The Affordable Care Act (ACA) calls for the creation of state-based competitive marketplaces, known as Affordable Health Insurance Exchanges (Exchanges), for individuals and small businesses to purchase private health insurance. ACA requires the Exchanges to become operational in 2014, with enrollment beginning Oct. 1, 2013.

Agents and brokers, including web-brokers, will play a role in educating consumers about Exchanges and insurance affordability programs and in helping consumers receive eligibility determinations, compare plans and enroll in coverage. In particular, agents and brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs).

On May 1, 2013, HHS’ Centers for Medicare & Medicaid Services (CMS) released guidance on the role that agents, brokers and web-brokers will play in the federally facilitated (FFE) and state partnership Exchanges. In this guidance, CMS also addresses common questions on the role of agents and brokers in all Exchanges, including state-based Exchanges, as well as questions specific to web-brokers.

Role of Agents and Brokers in FFEs and State Partnership Exchanges

Where permitted under state law, CMS will work with agents and brokers to assist consumers in completing the eligibility application, comparing and selecting qualified health plans (QHPs) and enrolling consumers through the Exchange. Agents and brokers intending to work with consumers in FFEs and state partnership Exchanges will be able to assist consumers in two ways:

(1) An issuer-based pathway, where an agent or broker uses an issuer’s website to assist the consumer; or

(2) An Exchange pathway, where an agent or broker assists the consumer using the Exchange website.

Both pathways will transmit an agent’s or broker’s identifying information to the appropriate issuer to facilitate payment, and will allow an agent or broker to assist qualified individuals and/or employers and employees with initial enrollment and changes during the coverage year, including changes that impact eligibility.

Registration with the Exchange

In states with an FFE or state partnership Exchange, all agents and brokers must register with CMS to assist qualified individuals for individual Exchange coverage. CMS also encourages agents and brokers working exclusively in SHOPs to register and complete training. An online registration process is expected to begin in thesummer of 2013, prior to open enrollment. In completing the registration process, the agent or broker will:

(1) Confirm his or her identity by answering a number of simple questions online;

(2) Complete an Exchange-specific online training course; and

(3) Agree to comply with federal and state laws, rules, standards and policies, including those related to privacy and security policies, as a condition of working with consumers in the Exchange.

Once an agent or broker has registered, he or she will receive anactive FFE user ID. This user ID is the agent or broker’s unique identifier in the Exchange, and it, along with the agent’s or broker’s national producer number (NPN), will be essential for the agent or broker to receive compensation from an issuer.

Issuer-based Pathway for Assisting Consumers

Many agents and brokers already use issuer websites to assist consumers and will be able to continue using issuer websites to work with consumers in the FFEs. This issuer-based pathway will be available to agents and brokers who are assisting individual consumers starting in the fall of 2013.

As is the case today, agents and brokers will be appointed by issuers. Issuers will check the agent’s or broker’s licensure status and will verify an agent or broker’s registration with the FFE or state partnership Exchange. Agents and brokers will be required to provide copies of their FFE training certificates and user IDs to issuers.

To use this pathway, an agent or broker will first log on to the issuer’s website. Once the consumer determines that he or she would like to apply for coverage through the FFE, the agent or broker will be securely redirected from the issuer’s agent website to the Exchange website to complete the eligibility application, using his or her FFE user ID to access the Exchange website. The agent or broker will need to enter his or her FFE user ID and NPN as part of the eligibility application.

CMS expects that the agent or broker will inform the consumer that the agent or broker will provide information for certain QHPs with which he or she has a business relationship, but that the consumer could directly access the FFE website where additional QHP information and choices are available.

Once the agent or broker has completed the application with the consumer and received the consumer’s eligibility determination from the FFE, the agent or broker will be securely redirected to the issuer’s website to assist the consumer with plan comparison, plan selection and enrollment. CMS has provided a process flow illustrating the issuer-based pathway.

Exchange Pathway for Assisting Consumers

Beginning in fall 2013, an agent or broker will also be able to assist consumers directly on the FFE website using the Exchange pathway. Agents and brokers will be able to use this pathway to help enroll qualified individuals with individual Exchange options as well as qualified employers and employees with SHOP options.

In the Exchange pathway, the consumer, employer or employee will log directly into his or her own Exchange account. The agent or broker may assist the consumer in creating this account if needed, but the consumer or a legally-authorized representative must create his or her own Exchange username and password. The consumer should not share this information with third parties, including agents and brokers.

The agent or broker will then work with the consumer to complete the eligibility application. The agent or broker can assist in comparing QHPs on the Exchange website and submitting the consumer’s selection. All plan choices will be displayed. The consumer will enter the agent’s or broker’s FFE user ID and NPN both as part of the eligibility application and enrollment transaction to indicate that the agent or broker assisted the consumer with plan selection and enrollment. CMS has provided a process flow illustrating the Exchange pathway.

FAQs on the Role of Agents and Brokers in All Exchanges

Can a state-based Exchange establish a commission schedule or pay commissions? How will FFEs, including state partnership Exchanges, address compensation? (Compensation includes commissions, fees or other incentives as established in the agreement between an issuer and an agent or broker.)

Nothing in the Exchange final rule prohibits a state from establishing laws, regulations and standards for issuer compensation of agents or brokers, including for enrolling individuals through that state’s Exchange. Accordingly, state-based Exchanges may establish parameters for compensating agents and brokers, by direct compensation from the Exchange or by having issuers pay commissions. If issuers will be paying commissions to agents or brokers, CMS encourages state-based Exchanges to consider providing information to issuers to facilitate these transactions.

FFEs and state partnership Exchanges will not establish a commission schedule or pay commissions directly to agents or brokers. Instead, CMS expects that the amount and terms of any commission would be negotiated by the issuer and the agent or broker. However, HHS has established a QHP certification standardfor issuers seeking certification in FFEs and federally facilitated SHOPs (FF-SHOPs) that would require QHP issuers to pay the same agent and broker compensation for enrollment through the FFEs and FF-SHOPs and for enrollment in similar health plans offered outside the FFEs and FF-SHOPs. CMS will reevaluate this approach in the future. FFEs and state partnership Exchanges will transmit agent/broker identifying information to issuers to facilitate payment.

However, note that agents and brokers who are acting as Navigators may not receive compensation from issuers.

May a state participating in a state partnership Exchange modify processes and infrastructure for agents and brokers, including for training and registration?

For FFEs, including state partnership Exchanges, CMS will be responsible for registering agents and brokers and conducting Exchange-related training. Upon completion of the registration and training, agents and brokers will complete a privacy and security agreement and obtain an FFE user ID.

States will continue to license and regulate agents and brokers, including those who assist consumers in the Exchange. States will also continue to establish licensure and continuing education requirements for agents and brokers, and may require additional state-specific training as a condition of licensure. However, the FFE training will not include state-specific training requirements in 2014.

When assisting qualified individuals enrolling through an Exchange, must an agent or broker display all QHPs? Must an agent or broker be able to enroll individuals in all QHPs?

With the exception of web-brokers (who must display all QHPs available in an Exchange), the Exchange final rule does not require agents and brokers to display all QHPs or facilitate enrollment into all QHPs. State-based Exchanges have discretion to implement policies that would require agents and brokers to display all QHPs (such as additional requirements for QHP issuers under state law or as part of the state-based Exchange QHP certification process) consistent with the Exchange final rule. State-based Exchanges may also provide information to consumers on agent and broker relationships with issuers, including appointment and compensation arrangements.

In FFEs and state partnership Exchanges, CMS will not require agents and brokers to facilitate enrollment into all available QHPs. (However, agents and brokers who are acting as Navigators would be required to facilitate enrollment into all available QHPs.) If the agent or broker is using the Exchange pathway to assist consumers, all QHP choices will be displayed. All agents and brokers must comply with applicable state laws, regulations and Exchange requirements, including standards related to relationships or appointments with issuers.

What happens if an individual working with an agent or broker is determined to be eligible for Medicaid or CHIP?

Agents and brokers who are approached by individuals and families looking for assistance with Exchange enrollment are expected to work with all consumers, including individuals who are ultimately determined to be eligible for Medicaid or CHIP. Any individual who is working with a registered agent or broker and is determined by an Exchange to be eligible for Medicaid or CHIP will receive an appropriate notice of assessment or determination of Medicaid/CHIP eligibility from the Exchange. In these cases, CMS expects the agent or broker to refer the individual to state agency. Agent and broker training will provide information on where to direct Medicaid or CHIP-eligible individuals.

How will agents and brokers work with qualified employers in FF-SHOPs?

Agents and brokers who assist qualified small employers in enrolling through an FF-SHOP will use the Exchange pathway, except that agents and brokers will not be required to obtain an FFE user ID. Like in the Exchange pathway for consumers shopping for individual coverage, the SHOP application will include a field in which the employer or agent/broker can enter an FFE user ID (if applicable) and/or NPN. This information will be transmitted to the QHP issuer selected by the employer as part of the group enrollment.

To what extent can agents and brokers continue communicating with consumers after they have been enrolled in a QHP through an Exchange?

Agents and brokers (including web-brokers) may continue to communicate with qualified individuals after they have enrolled in a QHP to the extent that communications comply with applicable laws and regulations. This communication also must comply with the privacy and security standards adopted by the Exchange, which limit how an agent or broker may use any information gained as part of providing assistance and services to a qualified individual. CMS expects to issue additional rulemaking on privacy and security requirements for non-Exchange entities. With respect to the FF-SHOP, agents and brokers are expected to be in continual contact with employers both before and after enrollment, as they will serve as a primary contact for customer service issues for employers.

Additional Guidance for Web-Brokers

Agents or brokers who enroll consumers through public-facing websites are referred to as “web-brokers.” Web-brokers will provide another option for consumers seeking to enroll in QHPs through the individual Exchanges, alongside traditional agents and brokers who will also be assisting consumers with enrolling through the Exchange.

CMS recognizes that many consumers currently purchase insurance online from web-brokers. 45 C.F.R. 155.220(c)(3) establishes requirements that would apply when consumers in the individual Exchanges select a QHP through an agent’s or broker’s website. The following questions and answers address the role of web-brokers in Exchanges.

Can state-based Exchanges work with web-brokers?

Yes. In addition to operating its own Exchange website, a state-based Exchange can work with web-brokers to provide an alternate plan selection option for consumers. States may allow web-brokers to use their websites to provide consumer information for comparing and selecting QHPs, subject to the standards specified in 45 C.F.R. 155.220(c) for individual market QHPs.

State-based Exchanges must continue to perform eligibility determination functions and transmit enrollment information to QHP issuers for all individuals enrolling through the Exchange, including those who enroll through the Exchange with the assistance of web-brokers.

Will FFEs offer the web-broker option?

Yes. To the extent permitted by a state, beginning in October 2013, CMS intends to work with web-brokers that meet all applicable requirements to provide an alternate option to help consumers select QHPs online. CMS is developing the capability to support integration between the web-broker’s website and the FFE’s website using secure redirect and application programming interface mechanisms. This interface will allow a qualified individual to:

Initiate his or her shopping experience on the web-broker’s website;
Connect securely to the FFE website to complete the eligibility application and determination process; and
Return securely to the web-broker’s site to compare plans and select a QHP.

How will web-brokers working with FFEs obtain consumer and QHP data?

In FFEs, the application programming interface will facilitate the secure transmission of key eligibility and enrollment information between the Exchange and the web-broker. CMS will make available to web-brokers QHP data, including premium information, provided by issuers to CMS. CMS will provide further technical guidance on how QHP data will be conveyed to web-brokers. Web-brokers will also receive consumer-specific eligibility information via a secure redirect from the Exchange, including contact information for the application, the individual or family’s eligibility determination and information on the maximum advance payment of premium tax credit (APTC) and cost-sharing reductions for which the individual or family is eligible.

After the consumer selects a QHP and the APTC amount has been determined, the web-broker will transmit the individual or family’s QHP selection and related information back to the Exchange. The Exchange will convey all enrollment information to appropriate QHP issuers. Individuals determined eligible for Medicaid and CHIP will be referred by the Exchange to the appropriate state agency.

Given the sensitive nature of personally identifiable information, web-broker websites will be required to comply with all existing and future privacy and security standards related to the use and handling of personally identifiable information obtained during the enrollment process, regardless of whether the enrollment is completed. These security standards will also require consumer authentication to prevent unauthorized access to sensitive information.

Under 45 C.F.R §155.220(c)(3)(iv), web-brokers must display all QHPs available through an Exchange. Is the FFE establishing standards for appointments with issuers?

Web-brokers must display all QHPs available through an Exchange, irrespective of compensation or appointment arrangements. Web-brokers must comply with all applicable state law, including state law related to appointments, as a condition of enrolling individuals through the Exchange. If a consumer intends to enroll in a QHP for which the web-broker does not hold an appointment, the web-broker should direct the consumer to the FFE.

In the FFE, will web-brokers be able to modify the display of QHPs presented on their websites? What consumer protections must web-brokers keep in mind?

In FFEs, CMS expects that:

The sort order of (or sorting algorithm for) QHPs will not steer a consumer to a particular QHP based upon financial consideration to the web-broker;
A web-broker will disclose to the consumer the specific source and nature of web-broker compensation and that the compensation does not affect the display of QHP options or the premiums charged;
Consumers will not be charged a separate transaction or service fee for shopping or enrolling in a QHP through a web-broker’s services or website; and
Web-brokers will display QHPs separately from non-QHPs and offer a QHP plan selection experience that is free from advertisements or information for other health insurance-related products and sponsored links advertising health insurance-related products (for example, an advertisement for a QHP issuer).

Web-brokers also may offer additional tools or decision support that the consumer can use to navigate or refine the display of QHPs. Once a consumer has completed QHP plan selection and enrollment, the web-broker may offer the consumer the ability to search for additional products or services, if desired. CMS expects that these types of offers will be made in a section of the web-broker’s website that is separate from the QHP display.

A web-broker must adhere to website disclosure and display standards specified in 45 C.F.R. 155.205(b)(1) and (c). In particular, a web-broker must make available quality information on each QHP offered through an Exchange easily accessible to consumers, including consumers with disabilities and limited English proficiency.

CMS also expects the web-broker to prominently display language explaining to consumers that the web-broker has entered into an agreement with CMS and has agreed to conform to website display and security standards. This language will also explain that the web-broker’s website is distinct from the FFE website and that consumers may opt to use the FFE website at any time. CMS will provide standard language that a web-broker may use on its website for this purpose in future guidance.

Source: Department of Health and Human Services

Morgan Parker

15:58 09 Jan 19

Working with BBG has always been a great pleasure. The customer service that we receive is ALWAYS top notch; knowing that you will always receive a response from someone is very important and we know that BBG will give us that. We have been a customer of BBG for many years, and have absolutely no complaints. Everyone that works at BBG is so nice and goes above and beyond, which is appreciated more than they know. Keep up the GREAT work!!

Allison Woodruff

12:34 09 May 19

Outstanding, prompt and friendly service. Would recommend BBG for any size group!

Holly Palmer

15:25 08 Feb 19

I've worked with BBG for 7 years and was responsible for introducing BBG at my new company. The service everyone at BBG provides is unparalleled- and they do it with a smile on their faces. BBG is more than an insurance broker. They are a full service firm that doesn't just sign companies up for benefit coverages, they act as a strategic advisor to determine what solutions fit best for each company's situation and demographic. This year, with BBG's insightful advice and patient guidance, we were able to save a significant amount of money at benefit renewal time while actually improving our offerings from the prior year. It was a win for our company and a win for our people. As an HR department of one, I take advantage of the HR advice provided by BBG as well. There are not enough adjectives to say how great it is to work with BBG.

John Farrell

16:04 08 Feb 19

The Business Benefits Group is top notch. I've worked with numerous benefits brokers over the years and they are second to none. Their personalized service has provided outstanding cost savings for my organization while also providing rich benefits to my employees. I truly appreciate their dedication and expertise. John A. Farrell III, HR Director, SHRM-SCP

Jason Thornhill

14:08 09 Jan 19

BBG has been pivotal in the dissemination of health benefits for Fonteva employees. They have remained consistent regardless of the level of stress involved in any situations. The aforementioned has been particularly appreciated during our Open Enrollment process. Derek Winn, the Senior Benefits Consultant, is exceptional!

Valentia Royal

20:16 16 Aug 18

As an HR Professional, I have had an opportunity to work with several benefits brokers and BBG is by far a stand out. The level of support, guidance, and assistance they provide as a broker is above and beyond. Everyone at BBG is knowledgeable and their willingness to make themselves available to not only our company, but our employees is unmatched. They have become an extension of our organizational family. In an industry that is ever changing, BBG is consistent in their level of service. Regular assessments of the industry and the market to bring its business partners the best tools, strategies, resources, and expertise, are just a few of the "benefits" of BBG.

Bree Acampora

15:07 03 Aug 18

Working with BBG has been a game changer for our company. From managing our annual benefit renewals to the day to day customer service they provide for our team and members, every individual we interact with is extremely knowledgeable and provides excellent customer service. The depth of resources BBG provides is second to none. We have an incredible rep who responds to our questions and concerns day or night and the technology platforms they have on offer have allowed us to streamline our HR functions to save us time and money. I could write a novel about all of the wonderful people, services and products BBG offers. They have become an integral part of our HR/Benefit strategy and an extension of our own "family oriented culture" as a company who puts this kind of service acumen and care at its forefront. Thank you BBG and here's to many more years of partnership.

Brad Becker

18:56 04 Oct 19

BBG defines excellence. Earlier this year we interviewed severally companies for benefits administration and BBG was hands down the best service and takes professionalism and service to whole nother level. They were able to provide great benefits and cost saving for our employees as well! If there was 6 starts i would put that for them.

Jay Greenstein

15:11 07 Oct 19

Great service! Remarkable team of folks. So happy I made the switch to BBG!

Chantel Harris

19:29 09 Oct 19

It has been an auspicious pleasure working with BBG. BBG truly has top notch professionals that consistently provide excellent and proactive customer service. They are very knowledgeable in their area of expertise and you can always count on them to provide the best advice/counsel regarding various applicable matters. We highly recommend BBG!

Lisa Donovan

19:36 09 Oct 19

Great staff, always willing to go that extra mile to get things done for you. Couldn't be happier.

Matt

14:09 25 Oct 19

I love working with BBG! As a department of one I know I can count on them to provide me with timely and accurate customer service when I need help. I also cannot imagine not having such a great broker relationship, as I know they are always looking our for our interests and make recommendations that can be helpful. BBG is a great resource for me, they are customer oriented and always there when I need them.

Chelsea Day

21:26 09 Jan 20

BBG is always extremely responsive and help answer any questions. We just recently went through open enrollment and it went incredibly smoothly. I would highly recommend them!!

Meg Nelbach

15:00 13 Jan 20

BBG is an incredible business partner and our dedicated consultants act like extended members of our company's team. In addition to the responsive, detail-oriented, and personalized services they offer, they also provide tools that are incredibly helpful, especially for smaller HR organizations. I look forward to partnering with BBG for many years to come and I'd highly recommend them for anyone seeking to upgrade their broker support!

Casey Costello

15:11 13 Jan 20

BBG takes the whole HR process from benefits enrollment to HR management, and streamlines the process to make it user-friendly, professional, and a huge time saver. Great organization made up of great people.

Hope Miller

22:29 26 Feb 20

We've used BBG for our business benefits & insurance for almost 7 years. They have amazing customer service across all of their departments. Their quick responses are helpful & direct. I appreciate our business relationship & highly recommend them to anyone looking for a broker!

Misty Gutierrez

15:27 22 Apr 20

We have used BBG to manage our company benefits for 10 plus years now. They provide excellent and timely service for all our corporate insurance needs. Highly recommend!

Mary Kate LaCroix

20:06 06 May 20

BBG has been terrific all around! They are always available to answer questions and help whenever we need them. We highly recommend them and look forward to our continued partnership!

Joe Webb

11:58 15 Jul 20

Mac, Walter and the BBG team are all top-notch folks. They are all easy to work with and just made life easy. The BBG team is able to work medical benefits, Defense Base Act, property insurance and anything HR related, all of which continue to make life easy for Small Businesses. Overall, BBG is an outstanding organization that provide Subject Matter Expertise in everything they do.

Leoprieto74

16:40 04 Aug 20

Michelle Milam is an incredible person! She made the whole process painless. She is also relentless in providing excellent Customer Service! I recommend her to everyone. Always quick to respond and always keeps me up to date in my insurance claim status. Thanks Michelle!!!

A Google User

21:02 23 Sep 20

We have tried out three different brokers and systems before selecting BBG and sticking with them. Mac and his team are professional, responsive, and easy to work with. Their relationship has been invaluable, and is clearly superior to systems that try to automate insurance and benefits consulting. They save us money, and help us select products that fit our company's corporate culture, and future business goals. They have also been scaling with our business, which has been growing by several employees every year. I imagine they'd do very well for large businesses. We cannot say enough about their customer support, and recommend them to anybody looking for benefits consulting and insurance.

Sign Up for Our Newsletter