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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 Program (SHOP) Marketplace.


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 is 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.


Upcoming Agent and Broker Webinars

Join us during our scheduled webinars to learn more from CMS experts on key topics.

Upcoming topics for April and May 2016 include:

  • Agent and Broker Tips for Assisting in the SHOP Marketplaces
    o April 20, 1:00 PM – 2:30 PM ET
    o Brief Description: This webinar will highlight how agents and brokers can effectively use the SHOP Marketplaces to serve employees and employers
  • Protection Requirements and Appropriate Usage of Consumer’s Personally Identifiable Information (PII)
    o May 11, 1:00 PM – 2:30 PM ET
    o Brief Description: This webinar will highlight the standards of conduct for agents and brokers, requirements for protecting and using consumer PII, and new requirements included in the 2017 Payment Notice and Letter to Issuers that will be effective starting for plan year 2017.  

Webinar Registration

To register for a webinar, please log in to www.REGTAP.info and complete the following steps:

  1. Select "Training Events" from "My Dashboard."
  2. Select the "View" icon next to the event title for the webinar you are interested in attending.
  3. Select "Register Me."

If you require assistance with webinar registration, you may contact the Registrar at 800-257-9520 or registrar@REGTAP.info. The registrars are available by phone from 9:00 AM – 5:00 PM ET, Monday through Friday. Registration closes 24 hours prior to each event.

Plan Year 2016 Open Enrollment

Key Open Enrollment Resources

CMS hosted a webinar session on October 14 to provide an overview of FFM Open Enrollment for plan year 2016 as well as highlight new agent and broker support for plan year 2016. The session also provided tips on the “Find Local Help” feature on HealthCare.gov, tips from the Marketplace Call Center, information on working with Assisters and Navigators, and information on understanding the consumer. Lastly, the session covered periodic data matching and the process for ending qualified health plan coverage.

Plan Year 2016 Open Enrollment: A Primer for Agents and Brokers

CMS hosted two webinar sessions of the “Plan Year 2016 FFM Open Enrollment: A Primer for Agents and Brokers” on October 21 and 28. The webinar covered key information about plan year 2016 Open Enrollment, and provided an overview of the plan year 2016 FFM enrollment pathways, the Individual Marketplace online application, highlights on the SHOP Marketplace, and an overview of next steps for consumers who fail to file and reconcile advance payments of the premium tax credit (APTC) for plan year 2014. The webinar also reviewed the process to revoke the agent/broker role for agents and brokers who did not complete plan year 2016 FFM registration prior to the expiration of their plan year 2015 Agreements with CMS.

  • November 2015

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs - Week 1 Slides

CMS hosted two webinar sessions on November 3 and November 5 to provide key Open Enrollment dates and reminders as well as information on how to prevent duplicate applications; the new provider lookup tool on HealthCare.gov, and resources for agents and brokers to use throughout Open Enrollment.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 2 Slides

CMS hosted two webinar sessions on November 10 and November 12 to provide key Open Enrollment dates and reminders as well as information on how to ensure National Producer Numbers (NPNs) are retained on renewals for plan year 2016; guidelines for agents and brokers working with assisters and Navigators; and responses to key agent and broker FFM registration, training, and eligibility questions.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 3 Slides

CMS hosted a webinar session on November 17 to provide key Open Enrollment dates and reminders as well as tips for assisting consumers with multi-tax households; information on how to ensure National Producer Numbers (NPNs) are retained on renewals for plan year 2016; instructions on how to search for an existing application; and responses to key agent and broker questions on FFM registration and training and the SHOP Marketplace.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 4 Slides

CMS hosted a webinar session on November 24 to provide key Open Enrollment dates and reminders as well as information about the new HealthCare.gov Prescription Drug Check feature; information on the use of mailings and email addresses by agents and brokers; updates on marketing opportunities with the Marketplaces; information on the designated market areas with the highest numbers of uninsured; and highlights of proposed Marketplace policies impacting agents and brokers from the proposed 2017 Payment Notice.

  • December 2015

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 5 Slides

CMS hosted a webinar session on December 1 to provide key Open Enrollment dates and reminders as well as information on the cut-off dates for plan year 2015 special enrollment periods and changes in circumstance; highlights from the proposed 2017 Payment Notice; tips for reminding consumers of their rights; a walkthrough of the new Prescription Drug Check tool; tips for consumers on Marketplace qualified health plan deductibles; and an overview of catastrophic plans.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 6 Slides

CMS hosted a webinar session on December 8 to provide tips from the Marketplace Call Center on assisting consumers; information on transitioning Consumer Operated and Oriented Plan (Co-op) Program enrollees for issuers ceasing to offer Marketplace plans; information on marketing opportunities for agents and brokers; information on the cut-off dates for plan year 2015 special enrollment periods and changes in circumstance; an overview of the income and household size  eligibility criteria; and a summary of how to become a web-broker in the FFMs.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 8 Slides

CMS hosted a webinar session on December 22 to provide updates on the December 15, 2015 Open Enrollment deadline extension, an overview of the Marketplace Application checklist, information on the SHOP Marketplace minimum participation requirement, an overview of SHOP Marketplace health and dental coverage options, a snapshot of Marketplace affordability for the FFMs for plan year 2016, and a walkthrough of the new Facility Lookup feature.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 9 Slides

CMS hosted a webinar session on December 29 to provide updates on Marketplace affordability for the FFMs for plan year 2016, highlights on marketing opportunities for agents and brokers, a walkthrough of the new Facility Lookup feature, tips on how to simplify the steps for staying covered through the Marketplaces to consumers, highlights on new research on small employers and the SHOP Marketplaces, information on the SHOP Marketplace minimum participation requirement, an overview of SHOP Marketplace health and dental coverage options, and information on the requirements for Privacy Notice Statements.

  • January 2016

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 10 Slides

CMS hosted a webinar session on January 5 to provide reminders on key Open Enrollment dates and tips from the Marketplace Call Center on assisting consumers, highlighting important information on assisting consumers in preparation for the 2015 tax season, and reporting personally identifiable information breaches.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 11 Slides

CMS hosted a webinar session on January 12 to review the agent/broker responsibility to take reasonable steps to ensure their consumers are providing accurate information to the Marketplace, information about the draft 2017 Letter to Issuers in the FFM, and to provide highlights about new research findings on small employers and the SHOP Marketplace.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 12 Slides

CMS hosted a webinar session on January 19 to highlight progress enrolling consumers for plan year 2016, provide tips on how to “close the deal” with clients before the end of Open Enrollment and for staying in touch after Open Enrollment ends, review what consumers need to know for tax season and how agents and brokers can help, provide information on health coverage exemptions available to consumers, and review the requirements for recording consumer consent and the restrictions for naming a business or website.

Operational Updates and Announcements for Agents and Brokers Participating in the FFMs – Week 13 Slides

CMS hosted a webinar session on January 26 to review exemption policies in preparation for the 2015 tax season, as well as to provide agents and brokers with tips on the following topics: “closing the deal” with clients before the January 31, 2016 enrollment deadline; staying in touch with clients after Open Enrollment; and assisting clients with account maintenance.

Marketplace Frequently Used Terms – Spanish

A glossary of the most frequently used Health Insurance Marketplace terms in Spanish. You may find this tool useful when enrolling Spanish-speaking clients.

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

Plan Year 2016 FFM Registration and Training NOW LIVE

Plan year 2016 FFM agent and broker registration and training is now available on the CMS Enterprise Portal at https://portal.cms.gov. Training is offered by CMS on the new Marketplace Learning Management System (MLMS) in English and Spanish, as well as through the CMS-approved vendors listed here in English.

For information on how to complete FFM registration and training for plan year 2016, see below.
 

    • Annual FFM Registration Requirements

      All agents and brokers participating in the FFM must complete registration on the CMS Enterprise Portal at https://portal.cms.gov (i.e., create an FFM user account, select the agent/broker role, and complete identity proofing) if they have not done so previously.

      To continue participation in the Federally-facilitated Individual Marketplace each year, agents and brokers must also complete a Marketplace Learning Management System (MLMS) profile, complete the required training and exams, and execute the Individual Marketplace Agreements (i.e., General and Privacy & Security Agreement). To begin this process, agents and brokers must log in to the CMS Enterprise Portal at https://portal.cms.gov with their existing credentials.

      To continue participation in the SHOP Marketplace each year, agents and brokers must also complete an MLMS profile and execute the SHOP Marketplace Agreement, and are strongly encouraged to complete the associated training and exams.  To begin this process, agents and brokers must log in to the CMS Enterprise Portal at https://portal.cms.gov with their existing credentials.

      For plan year 2016, agents and brokers can complete the CMS-developed training on the MLMS or through a CMS-approved vendor. Agents and brokers will access both the CMS-developed training and CMS-approved vendor training via the CMS Enterprise Portal. For more information on the CMS-approved vendors, click here.


      Key Registration and Training Resources

      • August 2015
      FFM Agent and Broker Plan Year 2016 Registration and Training Slides
      CMS hosted three sessions of the “FFM Agent and Broker Plan Year 2016 Registration and Training Requirements” webinar on July 22, July 29, and August 19, 2015. The webinar slides contain an overview of the role of agents and brokers in the Health Insurance Marketplaces, details on the FFM plan year 2016 registration and training requirements, and information on the CMS-approved vendor training option.

      September 2015
      Guidance on Plan Year 2016 FFM Registration and Training for Agents and Brokers
      CMS hosted seven sessions of the “Guidance on Plan Year 2016 FFM Registration and Training for Agents and Brokers” on September 9, 10, 11, 15, 17, 18, and 25, 2015. The webinars slides walk through the steps for the new registration process, give a brief overview of the SHOP Marketplace, and describe the new option to complete training through one of the CMS-approved vendors.

      • October 2015
      Quick Reference Guide – Plan Year 2016 FFM Registration for Agents and Brokers
      The Quick Reference Guide and the registration and training videos are resources designed as a guided tour to assist agents and brokers with understanding the new plan year 2016 FFM registration and training process on the Marketplace Learning Management System (MLMS) and via the new vendor training option.


      FFM Agent and Broker Plan Year 2016 Registration and Training Videos
      Important: Agents and brokers previously registered with the FFM should start at Step 4 and use their existing FFM user ID and password.
      Step 1 – Creating an Enterprise Portal Account
      Step 2 – Navigating to the Registration Status Page
      Step 3 – Completing Identity Proofing
      Step 4 – Accessing Training Options
      Step 5 – (Vendor Training Option) – Completing FFM Registration After Completing Training with a Third-Party Vendor


      CMS-approved Vendors Offering Plan Year 2016 FFM Agent and Broker Training

      CMS is pleased to announce that it has approved the following vendors to offer plan year 2016 training to agents and brokers participating in the FFM:

      America’s Health Insurance Plans (AHIP): for more information go to https://www.ahipexchangetraining.com/file.php/1/public/About.html

      Gorman Health Group (Gorman): for more information go to http://www.exchangebrokertraining.com/about

      National Association of Health Underwriters (NAHU): for more information go to http://www.nahu.org/education/ffmtraining/index.cfm

      Completion of a training curriculum, including the associated exams, through one of the above CMS-approved vendors will fulfill the FFM training requirement for agents and brokers registering to participate in the Individual Marketplaces for plan year 2016. CMS-approved vendors are required to cover, at a minimum, the same topic areas as are covered in the CMS training, and pursuant to 45 CFR § 155.222 are required to offer continuing education unit (CEU) credits in a minimum of five states where the FFM is operating. The number of CEUs and the states where they are available vary by vendor. Vendors charge a fee for taking their training.

      If you complete FFM training through a CMS-approved vendor, you will still need to execute the applicable Agreements with CMS on the Marketplace Learning Management System (MLMS) prior to assisting consumers seeking to enroll in health coverage through the FFM.

      CMS-approved vendor training can be accessed via the CMS Enterprise Portal at https://portal.cms.gov/.

      If you require assistance with any of the CMS-approved vendor training options, please contact the vendor’s help desk directly:

      • AHIP:
        o Phone support: 800-984-8919 from 8:00 AM – 12:00 AM ET, Monday through Friday and from 8:30 AM – 5:30 PM ET, Saturday and Sunday
        o Email: support@ahipinsuranceeducation.org
      • Gorman:
        o Phone support: 877-207-0349 from 8:00 AM – 7:00 PM ET, Monday through Friday and from 10:00 AM – 3:00 PM ET, Saturday and Sunday
        o Email: exchangetraining@gormanhealthgroup.com
      • NAHU:
        o Phone support: 844-257-0990 from 9:00 AM – 6:00 PM ET, Monday through Friday
        o Email: nahu-ffm@nahu.org

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

      Agent and Broker FFM Registration Completion List for Plan Year 2016

      6 [XLSX, 1MB]

      This list contains the National Producer Numbers (NPNs) for agents and brokers who have completed FFM registration for the 2016 plan year as of 4/20/16. CMS posts this list twice each month, reflecting registration data as of the date of the list. 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 FFM registration, and should be validated against state and/or other NAIC records to confirm state licensure.

    • This list is also available for issuers on the private issuer community of CMSzONE. Issuers must have account credentials and log into zONE to access the list.  CMS anticipates updating this list weekly with posting by Friday morning.
    • Agent and Broker FFM Registration Completion List for Plan Year 2015

      Plan Year 2015 Public Registration Completion List as of 4-20-16 [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 twice each month, reflecting registration data as of the date of the list. 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.

      FFM registration for plan year 2015 expired on 11/12/15.  

      Agent and Broker FFM Registration Completion List for Plan Year 2014

      Plan Year 2014 Public 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.

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

    • Agent and Broker FFM Registration Termination List for Plan Year 2016
    • Plan Year 2016 Public Registration Termination List as of 4-20-16 Agent and Broker FFM Registration Completion List for Plan Year 2016 [XLSX,1MB]  

    • This list contains the National Producer Numbers (NPNs) for agents and brokers whose FFM agreements and registration for the 2016 plan year have been terminated as of 4/20/16.  This list will be updated monthly, or as needed to reflect new termination actions.  Termination is described in regulation at 45 CFR § 155.220(f)-(g).
    • Web-broker Application Process

      A web-broker is an individual agent or broker, a group of agents and brokers, or a company that is interested in providing a non-Federally-facilitated Marketplace (FFM) website to assist consumers in the qualified health plan (QHP) selection and enrollment process as described in 45 CFR.§ 155.220(c)(3). FFM web-brokers must meet CMS’ regulatory and technical requirements and establish an Internet website with an Application Program Interface (API) connection to the FFM.

    • Web-brokers must be able to implement the technical requirements to connect with the FFM through the Direct Enrollment pathway. These technical requirements include understanding how to create and digitally sign a Security Assertion Markup Language (SAML) response and how to invoke Simple Object Access Protocol (SOAP) web services.

    • For more information on the web-broker requirements and application process, please contact CMS at webbroker@cms.hhs.gov. Interested parties should also review the guidance document “Role of Agents, Brokers, and Web-brokers in the Health Insurance Marketplaces.”

      Key Web-broker Resources

      • October 2015
        Web-broker 101 Webinar Slides (Slides from the September 30, 2015 Webinar)
        CMS hosted the Web-broker 101 webinar on September 30, 2015. The webinar slides contain information on the role of web-brokers in the FFM, the process for becoming a web-broker, and a summary of existing guidance for web-brokers, including requirements and best practices.

      2016 FFM Web Broker List

      Public 2016 FFM Web Broker Entity List

      This list contains the names of web-brokers participating in the Federally-facilitated Marketplace (FFM) who have signed 2016 Web-broker Agreements with CMS and completed FFM registration for the 2016 plan year. This list contains web-brokers whose requirements have been verified as of March 10, 2016. CMS will update this list on a periodic basis.

      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 Marketplace-specific Resources

When assisting employers and employees in completing the eligibility application and enrolling in coverage online through the SHOP Marketplace, an agent or broker will use the SHOP Marketplace Agent/Broker Portal.