Compliance Notice for Agents and Brokers

Health Insurance Marketplace® sent this bulletin at 03/21/2023 11:25 AM EDT

agents and brokers - selling in the healthcare dot gov marketplace

Compliance Reminders for Agents and Brokers

The Centers for Medicare & Medicaid Services (CMS) would like to provide the following reminders about Marketplace requirements to agents and brokers:

Agents and brokers must obtain consent from each client they work with prior to assisting them with Marketplace coverage, including prior to searching for a current application using an approved Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE) website.

Agents and brokers should only make updates to a consumer's application/policy at the direction of the consumer. The Marketplace standards of conduct specify that agents and brokers must obtain the consent of an individual, employer, or employee prior to assisting them. This includes, but is not limited to:
- Conducting a search for consumer applications using an approved DE/EDE website.
- Helping consumers apply for financial assistance or enrolling in a Marketplace qualified health plan (QHP).
- Calling the Marketplace Call Center to ask about the status of a Marketplace enrollment or make application changes.

Agents and brokers must ensure compliance with Marketplace regulations and guidance when establishing business relationships (e.g., for purposes of lead generation).
- Enrollment assistance must be provided by licensed and registered agents and brokers.
- Agents and brokers are required to obtain consent from the consumer. Even if a consumer has already spoken with and given consent to a customer service representative or sales lead-generating employee or vendor, the assisting agent or broker should re-review and confirm the consumer’s consent.
- Agents and brokers and any third party with which they have entered into a business relationship must adhere to requirements for the use and disclosure of all consumer personally identifiable information (PII)/protected health information (PHI), including all PII/PHI collected by the third party.

Agents and brokers cannot release, publish, or disclose consumer PII to unauthorized personnel and must protect this information in accordance with federal laws and regulations regarding the handling of PII.
Agents and brokers who are aware of others conducting a search for consumer applications using approved DE/EDE websites, enrolling consumers or making unauthorized changes to consumer’s application without their consent, or inappropriately accessing CMS systems, should report it to the Agent/Broker Email Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs.gov.

For more information about maintaining compliance with Marketplace requirements, see these resources:

This message is paid for by the U.S. Department of Health and Human Services. It was created and distributed by the Centers for Medicare & Medicaid Services. You're receiving this message because you signed up for email updates from the HealthCare.gov Team. You can update your preferences, receive fewer emails or pause emails until the next Open Enrollment period, or use our 1-click unsubscribe to stop receiving messages from the HealthCare.gov Team. Please contact support@subscriptions.cms.hhs.gov if you have questions or problems with your subscriptions.