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Health Care Reform

PIA supports a healthcare system that preserves the role of independent agents and brokers, builds on the private market and utilizes the successful state-based regulatory system.

Official ACA Training & Registration


The ACA requires agents and brokers who wish to utilize a Federally-Facilitated Marketplace (FFM) to complete online training and registration.

Official ACA Training – Part I — Agents and brokers are required to complete training from the federal government before they are eligible to sell health insurance policies in a FFM. Training can begin immediately by clicking the above link. You must start by creating an account, which will provide you with a Login ID and Password to access the training.

Official ACA Identity Proofing – Part II — After you have completed Part I (above), please allow 48 business hours for your training/testing results to be transmitted to the CMS Enterprise Portal, where Part II occurs. Agents and brokers must register on this website and complete the identity proofing process.

HHS/CMS Announcements


June 26, 2014, Proposed Rule From HHS — The U.S. Department of Health and Human Services (HHS) posted a proposed rule and several pieces of guidance related to plans for auto-enrollment for current Marketplace consumers. The proposed rule includes plans for helping existing Marketplace consumers get auto-enrolled for next year. These plans would give existing consumers a simple way to remains in the same plan next year unless they want to shop for another plan and choose to make changes. For more information please see the proposed rulepress release,guidance on annual redetermination for coverage for 2015 and the draft issuer renewal and discontinuance notice.

April 24, 2014, CMS BulletinThe bulletin provides Pre-existing Condition Insurance Program (PCIP) enrollees with a 60-day special enrollment period, which allows them to enroll in coverage through the FFM. Please see the PCIP Bulletin and PCIP  Fact Sheet.

March 18, 2014, Special Enrollment Periods in the MarketplaceThe deadline for open enrollment was March 31, 2014. Consumers who were in line by the deadline to complete enrollment will be covered due to issues with the website. Additionally, CMS is clarifying that under limited circumstance, people with complex cases may qualify for a special enrollment period. These include victims of domestic abuse and consumers who were found ineligible for Medicaid but whose accounts were not transferred to the Marketplace in a timely manner before March 31. These special cases are for specific situations where a consumer was not able to successfully complete enrollment during the open enrollment period, despite their efforts to do so and through no fault of their own. Below is a host of guidance notices and resources CMS released on March 18.

  • Rollout Materials
    • Guidance for Issuers on People “In Line”
    • Guidance for Issuers on Complex Cases
    • Third Party Payment (CMS-9943-IFC) — This Interim Final Rule, with comment, that requires issuers to immediately begin accepting third party payments for enrollee premiums and cost sharing from Indian tribes, tribal organizations, urban Indian organizations, the Ryan White HIV/AIDS programs, and state and federal government programs for enrollees in the individual Marketplaces. This rule builds on previous guidance CMS issued that encouraged issuers and Marketplaces to accept these types of payments. The rule is effective today.  The publication date will be 3/19/2014.  This ensures that consumers who rely on the specific third party payors identified in the rule to pay their premiums or cost-sharing payments can continue to access the care they need without delay.
    • CMS Bulletin to Marketplaces onAvailability of Retroactive Advance Payments of the Premium Tax Credit and Cost Sharing Reductions in 2014 Due to Exceptional Circumstances, and Related SHOP Issues - Frequently-Asked Questions (FAQs) (“Exchangification”):
    • FAQs on the Use of 1311 Funds and No Cost Extensions
    • Market standards NPRMThis proposed rule would update policy based on experience with initial open enrollment. Updates may include clarifying federally-managed services available for states in the second year of operations, expanding the use of data for efficient operations of the Exchange instead of minimum Exchange functions, developing privacy standards in the Exchange for the FFE and non-Exchange entities, implementing penalties related to false, fraudulent, or improper use of information, clarifying eligibility and appeals coordination responsibilities with state Medicaid agencies, and addressing treatment of retroactive eligibility from an appeal.  This proposed rule would also establish requirements for Exchanges and QHPs to implement specific quality-related provisions of the Affordable Care Act.
    • Product discontinuation bulletinand Fact sheet


March 14, 2014, 2015 Annual Letter to Issuers
The Centers for Medicare and Medicaid Services (CMS) released a final letter to issuers in the FFMs. The letter provides issuers seeking to offer Qualified Health Plans (QHPs), including Stand-alone Dental Plans (SADPs), in an FFM and/or Federally-facilitated Small Business Health Options Program (FF-SHOP), with operational and technical guidance to help them successfully participate in the Marketplaces.

Training Resources


September 4, 2014 The HHS in conjunction with PIA, conducted an Affordable Care Act (ACA) webinar on August 12, for PIA members that wish to participate in an FFM for the 2015 plan year. The webinar covered an array of topics, including information on the FFM registration process and training requirements required prior to assisting consumers in the FFM for the Individual Market and the Small Business Health Options Program (SHOP). The webinar was useful for those that are both new to the FFM as well as those who are renewing their registration for the 2015 plan year. The slides for this webinar are no available and can be found here.

Members can also find information on the CMS agents and broker's website containing a comprehensive list of resources for agents in the health insurance marketplace, including a document specifically covering what agents need to know for registering in the FFM for the 2015 plan year.

HHS/CMS Resources


October 31, 2014 — The CMS News for Agents and Brokers October edition.

September 2014, QHP Manual — In September, CMS released a manual for QHP issuers regarding their relationships with and oversight obligations for their affiliated agents and brokers, who will be assisting with enrollment in the QHPs offered through the FFMs.

September 26, 2014 — The CMS News for Agents and Brokers September edition.

July 7, 2014, Resource on FFM Registration for 2015 Plan Year — On July 7, CMS kicked off the FFM registration process for the 2015 plan year and provided for how to register, training, etc.

In addition to the main website containing all resourced for agents and brokers in the health insurance marketplace, CMS has issued information directly for the 2015 FFM plan year. Agents and brokers must complete certain registration requirements on an annual basis. Below you will find the following new and updated resources:

June 10, 2014 — CMS posted a fact sheet including letters from states recommending transition relief for employee choice in 2015. The fact sheet with the letters can be found here.

May 14, 2014, IRS FAQ Resource on ACA — The Internal Revenue Services (IRS) and the Department of Treasury released frequently asked questions to assist agents, brokers and employers on provisions of the ACA. The IRS has provided additional guidance on employer shared responsibility, seasonal worker coverage, minimum value and small business healthcare tax credits. The new FAQs can be accessed, along with existing FAQS, from the IRS Q&A index page by clicking here. The new questions are available in the employer shared responsibility, small business tax credit, and employer healthcare plans sections.

April 23, 2014 CMS Resource for SHOP — CMS posted two new SHOP tools to www.healthcare.gov:

  1. SHOP Tax Credit Estimator: This tool can tell you what the tax credit could be worth to your business.
  2. Full-time Equivalent Employee Calculator: This tool can help you find out if your business meets the definition of a small business for the SHOP, based on the number of employees. If your state runs its own SHOP, visit your state Marketplace for information on how to calculate FTEs.


More information about these tools can be found on the healthcare.gov blog.

February 25, 2014 — CMS posted three new resourced on CMS's agent/broker webpage. These documents help agents/brokers advise and enroll eligible consumer in FFMs. The documents are:

  1. Processing Applications: Multi-tax Households
  2. Plan Compare Overview: Comparing and Selecting Plans
  3. Tax Impacts of Health Insurance Coverage for Individuals & Families in 2014


Other helpful materials for agents/brokers in the FFMs are available on the CMS website.

Agent/Broker Registration Process FAQ — This document was created by the HHS and covers frequently asked questions as they related to agent/broker registration for a FFM.

HHS Resources — The HHS has created a website specific for agents and brokers. Official marketplace training and registration information can be found on this page.

Archive


Click here to view an archive of resources from 2013.