Filed Under:Health Insurance, Individual Health

CCIIO: Producers critical to small-group exchanges

CCIIO Director Gary Cohen (CMS photo)
CCIIO Director Gary Cohen (CMS photo)

The Center for Consumer Information & Insurance Oversight (CCIIO) has posted a guide that explains how it sees health insurance agents, brokers and Web brokers interacting with the new health insurance exchange (HIX) system.

The Patient Protection and Affordable Care Act (PPACA) requires CCIIO's parent, the U.S. Department of Health and Human Services (HHS), to work with state agencies to open exchanges, or Web-based health insurance supermarkets for individuals and small groups, in all 50 states and the District of Columbia by Oct. 1.

CCIIO -- pronounced "Sih-Sigh-Oh -- is an arm of another HHS agency, the Centers for Medicare & Medicaid Services (CMS).

Agents and brokers, including Web brokers, will be a major source of exchange assistance for individual consumers who use the exchanges, CCIIO officials say in the guide.

Producers will serve individual consumers along with exchange websites, exchange call centers, and in-person assisters, officials say.

Producers will be "helping consumers receive eligibility determinations, compare plans and enroll in coverage," officials say. 

"In particular, CMS anticipates 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)," officials say.

CMS will let states that are running their own exchanges decide how to handle producer commissions, but, if state-run exchanges do let producers get commissions, the department will encourage the exchanges to "consider providing information to issuers to facilitate these transactions (e.g., by providing the agent or broker's national producer number or state license number," officials say.

The federal exchanges, and the exchanges that CMS helps states run through partnership arrangements, "will not establish a commission schedule or pay commissions directly to agents or brokers," officials say. "As is the case in the market today, we expect that the amount and terms of any commission would be negotiated by the issuer and the agent or broker."

Any of the insurers that sell "qualified health plans" (QHPs) through federal exchanges will have to pay the same producer compensation for coverage sold through the exchanges that they pay for similar plans sold outside the exchange system, officials say.

To help producers get their commissions, the federal exchanges will transmit agent and broker identifying information to QHP issuers, officials say.

Officials also consider questions about which QHPs a producer who is using an exchange must offer.

Some states have said they will require brokers to offer all available QHPs.

The federal exchanges will require brokers to comply with state laws, regulations and exchange requirements, but they will not require exchange brokers to offer all QHPs, or a specific set of QHPs, officials say. 

See also:

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Nichole Morford

Nichole Morford
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