Michael Gomes's blog

On May 1, the Center for Consumer Information and Insurance Oversight (CCIIO) released new guidance on the role of “agents, brokers, and web-brokers” in Health Insurance Marketplaces/Exchanges. CCIIO describes how they foresee Brokers operating:

“Agents and brokers, including web-brokers, are among those who will play a role in educating consumers about Marketplaces and insurance affordability programs, and in helping consumers receive eligibility determinations, compare plans, and enroll in coverage. In particular, CMS anticipates that Brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs)”

In recent weeks, Congress has demonstrated an intent to change certain definitions and thresholds under the Patient Protection and Affordable Care Act (PPACA). On March 22, 2013, Senator Susan Collins (R-ME) submitted Amendment 144, which would change the definition of a large employer and remove the 30 hour requirement to be considered a full-time employee under PPACA. The legislative amendment would apply to the Senate Fiscal Year 2014 Budget Resolution (S. CON. RES.

The Patient Protection and Affordable Care Act (PPACA) requires large employers – those with 50 or more full-time employees and full-time equivalents – to offer their employees the opportunity to enroll in coverage that is both affordable and provides minimum value. While determining whether an employer is subject to this employer mandate is complicated in its own right, this determination can get even more complex when several employers are commonly owned.

Bundling Multiple Employers

The Department of Health and Human Services (HHS) has released an interim final rule that clarifies the role of Navigator and non-Navigator assistance personnel employed by both state and federal health insurance Exchanges as established by the Patient Protection and Affordable Care Act (PPACA). The proposed rule was published in the April 5 Federal Register. 

Navigators are those deemed by PPACA to provide assistance to consumers interested in purchasing health insurance coverage through state-based Exchanges. The non-Navigator assistance personnel are designated to provide additional consumer assistance, education, and outreach functions beyond the role of the Navigators. 

Legislation has been re-introduced in both the U.S. Senate and House of Representatives to help streamline insurance agent licensing between states while preserving key areas of state authority. Called the National Association of Registered Agents and Brokers Reform Act of 2013 (NARAB II), the bill would create an independent nonprofit entity comprised of insurance market representatives, state insurance commissioners, and other key stakeholders to help facilitate the ability of Brokers to sell insurance coverage in multiple jurisdictions.