Partnering with Agents/Brokers
Partnering with Agents and Brokers to Boost In-Person Assistance Click toand editEnrollment master
title style.
October 23, 2014 1
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Agenda I. Welcome
Molly Warren (moderator), Policy Analyst in the Best Practices Institute, Enroll America
Marcy Buckner, Senior Director of State II. The Role of the Affairs, National Association of Health Agent Underwriters
2
III. A Successful Partnership in Milwaukee
Heather Dummer Combs, Enrollment Project Manager, Milwaukee Enrollment Network
IV. Lessons Learned in Florida
Nick Duran, Florida State Director, Enroll America
V. Q&A
Submit your questions at any time using the chat box. © 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Why Agents and Brokers? 1. In-person assistance is crucial to maximizing enrollment 2. Agents and brokers are already trusted voices and sources of information for many consumers 3. Agents and brokers are knowledgeable and skilled at providing assistance to consumers 3
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
II. THE ROLE OF THE AGENT Marcy M. Bucker, Senior Director of State Affairs, National Association of Health Underwriters
4
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Agents and Brokers—The Basics • Nearly half a million independent agents and brokers help individuals and businesses find the right health plan and navigate their coverage once enrolled. • A consumer’s health insurance premium is the same when using an agent or broker as through the marketplace. • Agents and brokers are on the case to solve the consumer’s problems for the whole plan year.
Value of the Agent Consumers working with a health insurance broker gain a professional advisor who: 1. Understands all the coverage details in the plans available in the Marketplace 2. Knows about key differences between one company and another, such as provider networks, formularies, disease management programs, etc. 3. Knows which companies are easy to work with 4. Will be available throughout the year to answer questions and fix problems that may develop 5. Priority to maintain client satisfaction through the life of each insurance policy
Partnering with Agents/Brokers • Consumers do not have to be limited to working with one type of assister! • Agents and brokers can, and do, work in great partnership with navigators and other community-based assisters.
Distinctions of Agents and Brokers Versus Other Assisters • Agents and brokers are licensed by each state. • In addition to exchange privacy requirements, health insurance agents and brokers must abide by significant federal and state privacy and data security requirements. • Health insurance agents are required to carry professional liability insurance to protect consumers, which is known as “errors and omissions” insurance.
Strengths of Navigators, Non-Navigator Assisters, and Agents/Brokers
Navigators/ Assisters Outreach to underserved populations Language expertise Public program expertise
Both Public Education Marketing Referrals Providing impartial information Facilitating QHP enrollment
Brokers Private market expertise service after enrollment— claims, coverage issues, renewals Employer issues Compliance issues State insurance regulatory expertise
Exchange Participation by Brokers in 2014 There is no definitive data source for broker participation and enrollment assistance, but a variety of indicators show that broker interest was high and that client satisfaction was great: • Almost 75 percent of NAHU leaders surveyed in the summer of 2013 indicated they were obtaining marketplace certification. • 70,000 agents certified in FFM and 30,000+ agents certified in SBMs! • A recent Urban Institute Study shows that at about half of all exchange enrollees used sources other than the websites to enroll in coverage. Of those who used other assistance for exchange coverage, insurance agents and brokers had the highest rating; 84 percent of adults who used them found them very or somewhat helpful.
Broker Exchange Participation in 2015 • Broker recertification for the exchanges in ongoing now, and despite the challenges from last year, HHS indicates that early interest is high. • A June survey of NAHU leaders indicated that 69 percent plan to sell and service individual exchange policies in 2015.
Opportunities with Open Enrollment 2015 • Agents and brokers see many opportunities with the health insurance marketplaces ahead, but also remain concerned about potential challenges. • Opportunities include: – Online availability of the FF SHOP – Increased broker services for the FF SHOP – Technological improvements to federal and state-based exchange websites and operations – New market entrants and new health insurance market exchange products for consumers
Marcy M. Buckner Senior Director of State Affairs National Association of Health Underwriters [email protected]
III. A SUCCESSFUL PARTNERSHIP IN MILWAUKEE Heather Dummer Combs, Enrollment Project Manager, Milwaukee Enrollment Network
14
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Milwaukee Enrollment Network
The Milwaukee Enrollment Network (MKEN) is a multistakeholder collaboration organized to improve consumer outreach and education, strengthen enrollment support resources, and assist Milwaukee County residents in securing adequate and affordable public or private health insurance. 15
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
OE1 Tactics Support Agent Engagement and Referrals • Include listing of Agents in Milwaukee Enrollment Site Directory • Used by local 2-1-1 and other professionals to refer local consumers who need enrollment assistance
• Host a mixer for Agents, CACs and Navigators • Opportunity for Agents, CACs, and Navigators to describe their respective work, understand how they can work together, and begin to develop referral relationships.
16
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Additional Strategies • Agent listing used for referrals • Utilized by both Enrollment Assister and Mobilizer organizations
• Hotlines with local TV stations • Held three last year and are planning for at least two this year • Agents helped staff the phones, answering questions from callers
• Enrollment events • Agents helped assist consumers with enrolling in health coverage at various local enrollment events held during OE1 • Developing a list of Agents willing to assist with events this year
17
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Lessons Learned During OE1 • Find a list of agents you can start from • Wisconsin Office of Commissioner of Insurance list of Agents who took training on BadgerCare (state’s Medicaid program)
• Developing relationships is key • Hosted Mixer • Included Agents in our regular MKEN communications
• Important to have someone coordinate this work • MKEN is convened by organizations that provide staff support to manage its work
18
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Heather Dummer Combs Enrollment Project Manager Milwaukee Enrollment Network
19
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
IV. LESSONS LEARNED IN FLORIDA Nick Duran, Florida State Director, Enroll America
20
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Enroll America’s Florida Campaign Enroll America staff conduct grassroots organizing and consumer outreach and education across Florida.
21
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Added Value of Partnering with Agents and Brokers Additional capacity to provide in-person assistance Access to particular constituencies
Additional resources or funding for resources
22
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Enroll America’s Agent and Broker Partners in Florida • All sold plans from multiple insurers • All completed HHS training and certification to sell marketplace plans • All agreed to Enroll America’s assister pledge that outlines expectations for partners who provide in-person assistance • All willing to work hand in hand with other assister partners
23
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Partnership with First Coast MultiLine Agency Huge added value and great partnership: • Added crucial in-person assistance capacity in a region with only a handful of other assisters. • Particularly key to reaching the AfricanAmerican faith-based network in the area. • Stepped up financially to make donated space at the Regency Square Mall a reality.
24
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Lessons Learned During OE1 Do your homework and establish ground rules Agents and brokers partners were willing to work side by side with Navigators and CACs Agent and broker partners were well trained in customer service Agents and broker partners were hard workers....came in early and stayed late!
25
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Nick Duran Florida State Director Enroll America [email protected] 26
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
V. QUESTIONS?
27
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Questions What recommendations do you have for building relationships with agents/brokers?
28
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Questions And vice-versa, any tips for agents/brokers looking to partner with other assister and outreach groups?
29
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Questions What kinds of activities fostered the most productive partnerships between agents/brokers and other enrollment stakeholders?
30
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
#Ready4OE2 Webinar and Blog Series During October! Subscribe to Enroll America’s newsletter for updates: http://www.enrollamerica.org/
31
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
ADDENDUM: AGENT AND BROKER RESOURCES
32
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Agents and Brokers—The Basics •
• •
• •
•
•
Nearly half a million independent agents and brokers help American individual and business health care consumers find the right health plan and navigate the health care system throughout the life of their policy. Independent agents do not work for health insurance carriers, but instead run their own businesses. Agents are hired by individual consumers and employers to represent them before all of the insurance carriers with which the agent is affiliated. Only the individual consumer or employer can decide whether or not to keep their agent. The law requires that a consumer’s health insurance premium is the same, whether a person goes direct to a health insurance company or works with a professional agent. State laws prohibit agents from charging separate fees for services provided to individual health insurance consumers, as well as to most traditional employer group plans. Agents are paid by small commissions included as a pass-through fee in every single health insurance policy premium payment. This payment structure has existed for over 100 years and is a consumer convenience, but it is also required by a myriad of state-level licensing, consumer-protection and tax laws. An agent works on enrollment, but they are also on the case to solve the consumer’s problems for the whole plan year.
Value of the Agent •
Consumers working with a health insurance broker gain a professional advisor who: – – – –
•
•
Understands all the coverage details in the plans available in the Marketplace Knows about key differences between one company and another, such as provider networks, formularies, disease management programs, etc. Knows which companies are easy to work with. Will be available throughout the year to answer questions and fix problems that may develop.
It is the professional agent’s job to maintain client satisfaction throughout the life of each insurance policy. Research dating back decades continually shows that policies where there is an agent of record have better client satisfaction and retention rates, as well as fewer issues with health insurance claims. Consumers do not have to be limited to working with one type of assister! Agents and brokers can, and do, work in great partnership with navigators and other community-based assister.
Professional Distinctions of Agents and Brokers •
Agents and Brokers are licensed by each state. – – –
•
In addition to any exchange privacy requirements, Health insurance agents and brokers must abide by significant federal and state privacy and data security requirements. These include: – – – – –
•
•
There is a long-established system of non-resident licensing for those that operate in multiple states and a national database to track the licenses they hold and their conduct. State departments of insurance regulate marketing practices of insurers and insurance producers through regular market-conduct examinations and other means. In addition to any exchange training or certification, agents and brokers are subject to extensive and separate state-level continuing education requirements.
Federal Gramm Leach Bliley Act (GLBA) financial privacy requirements Federal Health Insurance Portability and Accountability Act(HIPAA) health privacy requirements Federal Health Insurance Technology for Economic and Clinical Health (HITECH) data security requirements Federal Do Not Call requirements State-specific privacy laws and regulations
Health insurance agents are required by the insurers and state laws to carry professional liability insurance to protect consumers, which is known as “errors and omissions” insurance. Health insurance agents and brokers have a personal legal and financial liability to follow all of these laws and requirements.
Exchange Participation by Brokers in 2014 •
There is no definitive data source for broker participation and enrollment assistance in the exchanges in 2014, but a variety of indicators show that broker interest was high and that client satisfaction was great. – – –
•
Almost 75 percent of NAHU leaders surveyed in the summer of 2013 indicated they were obtaining marketplace certification. Former HHS Secretary Kathleen Sebelius testified that approximately 70K agents were certified by the FFM. State exchange data shows the certification of at least 30k more agents and brokers.
A recent Urban Institute Study shows that at about half of all exchange enrollees used sources other than the websites to enroll in coverage. – –
–
One-third (29.1 percent) used other sources in addition to a website, and one-fifth (20.6 percent) used other sources instead of a website. Certain groups preferred direct assistance more than others. Hispanic and low-income adults, for example, were less likely to rely on a website and more likely to rely on direct assistance. Of those who used other assistance for exchange coverage, insurance agents and brokers had the highest rating; 83.9 percent of adults who used them found them very or somewhat helpful.
Broker Exchange Participation in 2015 • • •
Broker participation in 2015 is unknown at this time. Broker recertification for the exchanges in ongoing now, and despite the challenges from last year, HHS indicates that early interest is high. A June survey of NAHU leaders indicated that 69 percent plan to sell and service individual exchange policies in 2015, which is only a slight decrease from June 2013
Opportunities and Challenges with Open Enrollment 2015 • •
Agents and brokers see many opportunities with the health insurance marketplaces ahead, but also remain concerned about potential challenges. Opportunities include: – – – –
•
Technological improvements to federal and state-based exchange websites and operations New market entrants and new health insurance market exchange products for consumers Online availability of the FF SHOP Increased broker services for the FF SHOP
Concerns include: – – – – – –
Reenrollment and redeterminations for existing consumers Accuracy of health premium tax-credit determinations Challenges and much greater than anticipated time spent physically enrolling individual through all approved means last year. Ongoing authorization issues to act on a client’s behalf with the marketplace. Ongoing payment difficulties, and related liability concerns because lack of payment/client relationship means that they are not covered by their errors and omissions insurance policies but are still legally liable for advice given Lack of improvements to many broker needs planned for 2015 for the Individual FFM
title style.
October 23, 2014 1
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Agenda I. Welcome
Molly Warren (moderator), Policy Analyst in the Best Practices Institute, Enroll America
Marcy Buckner, Senior Director of State II. The Role of the Affairs, National Association of Health Agent Underwriters
2
III. A Successful Partnership in Milwaukee
Heather Dummer Combs, Enrollment Project Manager, Milwaukee Enrollment Network
IV. Lessons Learned in Florida
Nick Duran, Florida State Director, Enroll America
V. Q&A
Submit your questions at any time using the chat box. © 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Why Agents and Brokers? 1. In-person assistance is crucial to maximizing enrollment 2. Agents and brokers are already trusted voices and sources of information for many consumers 3. Agents and brokers are knowledgeable and skilled at providing assistance to consumers 3
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
II. THE ROLE OF THE AGENT Marcy M. Bucker, Senior Director of State Affairs, National Association of Health Underwriters
4
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Agents and Brokers—The Basics • Nearly half a million independent agents and brokers help individuals and businesses find the right health plan and navigate their coverage once enrolled. • A consumer’s health insurance premium is the same when using an agent or broker as through the marketplace. • Agents and brokers are on the case to solve the consumer’s problems for the whole plan year.
Value of the Agent Consumers working with a health insurance broker gain a professional advisor who: 1. Understands all the coverage details in the plans available in the Marketplace 2. Knows about key differences between one company and another, such as provider networks, formularies, disease management programs, etc. 3. Knows which companies are easy to work with 4. Will be available throughout the year to answer questions and fix problems that may develop 5. Priority to maintain client satisfaction through the life of each insurance policy
Partnering with Agents/Brokers • Consumers do not have to be limited to working with one type of assister! • Agents and brokers can, and do, work in great partnership with navigators and other community-based assisters.
Distinctions of Agents and Brokers Versus Other Assisters • Agents and brokers are licensed by each state. • In addition to exchange privacy requirements, health insurance agents and brokers must abide by significant federal and state privacy and data security requirements. • Health insurance agents are required to carry professional liability insurance to protect consumers, which is known as “errors and omissions” insurance.
Strengths of Navigators, Non-Navigator Assisters, and Agents/Brokers
Navigators/ Assisters Outreach to underserved populations Language expertise Public program expertise
Both Public Education Marketing Referrals Providing impartial information Facilitating QHP enrollment
Brokers Private market expertise service after enrollment— claims, coverage issues, renewals Employer issues Compliance issues State insurance regulatory expertise
Exchange Participation by Brokers in 2014 There is no definitive data source for broker participation and enrollment assistance, but a variety of indicators show that broker interest was high and that client satisfaction was great: • Almost 75 percent of NAHU leaders surveyed in the summer of 2013 indicated they were obtaining marketplace certification. • 70,000 agents certified in FFM and 30,000+ agents certified in SBMs! • A recent Urban Institute Study shows that at about half of all exchange enrollees used sources other than the websites to enroll in coverage. Of those who used other assistance for exchange coverage, insurance agents and brokers had the highest rating; 84 percent of adults who used them found them very or somewhat helpful.
Broker Exchange Participation in 2015 • Broker recertification for the exchanges in ongoing now, and despite the challenges from last year, HHS indicates that early interest is high. • A June survey of NAHU leaders indicated that 69 percent plan to sell and service individual exchange policies in 2015.
Opportunities with Open Enrollment 2015 • Agents and brokers see many opportunities with the health insurance marketplaces ahead, but also remain concerned about potential challenges. • Opportunities include: – Online availability of the FF SHOP – Increased broker services for the FF SHOP – Technological improvements to federal and state-based exchange websites and operations – New market entrants and new health insurance market exchange products for consumers
Marcy M. Buckner Senior Director of State Affairs National Association of Health Underwriters [email protected]
III. A SUCCESSFUL PARTNERSHIP IN MILWAUKEE Heather Dummer Combs, Enrollment Project Manager, Milwaukee Enrollment Network
14
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Milwaukee Enrollment Network
The Milwaukee Enrollment Network (MKEN) is a multistakeholder collaboration organized to improve consumer outreach and education, strengthen enrollment support resources, and assist Milwaukee County residents in securing adequate and affordable public or private health insurance. 15
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
OE1 Tactics Support Agent Engagement and Referrals • Include listing of Agents in Milwaukee Enrollment Site Directory • Used by local 2-1-1 and other professionals to refer local consumers who need enrollment assistance
• Host a mixer for Agents, CACs and Navigators • Opportunity for Agents, CACs, and Navigators to describe their respective work, understand how they can work together, and begin to develop referral relationships.
16
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Additional Strategies • Agent listing used for referrals • Utilized by both Enrollment Assister and Mobilizer organizations
• Hotlines with local TV stations • Held three last year and are planning for at least two this year • Agents helped staff the phones, answering questions from callers
• Enrollment events • Agents helped assist consumers with enrolling in health coverage at various local enrollment events held during OE1 • Developing a list of Agents willing to assist with events this year
17
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Lessons Learned During OE1 • Find a list of agents you can start from • Wisconsin Office of Commissioner of Insurance list of Agents who took training on BadgerCare (state’s Medicaid program)
• Developing relationships is key • Hosted Mixer • Included Agents in our regular MKEN communications
• Important to have someone coordinate this work • MKEN is convened by organizations that provide staff support to manage its work
18
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Heather Dummer Combs Enrollment Project Manager Milwaukee Enrollment Network
19
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
IV. LESSONS LEARNED IN FLORIDA Nick Duran, Florida State Director, Enroll America
20
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Enroll America’s Florida Campaign Enroll America staff conduct grassroots organizing and consumer outreach and education across Florida.
21
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Added Value of Partnering with Agents and Brokers Additional capacity to provide in-person assistance Access to particular constituencies
Additional resources or funding for resources
22
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Enroll America’s Agent and Broker Partners in Florida • All sold plans from multiple insurers • All completed HHS training and certification to sell marketplace plans • All agreed to Enroll America’s assister pledge that outlines expectations for partners who provide in-person assistance • All willing to work hand in hand with other assister partners
23
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Partnership with First Coast MultiLine Agency Huge added value and great partnership: • Added crucial in-person assistance capacity in a region with only a handful of other assisters. • Particularly key to reaching the AfricanAmerican faith-based network in the area. • Stepped up financially to make donated space at the Regency Square Mall a reality.
24
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Lessons Learned During OE1 Do your homework and establish ground rules Agents and brokers partners were willing to work side by side with Navigators and CACs Agent and broker partners were well trained in customer service Agents and broker partners were hard workers....came in early and stayed late!
25
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Nick Duran Florida State Director Enroll America [email protected] 26
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
V. QUESTIONS?
27
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Questions What recommendations do you have for building relationships with agents/brokers?
28
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Questions And vice-versa, any tips for agents/brokers looking to partner with other assister and outreach groups?
29
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Questions What kinds of activities fostered the most productive partnerships between agents/brokers and other enrollment stakeholders?
30
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
#Ready4OE2 Webinar and Blog Series During October! Subscribe to Enroll America’s newsletter for updates: http://www.enrollamerica.org/
31
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
ADDENDUM: AGENT AND BROKER RESOURCES
32
© 2014 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
10-23-14
Agents and Brokers—The Basics •
• •
• •
•
•
Nearly half a million independent agents and brokers help American individual and business health care consumers find the right health plan and navigate the health care system throughout the life of their policy. Independent agents do not work for health insurance carriers, but instead run their own businesses. Agents are hired by individual consumers and employers to represent them before all of the insurance carriers with which the agent is affiliated. Only the individual consumer or employer can decide whether or not to keep their agent. The law requires that a consumer’s health insurance premium is the same, whether a person goes direct to a health insurance company or works with a professional agent. State laws prohibit agents from charging separate fees for services provided to individual health insurance consumers, as well as to most traditional employer group plans. Agents are paid by small commissions included as a pass-through fee in every single health insurance policy premium payment. This payment structure has existed for over 100 years and is a consumer convenience, but it is also required by a myriad of state-level licensing, consumer-protection and tax laws. An agent works on enrollment, but they are also on the case to solve the consumer’s problems for the whole plan year.
Value of the Agent •
Consumers working with a health insurance broker gain a professional advisor who: – – – –
•
•
Understands all the coverage details in the plans available in the Marketplace Knows about key differences between one company and another, such as provider networks, formularies, disease management programs, etc. Knows which companies are easy to work with. Will be available throughout the year to answer questions and fix problems that may develop.
It is the professional agent’s job to maintain client satisfaction throughout the life of each insurance policy. Research dating back decades continually shows that policies where there is an agent of record have better client satisfaction and retention rates, as well as fewer issues with health insurance claims. Consumers do not have to be limited to working with one type of assister! Agents and brokers can, and do, work in great partnership with navigators and other community-based assister.
Professional Distinctions of Agents and Brokers •
Agents and Brokers are licensed by each state. – – –
•
In addition to any exchange privacy requirements, Health insurance agents and brokers must abide by significant federal and state privacy and data security requirements. These include: – – – – –
•
•
There is a long-established system of non-resident licensing for those that operate in multiple states and a national database to track the licenses they hold and their conduct. State departments of insurance regulate marketing practices of insurers and insurance producers through regular market-conduct examinations and other means. In addition to any exchange training or certification, agents and brokers are subject to extensive and separate state-level continuing education requirements.
Federal Gramm Leach Bliley Act (GLBA) financial privacy requirements Federal Health Insurance Portability and Accountability Act(HIPAA) health privacy requirements Federal Health Insurance Technology for Economic and Clinical Health (HITECH) data security requirements Federal Do Not Call requirements State-specific privacy laws and regulations
Health insurance agents are required by the insurers and state laws to carry professional liability insurance to protect consumers, which is known as “errors and omissions” insurance. Health insurance agents and brokers have a personal legal and financial liability to follow all of these laws and requirements.
Exchange Participation by Brokers in 2014 •
There is no definitive data source for broker participation and enrollment assistance in the exchanges in 2014, but a variety of indicators show that broker interest was high and that client satisfaction was great. – – –
•
Almost 75 percent of NAHU leaders surveyed in the summer of 2013 indicated they were obtaining marketplace certification. Former HHS Secretary Kathleen Sebelius testified that approximately 70K agents were certified by the FFM. State exchange data shows the certification of at least 30k more agents and brokers.
A recent Urban Institute Study shows that at about half of all exchange enrollees used sources other than the websites to enroll in coverage. – –
–
One-third (29.1 percent) used other sources in addition to a website, and one-fifth (20.6 percent) used other sources instead of a website. Certain groups preferred direct assistance more than others. Hispanic and low-income adults, for example, were less likely to rely on a website and more likely to rely on direct assistance. Of those who used other assistance for exchange coverage, insurance agents and brokers had the highest rating; 83.9 percent of adults who used them found them very or somewhat helpful.
Broker Exchange Participation in 2015 • • •
Broker participation in 2015 is unknown at this time. Broker recertification for the exchanges in ongoing now, and despite the challenges from last year, HHS indicates that early interest is high. A June survey of NAHU leaders indicated that 69 percent plan to sell and service individual exchange policies in 2015, which is only a slight decrease from June 2013
Opportunities and Challenges with Open Enrollment 2015 • •
Agents and brokers see many opportunities with the health insurance marketplaces ahead, but also remain concerned about potential challenges. Opportunities include: – – – –
•
Technological improvements to federal and state-based exchange websites and operations New market entrants and new health insurance market exchange products for consumers Online availability of the FF SHOP Increased broker services for the FF SHOP
Concerns include: – – – – – –
Reenrollment and redeterminations for existing consumers Accuracy of health premium tax-credit determinations Challenges and much greater than anticipated time spent physically enrolling individual through all approved means last year. Ongoing authorization issues to act on a client’s behalf with the marketplace. Ongoing payment difficulties, and related liability concerns because lack of payment/client relationship means that they are not covered by their errors and omissions insurance policies but are still legally liable for advice given Lack of improvements to many broker needs planned for 2015 for the Individual FFM
