♪
{Dave} Welcome and thanks for tuning in to Agent and Broker Learning On Demand, a Marketplace original series!
In this video, we’ll talk more about compensation for agents and brokers for Marketplace enrollments.
This is a topic we at CMS hear about frequently from agents and brokers.
As a reminder, throughout this video, the term “Health Insurance Marketplace,” or “Marketplace,” refers to
Federally-facilitated Marketplaces, or FFMs, including FFMs where states perform plan management functions,
and State-based Marketplaces on the Federal Platform, or SBM-FPs.
So, let’s get started.
Compensation includes any commissions, fees, or other incentives in the relevant contracts you may have with
qualified health plan issuers.
In the Marketplace, similar to enrollments in coverage offered outside the Marketplace, compensation comes
directly from issuers with whom you are affiliated.
Neither the Marketplace, nor CMS, sets or pays compensation to agents or brokers.
In general, you must meet a few requirements to receive commission for a Marketplace enrollment:
First, you need to have an appointment or compensation agreement with the QHP issuer in
accordance with state law.
Second, you must have completed Marketplace training and registration for the
applicable plan year prior to assisting with the enrollment.
And finally, you need to maintain an active health-related line of authority in the state
where the QHP is offered.
To receive credit for consumer enrollments in the Marketplace, your information, particularly
your name and National Producer Number, or NPN, should be recorded on the consumer’s application.
You should note that having a consumer add you as an Agent of Record is not the same as having your
NPN listed on the Marketplace application.
However, should a QHP issuer identify a particular enrollment with which you should have been
associated, the QHP issuer may add you to the enrollment even if you were not initially included
on the enrollment transaction sent by the Marketplace.
Issuers are required to confirm that you have completed Marketplace registration and
training for the applicable plan year prior to assisting consumers before issuing compensation for
enrollments by using the Agent and Broker FFM Registration Completion List.
If you think your NPN should have been included on a consumer’s Marketplace enrollment transaction,
but was not, you should contact the respective issuer directly.
If you work with a general agency and they are responsible for paying you, then check with
them along with the issuer.
CMS encourages agents and brokers to keep written evidence that they supported a
consumer enrollment, in case issues arise.
Such evidence may include a consent form from the consumer, a broker of record form, or similar
documentation that demonstrates the agent or broker assisted the consumer at the time of enrollment.
An issuer may issue compensation if there is documented evidence that the agent or broker
DID assist the consumer, BUT the NPN was left off the enrollment, IF all other requirements have
been met.
While the vast majority of compensation questions and issues should be directed to issuers themselves,
there are a few exceptions when agents and brokers should contact CMS.
One of these is equivalent compensation.
The Affordable Care Act requires that issuers must pay the same compensation for QHPs offered
through the Marketplace as they do for similar health plans offered outside the Marketplace.
If you have evidence that this may not be the case, you can contact the Agent/Broker Email Help Desk
with your concerns and ample supporting documentation.
Agents and brokers should also contact CMS if they have evidence that issuers are using discriminatory
practices that have the effect of discouraging enrollment of consumers with
significant health needs.
In terms of compensation arrangements, discriminatory practices could include
paying lower commissions for higher metal level plans, like platinum and gold plans, that are
associated with higher utilization compared to lower metal level plans, like silver and bronze plans.
If you have evidence that an issuer’s Marketplace compensation arrangement or marketing practices
may be discriminatory, you can contact CMS at marketconduct@cms.hhs.gov
or the applicable State Department of Insurance.
Again, be sure to include any documentation or records that describe the compensation structure
or practice in question.
CMS does not have the legal authority to pay commissions to agents and brokers or
mandate compensation.
The Marketplace does not play a role in appointments or compensation agreements between issuers and
agents and brokers and is not a party to the contracts between issuers and agents and brokers.
If you’re looking for more information on compensation in the Marketplace,
CMS has several resources available.
Check out the agent and broker general resources page.
CMS has a Marketplace compensation tip sheet entitled
“Agent and Broker Compensation for Marketplace Enrollments” available to help agents and brokers.
Enter “compensation” in the search field on the general resources page or refer to the
companion guide for this video series.
In addition, you can refer to “FAQs for Agents & Brokers” through CMS’s website.
For any additional questions or concerns on this topic, contact the Agent/Broker Email Help Desk.
Thanks for watching!
♪