Direct Enrollment by Web Brokers and Insurers
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Direct Enrollment by Web Brokers and Insurers
Direct Enrollment by Web Brokers and Insurers Claire McAndrew March 5, 2014 What is Direct Enrollment? • Insurer or web broker facilitates enrollment, including with financial assistance • Consumer never has to directly visit marketplace website or call center • AKA enrollment “through the marketplace” by an insurer or web broker Families USA 2014 • Optional for marketplaces, FFE allows How does direct enrollment work? • Step 1: Consumer starts on insurer or broker website and enters basic personal information • Step 2: Consumer is securely redirected to marketplace website to complete coverage and financial assistance application • Step 3: Marketplace securely transmits eligibility determination to the web broker or insurer Families USA 2014 How does direct enrollment work? • Step 4: Consumer is security redirected back to insurer or broker site select a qualified health plan (QHP) and determine amount of advance premium tax credit (APTC) to accept • Step 5: Web broker or insurer submits plan selection and APTC amount to the marketplace Families USA 2014 Who is performing direct enrollment now? • Fewer entities than expected. WHY? – Dependent on marketplace eligibility systems • HHS “pilot” program for insurer direct enrollment: OH, FL, TX • Web brokers: getinsured.com, healthsherpa.com (full process); ehealth.com, gohealth.com reportedly using call center determination • Expressing strong interest in increased involvement next year Families USA 2014 Benefits of Direct Enrollment • An additional outreach channel • Potential impact on marketplace web traffic Families USA 2014 Direct Enrollment: Concerns • Financial incentives influence how insurers and web brokers market to and enroll consumers • Protection of personal information • Complete information about financial assistance, including Medicaid Families USA 2014 Federal Requirements for Direct Enrollment Families USA 2014 Requirements for Insurers • Display comprehensive info about each plan they offer: – Premiums and cost-sharing – Summary of Benefits and Coverage – Enrollee satisfaction survey results and quality ratings – Medical loss ratio – Transparency of coverage measures – Provider directory Families USA 2014 Requirements for Insurers Families USA 2014 • Distinguish between QHPs and nonQHPs; indicate financial assistance is only for QHPs • Indicate other QHPs are available in marketplace via approved universal disclaimer; link to marketplace • Allow consumers to select and attest to an advanced premium credit amount Requirements for Web Brokers Families USA 2014 • List names of all marketplace QHPs • If provided by a marketplace or an insurer, post comprehensive plan details • If all plan details aren’t available, provide disclaimer that all QHP info is on marketplace site and link to site • If provided by marketplace or insurers, provide information that is accessible to individuals with disabilities and those with limited-English proficiency Requirements for Web Brokers Families USA 2014 • Allow consumers to withdraw from the process and use the official marketplace website at any time • Complete an agreement and register with the marketplace • Receive training in QHP options and financial assistance programs • Comply with marketplace privacy and security standards for personally identifiable information Requirements for Web Brokers • Not provide financial incentives such as rebates or giveaways • Comply with applicable state laws regarding agents and brokers Families USA 2014 Specific FFE Web Broker Requirements • Link to the official marketplace site and display a disclaimer stating: – Not the official marketplace site – Web broker may not display all QHP information – Web broker must meet federal requirements for how it enrolls consumers – Web broker must comply with privacy and security standards for consumer info Families USA 2014 Specific FFE Web Broker Requirements • Follow a formal termination process to end agreement with HHS – 30 days notice to HHS, notice and transitional support to customers, etc. • HHS can terminate web brokers for cause under a formal termination process Families USA 2014 Additional Protections Needed! Families USA 2014 Consumer Awareness of Financial Incentives • Expand FFE web broker disclaimer to all web brokers and add statements that: – Web brokers receive financial compensation for enrollment • Require web brokers to post information on their compensation • Forbid separate transaction or service fees Families USA 2014 Require Complete and Accurate Plan Info • Require web brokers to give comprehensive info about all plans • Prevent biased sorting of plans • Prevent posting of misleading information • Clearly distinguish marketplace QHPs from non-QHPs; prevent sales on same page • Always require compliance with accessibility requirements for language access and disability accommodations Families USA 2014 Require Info on Financial Assistance • Consumer should be made explicitly aware of APTC and cost-sharing reductions Families USA 2014 – After eligibility determination, show premiums with APTC factored in – Indicate which plans are CSR-eligible and show cost-sharing amounts w/ assistance Limit Marketing • No advertisements for health insurance products should be allowed • Could prohibit marketing of additional products (life and disability insurance, etc.) on insurer or broker sites – At a minimum, should not market them while consumers are shopping for/ enrolling in QHPs Families USA 2014 Protect Consumer Information • Prohibit use of personal info for marketing • Require disclosures for how info will be used; require proactive consumer consent before requesting info • Marketplaces must monitor for breaches; require immediately reporting of breaches Families USA 2014 Monitoring, Termination • Marketplaces should have formal monitoring systems in place – Monitor sites throughout the year, not just at beginning • Federal rules detail process for termination for cause for FFE web brokers; process needed in all marketplaces for web brokers and insurers – Should allow for immediate termination when misconduct is sufficiently egregious Families USA 2014 Advocacy steps • Gather Information – FFE: What web brokers/ insurers are doing direct enrollment in your state? – SBE: Is your state allowing direct enrollment? Have they been approached by insurers/ web brokers about it? What are future plans? • If direct enrollment permitted, advocate for standards: marketplace (HHS or state-run), insurance regulators, legislators • Monitor and report Families USA 2014 Further Resources • Contact: [email protected]; 202-628-3030 • Consumer Protections for Web Brokers that Participate in the Health Insurance Marketplace (Families USA, December 2013) http://familiesusa2.org/assets/pdfs/WebBrokers-Brief.pdf • Recommended Consumer Protections for Web-Based Agents and Brokers Offering Exchange Coverage (Consumers Union, September 2012): http://consumersunion.org/wp-content/uploads/2013/03/WebBased-Brokers-Recommendations-9-5-12.pdf Families USA 2014