The Centers for Medicare & Medicaid Services (CMS) recently sent compliance reminders for agents and brokers selling in the Marketplace. Agents, please remember to adhere to these regulations.
Prior Consent
Before helping individuals with Marketplace coverage, you must obtain consent from every client you consult. This requirement includes acquiring consumer consent before searching for a current application using an approved Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE) website. You can only update a client application or policy when that client instructs you to complete that task. The Marketplace standards of conduct stipulate that agents must obtain the consent of an individual, employer, or employee before helping them. This rule includes but is not limited to the following scenarios.Ā
- You search for consumer applications using an approved DE/EDE website.
- You help clients apply for financial assistance or enroll in a Marketplace qualified health plan (QHP).
- You call the Marketplace Call Center to ask about the status of a Marketplace enrollment or make changes to an application.
Clients who wish to give you consent to call on their behalf at the Marketplace Call Center must call 1-800-318-2596 and provide your name and National Producer Number (NPN). The client may also oversee a three-way call with you on the phone line with them. The client doing so will be giving you permission to access their account information and check the status of their submitted application. You may only check the status of Marketplace applications which document you as the assisting agent. Keep in mind that clients must authorize access to you every 365 days. This authorization is not the same as ensuring your NPN is on a consumer application for payment purposes with issuers.
Complying When Establishing a Relationship
Establishing a business relationship is critical in your work, and it remains vital that you ensure compliance with Marketplace regulations and guidance. As you know, agents must acquire consent from potential clients. If a consumer has already given consent having spoken to a customer service representative, vendor, or sales lead-generating employee, the agent should double-check and confirm. Additionally, potential clients can only be enrolled by licensed and registered agents.
Consumers’ personally identifiable information (PII) and protected health information (PHI) must be well-guarded. Agents and any third party with whom they have entered into a business relationship must follow the requirements for using and disclosing this sensitive information. Agents cannot release, publish, or disclose consumer PII to any unauthorized people and must protect this information per federal laws and regulations regarding the handling of PII.
Agents should report violations they witness to the Agent/Broker Email Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs.gov. Examples of violations may include an agent seeing others searching for consumer applications using approved DE/EDE websites, enrolling consumers or making unauthorized changes to applicationsĀ without their consent, or inappropriately accessing CMS systems.
Agents, we have resources available for you to use so you can comply with CMS guidelines. You may use our ACA Consumer Consent Call Script to help you navigate your client calls. We also have a PII consent form that is fillable. Please click the links below to access the resources.
ACA Consumer Consent Call Script
Personally Identifiable Information (PII) Consent form (Fillable)
Agents
We hope that this information on CMS compliance is useful to you.
Empower Brokerage is dedicated to helping you make informed decisions about your health and finances. Whether itās through webinar training, one-on-one calls, seminars, or marketing plans, we want you to be successful!
Give us a call at 888-539-1633 or leave a comment below if you have any questions.
Quick links:
