Final Rule For Health Insurance Exchanges

[CHUMPS FROM OXFORD]

A plethora of information...And it's not all good. Click on the link...if you dare.

GET OUT NOW!


Here's the final rule:

Sick!

"Enrollment application assistors. Get to know that term. And yes...This is VERY BROKER UNFRIENDLY!!! There is a big section of the role of Navigators etc...You may not like what you read....Also Quite clearly, community outreach programs may be used. Sounds familiar doesn't it?

Get out now folks. I warned everyone two years ago about the EXCHANGES. That's the big threat.

 

[Crabcake Johnny]

Response: In general, the responsibilities of a Navigator differ from the activities that an agent or broker. For example, the duties of a Navigator described under §155.210(e) of the final
rule include providing information regarding various health programs, beyond private health insurance plans, and providing information in a manner that is culturally and linguistically 96
appropriate to the needs of the population being served by the Exchange.

Moreover, any individual or entity serving as a Navigator may not be compensated for enrolling individuals in QHPs or health plans outside of the Exchange; as such, an agent or broker serving as a Navigator would not be permitted to receive compensation from a health insurance issuer for enrolling
individuals in particular health plans. That said, nothing precludes an Exchange's Navigator program from including agents and brokers, subject to the conditions of §155.210.


And it'll be up to each state to determine the agent's role:

Response: We accept the recommendation that Exchanges have the flexibility to determine the role of agents and brokers, including web-based entities, in their marketplaces. We have retained the language in §155.220(a), which codifies the statutory flexibility that States may determine whether agents and brokers may enroll individuals, employers and employees in QHPs and provide assistance to qualified individuals applying for financial assistance.

Agents can also use their own websites:

We also afford Exchanges discretion to allow agents and brokers to use their own Web sites to assist individuals in completing the QHP selection process, as long as such a Web site conforms to the standards identified in §155.220(c)(3)

 

[Justin Bilyj]

Gotta love facism...

 

[Yagents]

I'm already getting a headache. When someone figures this out, put it in layman's terms for us. This caught my eye

Either in their existing role or as Navigators, and consistent with State requirements, we expect that agents and brokers will enroll individuals into qualified health plans through an Exchange, similar to the work currently performed in the individual and small group markets.
40

 

[CHUMPS FROM OXFORD]

"Moreover, any individual or entity serving as a Navigator may not be compensated for enrolling individuals in QHPs or health plans outside of the Exchange"

That is worrisome.

 

[Crabcake Johnny]

Agents cannot determine eligibility:

An agent, broker, or web-based entity cannot perform eligibility
determinations as part of enrollment through the Exchange. We note that section (b)(2)(A) of 36B of the Internal Revenue Code as amended by the Affordable Care Act establishes that an
individual must enroll "through the Exchange" in order to access advance payments of the premium tax credit and cost-sharing reductions. However, in §155.220(c)(1), we specify that an
individual can be enrolled in a QHP through the Exchange with the assistance of an agent or broker only if the agent or broker ensures that the individual receives an eligibility determination
through the Exchange Web site.
- - - - - - - - - - - - - - - - - -

"Moreover, any individual or entity serving as a Navigator may not be compensated for enrolling individuals in QHPs or health plans outside of the Exchange"

That is worrisome.

Worrisome? That's fantastic. Agents can be compensated - navigators cannot.

 

[CHUMPS FROM OXFORD]

How is it fantastic?

 

[Dave020]

This has been discussed with carriers out here. It is taken to mean that agents will have to choose whether or not to sell inside as 'navigators' and if they do they are prohibited from selling outside (it's covered in the 602 pages somewhere, I saw it).

It has to do with avoidance of adverse selection and they don't want agent selling inside and outside at the same time.

 

[Crabcake Johnny]

Chumps; My concern was that navigators would be able to earn some type of commission if they "facilitated in the enrollment of...."

Bottom line; only licensed agents can earn a commission. Navigator, who are not licensed, cannot earn a commission.

As after doing a rather quick scan through the document - states basically determine everything. They get to determine the agent's role, any possibly mandatory training, etc...

 

[CHUMPS FROM OXFORD]

OK.I see you just edited your last post. I assumed that agents and Navigators would be considered as the same entity.

I would hope that it does not mean that if we sell inside the Exchange, we can not help someone who hypothetically makes a million bucks a year and wants to buy a 25k deductible plan outside the Exchange.