Who Can Be Exchange Navigators and How to Apply

The Center for Medicare & Medicaid Services (CMS), and the Center of Consumer Information & Insurance Oversight (CCIIO), are working together as extensions of the Department of Health and Human Services (HHS), and helping to oversee certain portions of the ACA rules and requirements.

To give you a little background before diving into the details, the CMS and CCIIO (pronounced “Sih-Sighyo”) will both be communicating a plethora of pertinent information in how agents/brokers will be able to participate, apply, and register on the exchange, and whether to serve as a navigator or to service potential or current clients. You will be seeing these acronyms a great deal, and we wanted you to become familiar with them, to keep you informed.

Exchange Rules for Navigators
The officials at CMS will be establishing a “certified application counselor program” to complement its navigator program. CMS said that they want to let producers serve as navigators as they recognize that they have traditionally helped consumers in choosing the best health insurance for themselves, their families, and/or their businesses. More details in the proposed regulations include:

• HHS wants to let agents/brokers serve as navigators, as long as the producers are not getting any consideration, including trailing commissions, from health insurers.
• Health insurers and their subsidiaries cannot become navigators.
• Issuers of stop-loss insurance, insurance for self-insured health plans, and the stop-loss issuers’ subsidiaries could not be navigators.
• The same compensation rules that apply to producers who sell health insurance would pertain to producers who sell stop-loss insurance.
• Agents and brokers who sell products other than insurance or stop-loss insurance could be navigators and also continue to collect compensation from the providers of those other lines of insurance products.

Exchange Navigator Grant Applications
The CCIIO has posted a grant application (see website link below) aimed at individuals and organizations that want to be “navigators,” or ombudsmen, for “federally facilitated exchanges”(FFEs). The Affordable Care Act (ACA) has about $54 million in navigator grant funding available, and those applications are due June 7, 2013.  Each grant would cover a 12-month period that would start August 15, 2013.

Grant Application website: http://www.grants.gov/search/search.do;jsessionid=GkSSRlwP2DX631pz15nhr67VQNlypBgStLyhjJFDh32snvhhT1pP!657861682?oppId=229854&mode=VIEW

We will continue to keep you up to date as more developments arise. As always, please contact our Government Relations team with any questions. By phone: 888-277-6464 or by email: bbochniak@michbusiness.org we value your feedback.