Agent Role in NEW Exchange Regulation

Yagents

Guru
5000 Post Club
12,140
Arizona
Thought I'd start a new thread title.

I've been reading the legislation, and read NAHU's initial interpretation below..........I think we have brighter days ahead of us, vs the alternative which was NADA. As I see it, I can be a NAV if I get certified (think CMS), to sell exchange only products, where compensation is paid by the exchange, from self sustained exchange funds (no federal grants), who must charge fees to insurance companies to participate in the exchange. After all the waste, I'm sure there will be very little left over for us. But, if you can figure out a system to do volume during enrollment periods, it could be viable and lucrative. (remember, no more UW). So lucrative, that you might NOT qualify for free Medicaid. It also looks like you can double dip, meaning, still accept commish from insur co's selling NON exchange products.

Exchange web templates will be avail to states, along with calculators to assist in the ADVANCED tax credit payment if eligible. And watch out for the required exch call centers, which will duplicate existing service from the ins. co, and cause confusion to the consumer, or transfer jobs.

Here's the reg: http://ofr.gov/OFRUpload/OFRData/2011-17610_PI.pdf

From NAHU:
The proposed regulation contains significant information about the potential role of agents and brokers and “navigators” in state-based exchanges. One thing the regulation proposes is a pathway for states to ensure that individuals and small groups have access to information about agents and brokers, should they wish to use one, on state exchange websites and in other publicly available materials. The regulation also requires that navigators, including agents and brokers acting as navigators, not receive commissions or other payments directly from health insurance carriers, but specifies that these requirements only apply to health insurance exchange products. These provisions would not preclude a navigator from receiving compensation from health insurance issuers in connection with enrolling individuals, small employers or large employers in products sold outside of the exchanges. Furthermore, the proposed rule states that navigators must meet any licensing, certification or other standards prescribed by the state or exchange, as appropriate, which will allow the state or exchange to enforce existing licensure standards.
NAHU Washington Update - 07/11/2011
 
The regulation also requires that navigators, including agents and brokers acting as navigators, not receive commissions or other payments directly from health insurance carriers, but specifies that these requirements only apply to health insurance exchange products. These provisions would not preclude a navigator from receiving compensation from health insurance issuers in connection with enrolling individuals, small employers or large employers in products sold outside of the exchanges.

unless I'm reading this wrong.. I see commissions to agents who only sell a policy OUTSIDE the exhanges. NAHU needs to make sure of a few things.

That we can sell inside the exchange and be compensated
That we can sell outside the exchange and be compensated
That individuals and families can purchase outside the exchange and still receive tax credit.

Big question for Agents is .. What products will be available to sell outside the exchanges and will they be cost effective enough for us to market. Too many unanswered quesions and lots of road blocks ahead. Lord help us.
 
If by "tax credit" you're referring to the subsidy, the subsidy is only available to those who purchase INSIDE an Exchange.
REF: Health Reform Subsidy Calculator - Kaiser Health Reform

The Exchange products will be very standardized and tiered in catagories like Bronze, Silver, Gold. People really won't NEED any help purchasing these, because they'll just pick a well-recognized insurance company name from the list, run a quote online and then sign up using a 2 page application that's similar to the Pre-Existing Insurance Plan (PCIP).

The Treasury Department (IRS), Insurance Companies and State Agencies are SUPPOSED to be all tied in to the Exchange so that your application data is instantly verifyable. A very tall order! In fact, from what I've read, this data-sharing/confirmation challenge could inself doom the exchanges.

-ac
 
That individuals and families can purchase outside the exchange and still receive tax credit

I was under the impression that the tax subsidy for individuals/families was only available inside the exchange. The small business tax credit is available outside or inside the exchange.
 
The regulation also requires that navigators, including agents and brokers acting as navigators, not receive commissions or other payments directly from health insurance carriers, but specifies that these requirements only apply to health insurance exchange products. These provisions would not preclude a navigator from receiving compensation from health insurance issuers in connection with enrolling individuals, small employers or large employers in products sold outside of the exchanges.

unless I'm reading this wrong.. I see commissions to agents who only sell a policy OUTSIDE the exhanges. NAHU needs to make sure of a few things.

That we can sell inside the exchange and be compensated
I'm going to guess a per application or per applicant fee one-time of $50 or $100 like PCIP. Agents will have to certify as Navigators and do all of the AHIP-like certification similar to CMS and MA/MAPD/PDP.

That we can sell outside the exchange and be compensated
That is between the agent and insurer.

That individuals and families can purchase outside the exchange and still receive tax credit.
Nope, PPACA specifically states tax credit/subsidy ONLY available on plans purchased through the exchange. 400% FPL is upper limit which is most of not all of the middle class.

Big question for Agents is .. What products will be available to sell outside the exchanges and will they be cost effective enough for us to market. Too many unanswered quesions and lots of road blocks ahead. Lord help us.
We don't know yet, but all plans must be QHP (Qualifying Health Plans) otherwise they could subject the subscriber to a fine for not having 'sufficient' or creditable health coverage.
 
I know making the tax credits avail outside the exchange is a top priority/agenda for NAHU right now. They want a robust and viable market outside the exchange......in case the state exchange blows up (a given)
 
:1confused:
Agreed. There will be no market inside or outside of the Exchange. No commissions will be paid. Zero.
That appears to be the case in both Mass and Utah. Both of those exchanges, by the way, were specifically mentioned as 'model' exchanges by Sebelius the other day :swoon:

My gut feeling is that NAHU is going to 'claim victory' for producers by getting minimal comp in or out on small group plans (% or flat per member).
 
Back
Top