits in federal marketplace states.

Marketplace training and registration is no longer available for the 2017 plan year. In fact, the system entered the “go-dark” period on July 21, 2017 in order to prepare for the launch of training for the 2018 plan year.

CMS has a resources page for agents and brokers. It can be accessed here.

Other resources that may be useful include:

New agent and broker guide to registration and training.

Returning agent and broker guide to registration and training.

Slide deck for returning agents and brokers.

Rule on Market Stabilization Finalizes Special Enrollment Documentation

Starting in June 2017, new consumers in all states served by the HealthCare.gov platform attempting to enroll through applicable special enrollment periods (SEPs) will have to undergo pre-enrollment verification of eligibility. Enrollees would have their enrollment delayed or “pended” until verification of eligibility is completed by the Exchange.

The goal of SEP documentation is to help stabilize the individual insurance market and limit a person’s ability to enroll in coverage only after they discover they need medical care.

A quick review of the final rule’s requirements finds the following regarding SEPs:

  • Pre-enrollment verification applies to federally facilitated and state based exchanges that use the HealthCare.gov platform
  • Enrollees claiming special enrollment period (SEP) eligibility must submit their application and select a Qualified Health Plan (QHP)
  • Enrollment is “pended” until verification of SEP eligibility
  • Start date of coverage is determined by date of QHP selection
  • Consumers have 30 days from date of QHP selection to provide documentation of their qualification for the SEP
  • The exchange will attempt to obtain eligibility through automated means such as verifying birth by “confirming baby’s existence” or electronically verifying that the consumer was denied Medicaid or CHIP
  • Enrollees have proof of previous year health coverage via tax statements which may be helpful in some circumstances
  • Letters from insurers, employers and government health programs are acceptable documentation
  • SEP verification will be phased in with emphasis on the highest volume situations
    • Loss of minimum essential coverage
    • Permanent move
    • Medicaid/CHIP denial
    • Marriage
    • Adoption.

State based exchanges not using the federal platform have the flexibility to determine whether and how to implement pre-enrollment verification of eligibility for SEPs. The final rule suggests that states that have difficulty implementing verification should consider allowing issuers to conduct verification.

 

New Rule Aimed at Market Stabilization

The Trump administration has published a new proposed rule aimed at stabilizing the individual insurance market. This coincides with NAHU’s emphasis on the critical need to stabilize the individual insurance market.

Critics will say that the rule doesn’t do enough. However, the rule advises that this first step is one of several that will be taken.

One of the provisions calls for individuals to verify that they qualify for a Special Enrollment Period (SEP). Anyone applying for new coverage will be required to provide verification of their SEP beginning in June 2017. Coverage will be pended awaiting verification.  The administration estimates that this may impact as many as 650,000 individuals.

The proposal would also require that SEP enrollment due to marriage would require that one of the spouses had minimum essential coverage prior to filing for coverage via SEP. The proposal would also limit changes in metal levels – the richness of the plan – for SEP-related changes.

Comments are due by March 7, 2017.

The rule can be reviewed here.