Enroll America - Here's the Solution Folks!

[Dave020]

So, MD will have SHOP navigators? In CA, Navigators are prohibited from facilitating SHOP plans at all.

An Individual Exchange Navigator:
‐*May conduct all ACA‐required functions, e.g., conduct
education and outreach, distribute information about and
facilitate selection, enrollment, renewal, disenrollment,
etc. in qualified plans; conduct eligibility determinations
for Medicaid, MCHP, and premium subsidies, provide
ongoing support with respect to these functions
‐*May not provide information or services related to
health benefit plans or other products not offered in the
Individual Exchange; shall refer inquiries to insurance
producers or SHOP Exchange Navigators as appropriate
‐*Shall refer individuals with insurance obtained through
an insurance producer back to producer unless individual
is eligible for premium subsidies and producer is notauthorized to sell in Exchange
‐*Shall comply with all Medicaid and MCHP regulations
‐*Must be trained and hold Navigator certification issued
by the Individual Exchange
‐*Must work for an entity engaged by Individual Exchange
‐*Navigators and Navigator entities need not provide the
full scope of Navigator services but may be engaged
instead to provide a subset of Services

A SHOP Exchange Navigator:
‐*May conduct education and outreach, distribute
information, and sell qualified plans in the SHOP
Exchange; facilitate activities related to plan selection,
enrollment, renewals, disenrollment, tax credit eligibility,
referrals, and ongoing support
‐*May not provide information or services related to
health benefit plans or other products not offered in
SHOP Exchange
‐*May not seek to replace any health benefit plan already
offered by a small employer unless the employer is
eligible for a tax credit
‐*Must hold a SHOP Navigator license issued and
regulated by Insurance Commissioner

 

[Crabcake Johnny]

This is what's proposed - nothing finalized yet. The question of the day is what does "facilitate" enrollment mean? Will they be able to go door to door, "educate" people then had them an app and walk them through it?

 

[Dave020]

This is what's proposed - nothing finalized yet. The question of the day is what does "facilitate" enrollment mean? Will they be able to go door to door, "educate" people then had them an app and walk them through it?

That is what they can do in CA. Sign 'em up and collect $58 per enrolled application. Here, Navs can sell the plans without a license and get paid by the exchange. They just can't receive comp from an insurance carrier.

 

[Crabcake Johnny]

If...and only if navigators can indeed go door to door and get a per-enrollment fee, areas will be blanketed by enrollment teams. Also expect a very high level of fraud.

 

[Dave020]

This on caught my eye

*Shall refer individuals with insurance obtained through
an insurance producer back to producer unless individual
is eligible for premium subsidies and producer is not authorized to sell in Exchange

They can't pick off an agent's clients if the agent is certified with the exchange. This would certainly be a potential motivator for agents in MD to certify.

 

[somarco]

Producers will be overseen by CMS and the state DOI as it is now.

I assume that only applies to agents certified to sell HIX plans.

The rest of us can tell CMS to pound sand.

 

[Yagents]

Yah, but if you pound sand, you get diamonds. Win Win

 

[VolAgent]

Yah, but if you pound sand, you get diamonds. Win Win

Actually, that would be coal. Sand will get you computer chips.

 

[Yagents]

I ditched geology class......obviously

 

[Ann H]

How could you miss that YAgents? Everyone knows a woman's best friend is coal.