Commentary December 31, 2021 at 07:44 AM Share & Print
HealthCare.gov managers want to set new standards for the information that agents and brokers put on client coverage applications.
The Centers for Medicare and Medicaid Services — the arm of the U.S. Department of Health and Human Services that oversees the federal health insurance exchange program — talks about the standards in a new set of draft guidelines for the 2023 coverage year.
HealthCare.gov helps consumers sign up for health insurance policies from private insurers and use income-based federal premium tax credit subsidies to pay for the coverage.
CMS says insurance producers should supply the clients’ own email addresses, telephone numbers and mailing addresses, not their own contact information, in client contact information fields when helping clients submit applications for coverage through HealthCare.gov.
CMS is proposing the changes because “it has observed agents, brokers and web-brokers submitting unauthorized exchange applications on behalf of consumers without their knowledge or content” when the applications contain the producers’ own contact information, CMS officials write in the proposed “Patient Protection and Affordable Care Act: Benefit Payment Parameters for 2023″ document.
The proposed changes would not affect requirements for producers to enter their own contact information in producer registration materials and in any producer contact information fields on the consumers’ applications.
The draft is set to appear in the Federal Register Jan. 5, 2022.
Comments on the draft will be due Jan. 27, 2022.
What the Proposals Mean
Because HealthCare.gov is such a big, busy, consumer-facing federal government website, any application rules it sets could eventually influence other federal agencies’ rules for communications from consumers’ professional representatives.
Affordable Care Act Exchange Basics
HealthCare.gov is part of the Affordable Care Exchange exchange system.
Congress created the ACA exchange system in 2010, in an effort to encourage young, healthy people to pay for private health coverage, and to reduce the average level of health risk and average premiums for all people with private health coverage.
Some states have their own, locally run exchange programs.
CMS is providing ACA exchange services for people in 33 states in 2022.
The ACA exchange system has been getting about half of its signups from agents, brokers and web brokers.
CMS puts the updates needed to keep HealthCare.gov and the state-based exchanges going in annual parameter update documents.
The administration of former President Donald Trump drafted the parameters guidelines for the 2022 coverage year, and the administration of President Joe Biden adjusted and updated the Trump administration’s guidelines.
The parameters guidelines for 2023 is the first set that the Biden administration is getting to draft from scratch.
The Contact Information Requirements
CMS officials say in the new draft parameters guidelines that they want see a consumer email address on a coverage application that is “secure, not disposable, and belongs to the consumer”; from an email provider that does not remove email from the inbox after a set period of time; and that can’t be accessed by the agent, broker or web-broker.
Officials want to set similar types of standards for the consumer telephone numbers and addresses on applications, and they want to prohibit applicants from using postal mail boxes supplied by the agents, brokers or web brokers.
In a discussion of the proposed ban on use of disposable email addresses, officials acknowledge that some consumers may use those addresses to avoid getting spam.
“But the use of these email addresses on exchange applications defeats the purpose of entering an email address and occurs at a higher rate on applications assisted by agents, brokers, and web-brokers, many of which are unauthorized,” officials say. “Consumers who wish to avoid receiving emails from the exchange and who are being assisted by an agent, broker, or web-broker may simply omit a contact email address from their exchange application.”
Consumers will have to put their own telephone numbers and mailing addresses on their applications, officials say.
Other Parameters Draft Items
CMS officials note in the draft guidelines that an existing regulation states that the open enrollment period for 2023 coverage, or period when consumers can sign up for individual major medical coverage without showing they have what the government classifies as a good reason to be buying coverage, will run from Nov. 1, 2022, through Jan. 15, 2023.
Officials have proposed for the 2023 coverage year that:
• Producers should tell consumers about the reasons being given in any special enrollment period applications, to keep producers from trying to increase off-season sales by lying about why consumers are eligible to apply for coverage.
• Consumers should have to sign off on the income predictions in coverage applications, to keep producers from lying about consumers’ income to maximize their premium subsidies and minimize their out-of-pocket premium payments.
• HealthCare.gov should hold the user fees it charges health coverage providers at 2.75% of the monthly premiums.
In the past, CMS has put the new annual maximum cost-sharing limit, or limit on how much plans can expect consumers to pay each year for in-network, covered care, in the parameters guideline drafts. In the new parameters draft, CMS says it will post the 2023 annual out-of-pocket max in a separate document in January.