Health plans

Alliance of Community Health Plans Releases Public Comments on Centers for Medicare & Medicaid Services Proposed Rule

WASHINGTON, 23 octoberDan Jones, vice-president of federal affairs at the Alliance of Community Health Plans, posted a public comment on the Medicare and Medicaid Service Centers proposed rule entitled “Requirements for Air Ambulance Services, Agent and Broker Disclosures, and Supplier Enforcement”. Comment was written on October 15, 2021, and posted on October 19, 2021:

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The Alliance of Community Health Plans (ACHP) appreciates the opportunity to comment on the proposed rule that will require health plans to account for compensation provided to agents or brokers who enroll people for health insurance coverage. Our Member Health Plans strongly encourage consumers to be educated about the costs of medical services and to receive clear, personalized information that helps evaluate and compare high quality health care options.

ACHP represents the most successful nonprofit health plans in the country, improving affordability and health system outcomes. ACHP member companies are provider-aligned healthcare organizations that provide high-quality coverage and care to more than 24 million Americans in 36 states and DC. the improvement of piloted systems.

The ACHP is committed to ensuring that every consumer has access to affordable, high-quality coverage through Marketplaces. Our member health plans remained in the marketplace through ACA’s first tough years to ensure their communities had access to comprehensive and affordable coverage, even when that meant offering coverage at a loss. We consistently advocate for policies that stabilize the individual market and expand access to affordable coverage options for working families across the country, including an amicus brief in California v. Texas to emphasize the importance of a strong and stable individual market.

We support the transparency of a broker’s personal interest and financial incentives when recommending certain health benefit packages. We offer the following recommendations to improve the proposed rule:

Simplify information in disclosures for better use by consumers

The ACHP recommends that the Administration simplify the disclosure requirements to ensure that they are easily understood by consumers and taken into account during the registration process. We support the introduction of much-needed transparency into the process, but remain concerned that without simplification, disclosures could lead to more confusion and potentially deter listing. Individual health insurance brokers usually don’t get high commissions and sell these plans because they believe it is important to help people cover themselves. As a result, any disclosure of low level commissions to individuals is extraneous at best, and at worst, will be confusing and delay the transaction. Without ease of understanding and simplification, these disclosures will quickly become well-intentioned but overlooked.

We recommend that the Administration prescribe a specific format for issuer commission schedules or other documents that detail the direct or indirect compensation applicable in disclosures to registrants when such disclosure is delegated to the broker or agent. Otherwise, brokers or agents would be allowed to determine not only the relevant information to attach to the registration documents, but also the form (print, electronic, etc.). The terms of indirect remuneration, such as bonuses, vary from country to country and between different insurers. This requirement will not result in a simple, cohesive document that would help make informed purchasing decisions.

Moreover, this lack of specificity and simplicity will only serve to support the bad actors, who will play with the system and display the information in a way that is intentionally difficult to understand. We recognize that small agencies with little or no support staff may find this difficult, and we encourage administration to implement streamlined reporting based on the size and capabilities of an organization.

The ACHP does not recommend that the Administration include national producer numbers as a mandatory field, as they are not systematically used outside of federal market activities. We also ask the Administration to confirm that administrative fees paid to flow-through entities that are not agents or brokers are outside the scope of any disclosure or reporting obligations.

We appreciate this administration’s browser provisions in the Benefit and Payment Notice settings for 2022 to strengthen the navigator / broker role by ensuring consumers get the help they need to sign up for the plans. Marlet. The No Surprises Act broker rules should complement this effort by identifying when brokers compete or at odds with browsers, without forcing consumers to consider whether a commission fee is steering them toward a plan that won’t respond. to their needs. Unless these disclosures are simplified and tailored for the benefit of the consumer, transparency of brokerage fees will not have the desired “informed consumer” effect. More likely, they will be ignored or introduce consumer distrust into the process of buying coverage. It’s the behind-the-scenes reporting from HHS health plans on brokerage commissions that will better protect consumers from potential bad actors.

Target brokers who push non-ACA individual plans

The ACHP recommends distinguishing between the incentives to purchase individual coverage versus short-term and limited-term insurance, as well as the total number of people enrolled in each type of plan. We support the annual reporting requirement in the proposed rule for health plans to file reports on the health insurance monitoring system after payments have been made to agents and brokers. This retrospective reporting requirement will be very helpful in identifying brokers who focus on short term insurance that will not protect consumers against high reimbursable fees.

Inasmuch as april 2020 Urban Institute According to a study, many brokers refuse to sell products they deem too risky for consumers, despite higher financial incentives. These retrospective reports, if specific enough, will help identify when brokers enroll people in plans for reasons other than a short-term bridge to better coverage.

Eliminate broker renewal fees

Under the proposed rule, insurers, through their brokers, would make the same disclosure of commission charges when a participant renews a policy. For individual coverage, this disclosure would occur at the same time as the notice of plan renewal. Where there are no state requirements for documentation, the disclosure should be sent with the invoice for the first premium payment for the initial coverage term and for each renewal period. Once again, this disclosure to the consumer will not help them make an informed choice in terms of health insurance and will be all the less relevant when renewing. Typically, consumers automatically renew their policies without the help or advice of an agent or broker.

Instead, the ACHA recommends that the Administration eliminate renewal fees as they provide no real incentive to brokers and reward them for consumer decisions that they have not influenced. As guardians of the premium, there is no value in brokers or agents being paid for renewals of coverage at the expense of consumers.

Extended compliance period

The ACHP recommends a compliance window of at least 90 days after the rules are finalized. Once these new requirements are finalized, issuers will need sufficient time to develop disclosure documents, update initial registration packages and renewal documents, and work with agents, brokers and marketplaces to broadcast the news. We recommend that, in addition to applying the information obligations to contracts concluded between an agent or broker and an issuer on or after December 27, 2021, issuers should have at least 90 days after the rule is finalized before the disclosure requirements come into effect.

Thank you for considering the recommendations of the ACHA. If you have any questions or need additional information, please contact our Director of Public Policy, Michel bagel To [email protected].


Dan Jones

Vice President of Federal Affairs

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The proposed rule can be viewed at:

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