Quote Engines, Web Brokers, Subsidy Calculators

[AllenChicago]

Translated:
If we didn't need so many apps to make this thing work we wouldn't even consider it, so make sure you run a clean ship web-brokers.

Thanks for summing it up so succinctly, Houcoogster. I'm thankful that the insurance companies will pay us, because the CMS and HHS rules promise brokers nothing, but ask us to comply with every nuance of the rules, or else you get the ax... with 30 days advance notice, of course.

 

[Yagents]

This is what's being referenced. Can someone please decipher it for me? I hate this legal ease

http://www.ofr.gov/(X(1)S(42mxjtt4gwqqkbq0sauqncgv))/OFRUpload/OFRData/2013-14540_PI.pdf

What if producers and FFEs break up? | LifeHealthPro

 

[CHUMPS FROM OXFORD]

" Can someone please decipher it for me?"

What do you mean? That's what we depend on you to do!

 

[Yagents]

I feel so "used"!! I need to find new friends, preferably lawyers who know how to read this crap.

 

[Ann H]

This is what's being referenced. Can someone please decipher it for me? I hate this legal ease

http://www.ofr.gov/(X(1)S(42mxjtt4gwqqkbq0sauqncgv))/OFRUpload/OFRData/2013-14540_PI.pdf

What if producers and FFEs break up? | LifeHealthPro

The Lifehealthpro article is confusing to me. The title says, "What if Producers and FFE break up", and then the article wanders away from that premise completely.

The 252 page document is on my "read this while in the bathtub" list now. I read the portion directed to agents and brokers, and stumbled upon a few other key factors already, and here is my take on it:

First, remember that these are proposed rules. They are taking comments, and will come out with their final rules. Usually, in proposed rules, when it says they are considering an amendment to make the process more functional, it's a sign that the final rule will probably make that amendment.

Page 49 - Important distinctions about what makes plans "substantially the same" inside and outside the govt exchange, so that they must have the same premium, benefits and commission. It says, "among other things, the benefits package, provider network, service areas, and cost-sharing
structure of the two offerings must be identical." Clearly, the mention of provider network is important.

Page 56 - It says, "In 45 CFR 155.220(c), 155.220(d), and 155.220(e), we established general Exchange
standards that agents and brokers must meet to assist individuals in enrolling in QHPs and
applying for advance payments of the premium tax credit and cost-sharing reductions, This is clarification that they allow agents to assist individuals in applying for subsidies as well as assist in enrolling in coverage. It doesn't mean the agent MUST assist with subsidy applications, but indicates they expect the agent to be involved in that process.

Page 56-57 - last paragraph of page 56 reiterates the 2 pathways for agent/brokers to use to enroll (carrier website or FFE), and Page 57 paragraph 2 begins the discussion of web-broker requirements.

Page 57 - Clarifies what defines a web-broker by saying, "Section 155.220(c)(3) establishes standards that apply if an agent or broker uses its publicly-facing Internet Web site to assist individuals in selecting or enrolling in a QHP through the Exchange. Agents or brokers who do so are referred to as “Web-brokers” for the purposes of this proposed rule" I think this would apply to all of us who use Quotit, Norvax or any other quote engine to show plans and rates. That's my take on it.

Page 57 - Immediately after the sentence above, the document begins a whole section about how they are planning to amend the rules because the way they are written right now is not functional. Sometimes they say they are just delaying a rule, but not amending. Really, what they are saying here is that the exchange is not ready, so they won't make web-brokers comply with requirements for which they have no ability to comply. For instance, user satisfaction ratings (there are none at this point).

Page 57 - Let's start with what web brokers are required to display, "In particular, §155.205(b)(1) requires the display of standardized comparative information on each available QHP, including its: (a) premium and cost-sharing information; (b) summary of benefits and coverage; (c) metal level (bronze, silver, gold, or platinum); (d) enrollee satisfaction survey results; (e) quality ratings; (f) medical loss ratio, (g) transparency of coverage measures, and (h) provider directory. "

Page 57 & 58 - now comes the realization that not all that information is available, nor could web brokers be able to display it in time - "After taking into consideration concerns from issuers, we propose to limit the Web broker’s obligation to disclose and display the QHP information to all the information provided to the Web-broker by the Exchange or directly by the issuer. We recognize that an Exchange may not be able to provide all Web-brokers with certain data elements necessary to meet the §155.205(b)(1) requirements, such as premium and rate information, depending upon confidentiality requirements, the extent to which Web-brokers are appointed by individual QHP issuers, and State laws regarding agent and broker appointments. We also recognize that some of the required data, such as quality rating and enrollee satisfaction survey results, may not be available in the first year of Exchange operations, in which case Web-brokers would also not need to display this information. We seek comment on whether this provision should be limited to FFEs"

Page 58 - next they say it's not an amendment, just a delay, and web-brokers "should display all information provided by the Exchange or an issuer in a manner that is as consistent with the requirements in §155.205(b)(1) as possible."

Page 58 - "Even if a Web-broker is unable to display certain QHP information identified in §155.205(b)(1) because it is not provided by the Exchange or a QHP issuer, it must still display a
list of all available QHPs for the consumers to view, as required by §155.220(c)(3)(ii).

Page 58 - We also propose that, to address situations where the Web-broker is unable to display certain QHP information identified in §155.205(b)(1), the Web-broker must display a link to the Exchange Web site so the consumer may obtain the additional information.

Page 58 & 59 - Instead of modifying only §155.220(c)(3)(i), we considered removing §155.220(c)(3)(ii), which requires Web-brokers to provide consumers with the ability to view all QHPs offered through the Exchange. We decided not to propose this approach so that the consumer would be aware of all available QHP options, even if some of the specific plan details may not be available on the Web-broker’s Internet Web site. We invite comment on this proposal.

Page 59 - We also propose to amend §155.220(c)(3) by adding a new paragraph (c)(3)(vii), which would require Web-brokers’ Internet Web sites in an FFE to prominently display language notifying consumers that: (a) the Web-broker’s Internet Web site is not an FFE Web site; (b) the Web-broker’s Web site might not display all QHP data available on the Exchange Web site; (c) the Web-broker has entered into an agreement with HHS pursuant to § 155.220(d); and (d) the
Web-broker agrees to comply with standards specified in § 155.220(c) and (d). We believe that this additional standard is in the best interest of the consumers in an FFE, as it will help
consumers distinguish between an FFE Web site and the Internet Web sites of Web-brokers, and it will inform consumers that agents and brokers must comply with FFE standards and
requirements before they can assist and enroll consumers

Page 59 - Very important. This is about the Web-broker's interface with the FFE for the subsidy/eligibility app, which CMS says will return the client back to the web-broker's website for comparison & plan selection. Remember when reading this, that CMS has a 3 step process for their govt exchange marketplace - apply for eligibility/subsidy, shop & pick a plan, enroll in that plan. That famed 21 page app (that is now "condensed" into 12 pages and a bunch of addendums) is an application to be eligible to shop on the govt exchange marketplace as well as an app for subsidies. HHS expects to make available an application programming interface that would permit Web-brokers to use their public-facing Internet Web sites to assist consumers in enrolling through individual market QHPs offered through an FFE (“FFE API”). An FFE API would allow a person seeking to enroll in a QHP to initiate his or her shopping experience on a Web-broker’s Internet Web site, connect securely to an FFE Web site to complete the eligibility application and determination process, and return securely to the Web-broker’s Internet Web site compare and select QHPs. It is my understanding from Quotit that they intend to provide an interface like this.

Page 59-60 - We understand that some Web-brokers may enter into arrangements with other agents and brokers under which those agents and brokers would be able to enroll qualified individuals in an FFE through the Web-broker’s Internet Web site. We are concerned about these arrangements... Too much text to put in here. This may be referencing quote engines like Quotit or Norvax, or it may be talking about GA's, FMO's, IMO's, etc. Really, it's just saying they will crack down on this, but are considering requiring the web-broker with the FFE connection to get a signed contract from all sub-brokers or users of their system.

Page 61-66 - Security requirements for agents, 30 day notice to terminate voluntarily, termination for cause and appeal rights...

Page 75-76 - Rules for carrier's non-licensed assisters and customer service staff. I don't think they are talking about Navigators and Assisters programs here, I think they are talking about carrier staff. EDIT ON 6/23/2013 - Thanks Yagents for bringing to my attention how important this subject is. I guess the proposed rule is to allow UNLICENSED carrier staff to write new business for their carrier. Pretty important stuff. Here is the quote - "Section 1413 of the Affordable Care Act directs the Secretary to establish, subject to minimum requirements, a streamlined enrollment process for enrollment in QHPs and all insurance affordability programs. Many issuers currently have customer service representatives who assist applicants in the application and plan selection process and assist enrollees in making changes to their coverage. Some of these representatives might not be licensed by the State as agents, brokers, or producers. Accordingly, we propose to add section §155.415 that would, a the Exchange’s option and to the extent permitted by State law, permit issuer customer service representatives who do not meet the definition of agent or broker in §155.20 to assist qualified individuals in the individual market with: (a) applying for an eligibility determination or redetermination for coverage through the Exchange; (b) applying for insurance affordability programs; and (c) facilitating the selection of a QHP offered by the issuer represented by the customer service representative, provided that such issuer customer service representatives meet the proposed requirements set forth in §156.1230(a)(2)."

Pages 76-78 - New Special enrollment period if a "non-exchange entity" enrolls someone in an inappropriate plan for them, doesn't get the subsidy available for the client, puts them incorrectly in a plan, etc. Those "non-exchange entities" are defined on page 77 "we would interpret a non-Exchange entity providing enrollment assistance or conducting enrollment activities to include, but not be limited to, those individuals and entities that are authorized by the Exchange to assist with enrollment in
QHPs (such as a Navigator...)... non-Navigator consumer assistance personnel,... certified application counselor,... an agent or broker assisting consumers in an Exchange under §155.220; issuer customer service representatives assisting consumers in an Exchange,... or a QHP conducting direct enrollment. It mentions audits of non-exchange enrollers who have a lot of consumer complaints. And, ending this section on Page 78, it sums it up with, "If the Exchange determines that the error or inaction on the part of the non-Exchange entity caused the qualified individual to be harmed (including, but not limited to failure to be enrolled in a health plan, enrolled in the incorrect health plan or failure to receive advance payments of the premium tax credit or cost-sharing reduction), the Exchange may provide for a special enrollment opportunity to correct the error." So, pretty much everyone except the exchange staff themselves. This means we have an SEP to correct "mistakes"!

Page 78-79 - lists people who can assist with SHOP apps, by saying, "We propose that “SHOP application filer” would mean an applicant, an authorized representative, an agent or broker of the employer, or an employer filing for its employees where not prohibited by other law. By broadening who can file an employee application beyond just an CMS-9957-P 79 employee, we propose to permit the entities that have traditionally assisted employees in filing applications to provide such assistance.

I stopped reading there. My browser says I've found 95 out of 187 instances of the word "agent", so clearly there is more in this document about us. I'll read more later.

 

[CHUMPS FROM OXFORD]

Great job Ann.

You said: you will "read this while in the bathtub."

Please note difference between males and females. We also sometimes read things like this in the bathroom, but ...well...you know. We're sitting down. Sometimes for a while.

 

[AllenChicago]

A huge huge thank you ann! how long is the comment period for these proposed rules? all affected parties have to be ready to roll by October the first.

 

[Ann H]

A huge huge thank you ann! how long is the comment period for these proposed rules? all affected parties have to be ready to roll by October the first.

When is the deadline for comments? Well, here is what the document actually says:

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on [OFR--insert date 30 days after date of publication in the Federal Register]​

 

[taterpeeler]

every single time I go run face to face calls all hell breaks loose on the forum and insurance carriers making goofy decisions like Aetna just did..... now I have homework... thanks annie

 

[AllenChicago]

When is the deadline for comments? Well, here is what the document actually says:

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on [OFR--insert date 30 days after date of publication in the Federal Register]
​

Well Ann, it looks like they've at least compressed the comments timeframe, but I can't find any guidelines on the internet regarding what is the minimum amount of time that must pass between the Proposed Rule and the Final Rule. (I think there are Interim Rules too?)

The closer HHS and/or CMS comes to September for issuing Final rules, the more likely that the State Exchanges will simply crash, or not be ready for the big Exchange Shakedown Test Drives that are supposed to occur between Sept 1st and the 10th in most states.