Reform Alert - News from the Blues' Office of National Health Reform

CCIIO releases new agent, broker, and web-broker guidance

Update: July 25, 2013 — CMS announces agent/broker webinar

June 11, 2013

On May 1, the Center for Consumer Information and Insurance Oversight (CCIIO) issued guidance on the role of agents, brokers, and web-brokers in Health Insurance Marketplaces.

Agents and Brokers:

  • The guidance confirms that CMS will allow two pathways for agents and brokers in Federally-facilitated Marketplaces (FFMs) and State Partnership Marketplaces:
    • Issuer-based pathway where an agent or broker uses an issuer’s website to assist the consumer in enrolling in coverage.
    • Marketplace pathway where an agent or broker uses the Marketplace website to assist the consumer in enrolling in coverage.
  • FFMs and State Partnership Marketplaces will not establish a commission schedule or pay commissions directly to agents or brokers.
  • In FFMs and State Partnership Marketplaces, CMS will be responsible for registering agents and brokers and conducting Marketplace-related training. FFM training will not include state-specific training in 2014.
  • Upon completion of registration and training, agents and brokers will complete a privacy and security agreement and be issued a user ID.
  • As is the case today, agents and brokers will be appointed by issuers. Issuers will be responsible for checking the agent’s or broker’s licensure status and will verify an agent’s or broker’s registration with the Federally-facilitated or State Partnership Marketplace. Agents and brokers will provide copies of their Federally-facilitated Marketplace training certificates and user IDs to issuers as part of the appointment process.
  • Agents and brokers who assist qualified small employers in enrolling through the FF-SHOP will use the Marketplace pathway, except that agents and brokers will not be required to obtain a Federally-facilitated Marketplace user ID.

Web-brokers:

  • CMS intends to work with web-brokers to provide an alternate option to help consumers select Qualified Health Plans (QHPs) online. CMS is developing the capability to support integration between the web-broker’s website and FFM using secure redirect and application programming interfaces.
  • CMS will make available to web-brokers QHP data, including premium information, provided by issuers to CMS. CMS will provide further technical guidance on how QHP data will be conveyed to web-brokers.
  • Web-brokers do NOT have to be appointed by all health plans, but if the consumer wants to enroll in a QHP that the web-broker doesn’t have appointment for, the web-broker has to direct the consumer to the FFE.
  • CMS expects web-brokers to display QHPs separately from non-QHPs, and offer a QHP plan selection experience free from advertisements or information for other health-insurance related products and sponsored links. However, web-brokers can offer the consumer the ability to search for additional products or services after the consumer has completed QHP plan selection and enrollment.

Where can I find more information?
More information can be found at Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces.


The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

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