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).
- August 1, 2012
Minimum Acceptable Risk Standards for Exchanges Guidance [PDF, 184KB]
- May 2014
Frequently Asked Questions Regarding Agents and Brokers [PDF, 142KB]
- September 4, 2014
QHP Manual: Agents and Brokers Chapter [PDF, 714KB]
- November 7, 2014
Role of Agents, Brokers, and Web-brokers in the Health Insurance Marketplaces [PDF, 500KB]
- February 20, 2015
Final 2016 Letter to Issuers in the Federally-facilitated Marketplace
- April 28, 2015
Frequently Asked Question Regarding Agents and Brokers (Including Web-brokers) and FFM Online Consumer Functionality
- March 27, 2012
CMS-9989-F: Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers (Exchange Final Rule) [PDF, 906 KB
- June 4, 2013
CMS-9964-F2: Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program (SHOP Final Rule) [PDF, 248KB]
- August 28, 2013
CMS-9957-F: Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility Appeals (Program Integrity Rule) [PDF, 648 KB]
- March 4, 2014
HHS Notice of Benefit and Payment Parameters for 2015 (2015 Payment Notice) [PDF, 1.1 MB]
- May 16, 2014
CMS-9949-F: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond [PDF, 578 KB]
- September 5, 2015
CMS–9941–F: Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges
- February 27, 2015
CMS–9944–F: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016; Final Rule
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.
Annual FFM Registration Requirements
To continue participation in the FFM for the individual market each year, 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-SHOP, each year agents and brokers must execute the FF-SHOP Agreement, 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 Training and Registration Resources
Stay tuned for upcoming training and registration resources for plan year 2016.
Agent and Broker FFM Registration Completion List for Plan Year 2015
Registration_Completion_List_as_of_08-06-15_Public [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.
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.
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 C.F.R. 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.
For more information on the web-broker requirements and application process, please contact CMS at firstname.lastname@example.org. Interested parties should also review the guidance document “Role of Agents, Brokers, and Web-brokers in the Health Insurance Marketplaces.”
Public 2015 FFM Web Broker Entity List
This list contains the names of web-brokers participating in the Federally-facilitated Marketplace (FFM) who have signed 2015 Web-broker Agreements with CMS and completed FFM registration for the 2015 plan year. This list contains web-brokers whose requirements have been verified as of August 20, 2015. This list will be updated on a periodic basis.
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
- December 1, 2013
Helping Consumers Complete an Enrollment: Tips for Agents and Brokers [PDF, 129KB]
- January 28, 2014
Federally-facilitated Marketplace Enrollment: Tips for Agents and Brokers in the Individual Market [PDF, 2.0 MB]
- February 24, 2014
Processing applications: Multi-tax households [PDF, 232KB]
- February 24, 2014
Plan Compare Overview: Comparing and Selecting Plans [PDF, 2174KB]
- March 31, 2014
Overview of New Change in Circumstances Functionality [PDF, 1MB]
- May-June, 2014
IRS Virtual Town Hall Series: The Premium Tax Credit – What You Need to Know [PDF, 295KB]
- May-June, 2014
IRS Premium Tax Credit Resources [PDF, 139KB]
- August, 2014
Tips to Resolve Outstanding Data Matching Issues (or Inconsistencies) [PDF, 525KB]
- November, 2014
Plan Year 2015 Open Enrollment: Tips for Agents and Brokers (Slides from Webinar Series) [PDF 2,280KB]
- November 12, 2014
Operational Tips for Agents/Brokers Assisting Consumers with Plan Year 2015 Enrollments in the Federally-facilitated Marketplace [PDF 478 KB]
- January 2015
Eligibility and Enrollment in the Federally-facilitated Marketplace: Twelve Tips for Agents and Brokers Webinar Slides (Slides from the January 2015 Webinar Presentation)
- June 2015
Special Enrollment Period (SEP) Webinar Slides (Slides from the April 29,2015 Webinar )
CMS hosted the Special Enrollment Periods (SEPs) for the Federally-facilitated Marketplace (FFM) webinar on April 29, 2015. The webinar slides contain information on the key policies and processes related to SEPs in the FFM, including the definition of an SEP, the qualifying life events and exceptional circumstances that make consumers eligible for SEPs, how to report SEPs, what happens once a consumer is approved for an SEP, and the coverage effective dates for various SEPs.
- August 2015
FFM Agent and Broker Plan Year 2016 Registration and Training Slides
CMS hosted three sessions of the “Federally-facilitated Marketplace (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.
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