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The Center for Consumer Information & Insurance Oversight

 

Resources for Agents and Brokers in the Health Insurance Marketplaces

Contents


Background

To the extent permitted by states, licensed agents and brokers may assist consumers in applying for qualified health plans (QHPs) and insurance affordability programs including premium tax credits and cost-sharing reductions. They play a crucial role in educating consumers about the Health Insurance Marketplaces, both during annual open enrollment and throughout the coverage year.

Some states have set up a State-Based Marketplace, while other states work with the federal government in a State-Partnership Marketplace or Federally-facilitated Marketplace (FFM). Agents and brokers can help consumers, no matter what state the consumers live in, as they apply for and choose insurance options. Agents and brokers who wish to participate in the FFM must first complete a two-part registration process (see “Registration for the Federally-facilitated Marketplace” below for more information on this requirement). This page contains resources for agents and brokers who are assisting individual market consumers in the Marketplaces, as well as small group market employers and employees in the Small Business Health Options Programs (SHOPs).


General Resources

Guidance

Regulations

 

News for Agents and Brokers

News for Agents and Brokers is an electronic source of information for Federally-facilitated Marketplace (FFM) Agents and Brokers. As with other communications to our Agents and Brokers, this monthly newsletter will be disseminated electronically to Agents and Brokers on our e-mail listserv. We are committed to keeping Agents and Brokers informed about upcoming webinars/trainings, registration resources, relevant guidance and regulations, important announcements, and other useful information. Please take a moment to read the latest issue.

 

Registration for the Federally-facilitated Marketplace (FFM) for the individual market and the Federally-facilitated Small Business Health Options Program (FF-SHOP)

Initial FFM Registration Requirements

Agents and brokers who will be participating in the FFM for the individual market for the first time must complete a two-part registration process.
     Part I: Visit https://Marketplace.MedicareLearningNetworkLMS.com to complete
         • Required individual market training; and
         • Execution of the Agent Broker General Agreement and the Agent Broker Agreement for the 
            FFM- Individual Market (“Privacy and Security Agreement”).

     Part II: Visit the CMS Enterprise Portal: https://portal.cms.gov/ to complete
         • Creation of an FFM user account; and
         • Identity proofing.

Agents and brokers who will be participating in the FF-SHOP for the first time will also complete a two-part registration process.
     Part I: Visit https://Marketplace.MedicareLearningNetworkLMS.com to complete
         • Optional (but highly encouraged) SHOP training; and
         • Execution of the Agent Broker Agreement for the FF-SHOP (“FF-SHOP Privacy and Security Agreement”).

     Part II: Visit the CMS Enterprise Portal: https://portal.cms.gov/ to complete
         • Creation of an FFM user account; and
         • Identity proofing (new for plan year 2015 enrollment).

Annual FFM Registration Requirements

To continue participation in the FFM for the individual market for the 2015 plan year and future plan years, agents and brokers must complete an annual registration renewal process that includes completion of required training, and execution of the FFM Agreements. To continue participation in the FF-SHOPs for the 2015 plan year and future plan years, agents and brokers must execute the FF-SHOP Agreement annually, and are encouraged to complete training. All agents and brokers participating in the FFM for the individual market and FF-SHOP must complete Part II (create an FFM user account and complete identity proofing) if they have not done so previously.

Key Dates

  • The Agent and Broker Agreements that were signed with the FFM for the 2014 plan year expired on September 30, 2014.
  • Agents and brokers in the FFM for the individual market must complete plan year 2015 registration prior to assisting consumers with plan year 2015 enrollments.  Annual open enrollment runs from November 15, 2014 to February 15, 2015.
  • Agents and brokers in the FF-SHOP must complete plan year 2015 registration  in order to be authorized access to the SHOP Agent Broker portal available through HealthCare.gov.

Key Training and Registration Resources

In order to fully understand the steps of the registration process and what is required of you as an agent or broker, CCIIO recommends reviewing several key resources.

Agent and Broker Federally-Facilitated Marketplace (FFM) Registration Completion List

Agent and Broker FFM Registration Completion List for Plan Year 2015

Plan Year 2015 Registration Completion List as of November 1, 2014 [XLSX, 1MB]

This list contains the national producer numbers (NPNs) for agents and brokers who have completed FFM registration for the 2015 plan year. CMS posts this list at the start of each calendar month, reflecting data as of the prior calendar month. NPNs can be searched by clicking the arrow in cell A2, or by using the “Ctrl + F” (or “Command +F) keystroke.  All NPNs are self-reported by the agent or broker during Part I of FFM registration, and should be validated against state and/or other NAIC records to confirm state licensure.

Agent and Broker FFM Registration Completion List for Plan Year 2014

Plan Year 2014 Registration Completion List [XLSX, 2.2 MB]

This list contains the national producer numbers (NPNs) for agents and brokers who have completed FFM registration for the 2014 plan year. All NPNs are self-reported by the agent or broker during Part I of FFM registration, and should be validated against state and/or other NAIC records to confirm state licensure.

FFM registration for plan year 2014 expired on 9/30/2014.  Agents and brokers should complete FFM registration for the 2015 plan year by 9/30/2014 if they wish to assist consumers with plan year 2014 special enrollment periods (SEPs) and plan year 2015 open enrollment beginning 11/15/14.


Eligibility Application and Enrollment

When assisting individual market consumers in completing the eligibility application and enrolling in health care coverage online through the FFM, an agent or broker may use one of two pathways:

  • The Direct Enrollment Pathway: In this pathway, registered agents and brokers affiliated with certain QHP issuers or web-brokers may connect to the Federally-facilitated Marketplaces through the QHP issuer’s or web-broker’s web site. The agent or broker logs in to the QHP issuer’s or web-broker’s website with their agent/broker account, and “drives” the application and enrollment process; the consumer does not log in, but must consent to giving their personally identifiable information (PII) to the agent or broker.
  • The Marketplace Pathway (via www.HealthCare.gov): In this pathway, registered agents and brokers help consumers to complete the eligibility application and enroll in coverage directly at HealthCare.gov. The consumer creates an account, logs in to the site with a consumer account, and “drives” the process; the agent or broker does not log in to HealthCare.gov.  Agents and brokers must obtain consumers’ consent before accessing or viewing the consumer PII.

Key Eligibility Application and Enrollment Resources

SHOP-Specific Resources

When assisting employers and employees in completing the eligibility application and enrolling in coverage online through the FF-SHOP, an agent or broker will use the SHOP Enrollment Pathway.  

  • In this pathway, licensed and registered agents and brokers will connect to the FF- SHOP through the SHOP Agent Broker Portal available through HealthCare.gov or by visiting https://healthcare.gov/marketplace/small-businesses/agent
  • The agent or broker logs in to the SHOP Agent Broker Portal with their FFM User ID and establishes an authorization with an employer, and assists with the application, enrollment process, and case management for employers in SHOP.
  • An employer must create their own log in through HealthCare.gov and confirm the authorization of an agent or broker before the agent or broker may gain access to their account.  
  • All agent and broker authorizations in SHOP will be established at the employer-level, employees can not authorize a separate agent or broker but can enroll with the assistance of their employer selected and authorized agent or broker.

Key SHOP Resources

Links to Agent and Broker Industry Trade Associations