Direct Enrollment by Web Brokers and Insurers

Transcription

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