Broker & Agent Onboarding - Session 1

July 24, 2013

An Overview of the Exchange

Overview • Affordable Care Act (ACA) was passed in

2010 • Individual Mandate: requires everyone to

have health insurance by 2014. • Establishment of Exchanges: Nevada

Health Link • Participation Requirements: Citizen/Lawful

Presence; Not Incarcerated, Resident/Intend to Reside

• Initial Open Enrollment: October 1, 2013 – March 31, 2014

• Future Open Enrollment: October 15 – December 7

Goals of The Exchange • Increase the number of insured persons in

Nevada. • Facilitate the purchase and sale of health

insurance • Assist qualified employers in the

enrollment and purchase of health coverage and the application for subsidies for enrollees

• Provide consumer education on matters relating to enrollment in and effective use of health insurance

• Assist residents of Nevada with access to programs, premium assistance tax credits and cost-sharing reductions

Guidelines, Roles and Responsibilities • Insurance brokers and agents will play a

critical role for Nevada Health Link and the online marketplace.

• Brokers and agents will be able to enroll individuals, families, and employers in Qualified Health Plans (QHPs) offered on Nevada Health Link and will be compensated by the carrier for doing so.

• Brokers and agents will be the leaders of the insured population.

Guidelines, Roles, and Responsibilities, cont. • Broker and/or agent responsible to make

sure that they are appointed with all of the carriers offering QHPs on Nevada Health Link.

• Payment of commissions will be governed by the agreement between the broker/agent and the carrier. • Nevada Health Link will transmit your National

Producer Number to the carrier with each enrollment file.

• The carrier will pay commissions, not Nevada Health Link.

Guidelines, Roles, and Responsibilities, cont. • Licensed brokers and agents will be required to

attend a brief training course on the use of Nevada Health Link’s web portal.

• The training session will last approximately four hours and cover: • Use of the web portal enrollment system • Medicaid and Nevada Check Up (CHIP)

eligibility and enrollment • Enrollment of individuals in QHPs and Advance

Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR)

• Nevada Health Link privacy and security agreement

• Nevada Health Link operating agreement

Expectations of Brokers and Agents • Brokers and agents will manage

Exchange clients on the Exchange website Broker/Agent portal to include: • Run proposals • Sales • Enrollment • Premium payment tracking • Service issues

Single Streamlined Application • Intuitive streamlined application for health

insurance enrollment and renewal. • Developed with Medicaid a number of pre-

application steering questions and a streamlined application for benefits.

• Single application for benefits that collects information to determine eligibility for all medical programs, tax credits, and cost sharing benefits available.

Single Streamlined Application, cont.

Shop and Compare

• Farmer’s market for health insurance • Web portal • Select and enroll in health insurance • Aggregate premiums • Determine eligibility for public assistance

programs, individual tax credits, and cost-sharing reductions

Shop and Compare, cont.

Shop and Compare, cont.

Working with Navigators and Enrollment Assisters • The Affordable Care Act (ACA) requires

Exchanges to establish a Navigator program

• Navigators and Enrollment Assisters will facilitate enrollment in qualified health plans offered by the Exchange. • They will be funded by grants provided by the

Exchange.

Training of Navigators

• AB 425: Division of Insurance (DOI) established the Certification for Exchange Enrollment Facilitators (EEFs)

• Certification Requirements • 20 hour precertification course • Certification exam • Background check • Application with DOI • Certification with DOI • Training with Exchange • Appointment by Exchange as EEF

Broker of Record & List Billing • Broker of Record

• Can be updated throughout the plan year • Process still under development

• List Billing • Allow employer to pay towards individual plan • Similar to Tribal payment options • Post October 1, 2013 implementation

Submitted Q & A

Nevada Health Link Silver State Health Insurance Exchange 2310 South Carson Street, Suite 2 Carson City, NV 89701 brokersandagents@exchange.nv.gov http://exchange.nv.gov/Resources/Brokers_Agents/

NevadaHealthLink.com