The document discusses the importance of in-person assistance through agents and brokers in health insurance enrollment, highlighting their role as trusted advisors who help consumers navigate their options. It outlines successful partnerships in regions like Milwaukee and Florida, emphasizing the value of collaboration between agents, navigators, and other assistive organizations to improve outreach and education efforts. Additionally, it addresses the opportunities and challenges faced by brokers in 2015's open enrollment period, noting the need for technological improvements and training to enhance service delivery.

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Partnering with Agents and
Brokers to Boost In-Person
Assistance and Enrollment
October 23, 2014

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Agenda
I. Welcome Molly Warren (moderator), Policy Analyst in
the Best Practices Institute, Enroll America
II. The Role of the
Agent
Marcy Buckner, Senior Director of State
Affairs, National Association of Health
Underwriters
III. A Successful
Partnership in
Milwaukee
Heather Dummer Combs, Enrollment Project
Manager, Milwaukee Enrollment Network
IV. Lessons
Learned in
Florida
Nick Duran, Florida State Director, Enroll
America
V. Q&A Submit your questions at any time
using the chat box.

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1. In-person assistance is
crucial to maximizing
enrollment
2. Agents and brokers are
already trusted voices and
sources of information for
many consumers
3. Agents and brokers are
knowledgeable and skilled
at providing assistance to
consumers
Why Agents and Brokers?

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10-23-14
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II. THE ROLE OF THE AGENT
Marcy M. Bucker, Senior Director of State Affairs, National Association of Health Underwriters

5. Agents and Brokers—The Basics
•Nearly half a million independent agents and brokers help individuals and businesses find the right health plan and navigate their coverage once enrolled.
•A consumer’s health insurance premium is the same when using an agent or broker as through the marketplace.
•Agents and brokers are on the case to solve the consumer’s problems for the whole plan year.

6. Value of the Agent
Consumers working with a health insurance broker gain a professional advisor who:
1.Understands all the coverage details in the plans available in the Marketplace
2.Knows about key differences between one company and another, such as provider networks, formularies, disease management programs, etc.
3.Knows which companies are easy to work with
4.Will be available throughout the year to answer questions and fix problems that may develop
5.Priority to maintain client satisfaction through the life of each insurance policy

7. Partnering with Agents/Brokers
•Consumers do not have to be limited to working with one type of assister!
•Agents and brokers can, and do, work in great partnership with navigators and other community-based assisters.

8. Distinctions of Agents and Brokers Versus Other Assisters
•Agents and brokers are licensed by each state.
•In addition to exchange privacy requirements, health insurance agents and brokers must abide by significant federal and state privacy and data security requirements.
•Health insurance agents are required to carry professional liability insurance to protect consumers, which is known as “errors and omissions” insurance.

9. Strengths of Navigators, Non-Navigator Assisters, and Agents/Brokers
Brokers
Private market expertise
service after enrollment— claims, coverage issues, renewals
Employer issues
Compliance issues
State insurance regulatory expertise
Both
Public Education
Marketing
Referrals
Providing impartial information
Facilitating QHP
enrollment
Navigators/ Assisters
Outreach to underserved populations
Language expertise
Public program expertise

10. Exchange Participation by Brokers in 2014
There is no definitive data source for broker participation and enrollment assistance, but a variety of indicators show that broker interest was high and that client satisfaction was great:
•Almost 75 percent of NAHU leaders surveyed in the summer of 2013 indicated they were obtaining marketplace certification.
•70,000 agents certified in FFM and 30,000+ agents certified in SBMs!
•A recent Urban Institute Study shows that at about half of all exchange enrollees used sources other than the websites to enroll in coverage. Of those who used other assistance for exchange coverage, insurance agents and brokers had the highest rating; 84 percent of adults who used them found them very or somewhat helpful.

11. Broker Exchange Participation in 2015
•Broker recertification for the exchanges in ongoing now, and despite the challenges from last year, HHS indicates that early interest is high.
•A June survey of NAHU leaders indicated that 69 percent plan to sell and service individual exchange policies in 2015.

12. Opportunities with Open Enrollment 2015
•Agents and brokers see many opportunities with the health insurance marketplaces ahead, but also remain concerned about potential challenges.
•Opportunities include:
–Online availability of the FF SHOP
–Increased broker services for the FF SHOP
–Technological improvements to federal and state-based exchange websites and operations
–New market entrants and new health insurance market exchange products for consumers

13. Marcy M. Buckner
Senior Director of State Affairs
National Association of Health Underwriters
mbuckner@nahu.org

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III. A SUCCESSFUL PARTNERSHIP IN MILWAUKEE
Heather Dummer Combs, Enrollment Project Manager, Milwaukee Enrollment Network

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Milwaukee Enrollment
Network
The Milwaukee Enrollment Network (MKEN) is a multi-stakeholder
collaboration organized to improve
consumer outreach and education, strengthen
enrollment support resources, and assist Milwaukee
County residents in securing adequate and affordable
public or private health insurance.

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OE1 Tactics
Support Agent Engagement and Referrals
• Include listing of Agents in Milwaukee Enrollment
Site Directory
• Used by local 2-1-1 and other professionals to refer local
consumers who need enrollment assistance
• Host a mixer for Agents, CACs and Navigators
• Opportunity for Agents, CACs, and Navigators to describe their
respective work, understand how they can work together, and
begin to develop referral relationships.

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Additional Strategies
• Agent listing used for referrals
• Utilized by both Enrollment Assister and Mobilizer organizations
• Hotlines with local TV stations
• Held three last year and are planning for at least two this year
• Agents helped staff the phones, answering questions from
callers
• Enrollment events
• Agents helped assist consumers with enrolling in health
coverage at various local enrollment events held during OE1
• Developing a list of Agents willing to assist with events this year

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Lessons Learned
During OE1
• Find a list of agents you can start from
• Wisconsin Office of Commissioner of Insurance list of Agents
who took training on BadgerCare (state’s Medicaid program)
• Developing relationships is key
• Hosted Mixer
• Included Agents in our regular MKEN communications
• Important to have someone coordinate this work
• MKEN is convened by organizations that provide staff support
to manage its work

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Heather Dummer Combs
Enrollment Project Manager
Milwaukee Enrollment Network

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IV. LESSONS LEARNED IN FLORIDA
Nick Duran, Florida State Director, Enroll America

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Enroll America’s Florida
Campaign
Enroll America staff
conduct grassroots
organizing and
consumer outreach
and education across
Florida.

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Added Value of Partnering
with Agents and Brokers
Additional capacity to provide
in-person assistance
Access to particular
constituencies
Additional resources or
funding for resources

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Enroll America’s Agent and
Broker Partners in Florida
• All sold plans from multiple insurers
• All completed HHS training and
certification to sell marketplace plans
• All agreed to Enroll America’s assister
pledge that outlines expectations for
partners who provide in-person
assistance
• All willing to work hand in hand with
other assister partners

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Partnership with First
Coast MultiLine Agency
Huge added value and great partnership:
• Added crucial in-person assistance capacity in a
region with only a handful of other assisters.
• Particularly key to reaching the African-
American faith-based network in the area.
• Stepped up financially to make donated space
at the Regency Square Mall a reality.

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Lessons Learned
During OE1
Do your homework and establish ground
rules
Agents and brokers partners were willing to
work side by side with Navigators and CACs
Agent and broker partners were well trained
in customer service
Agents and broker partners were hard
workers....came in early and stayed late!

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Nick Duran
Florida State Director
Enroll America
nduran@enrollamerica.org

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10-23-14
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V. QUESTIONS?

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Questions
What recommendations do you have for building
relationships with agents/brokers?

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And vice-versa, any tips for agents/brokers
looking to partner with other assister and
outreach groups?
Questions

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What kinds of activities fostered the most
productive partnerships between agents/brokers
and other enrollment stakeholders?
Questions

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#Ready4OE2 Webinar and
Blog Series During October!
Subscribe to Enroll America’s newsletter for updates:
http://www.enrollamerica.org/

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ADDENDUM: AGENT AND BROKER RESOURCES

33. Agents and Brokers—The Basics
•Nearly half a million independent agents and brokers help American individual and business health care consumers find the right health plan and navigate the health care system throughout the life of their policy.
•Independent agents do not work for health insurance carriers, but instead run their own businesses.
•Agents are hired by individual consumers and employers to represent them before all of the insurance carriers with which the agent is affiliated. Only the individual consumer or employer can decide whether or not to keep their agent.
•The law requires that a consumer’s health insurance premium is the same, whether a person goes direct to a health insurance company or works with a professional agent.
•State laws prohibit agents from charging separate fees for services provided to individual health insurance consumers, as well as to most traditional employer group plans.
•Agents are paid by small commissions included as a pass-through fee in every single health insurance policy premium payment. This payment structure has existed for over 100 years and is a consumer convenience, but it is also required by a myriad of state-level licensing, consumer-protection and tax laws.
•An agent works on enrollment, but they are also on the case to solve the consumer’s problems for the whole plan year.

34. Value of the Agent
•Consumers working with a health insurance broker gain a professional advisor who:
–Understands all the coverage details in the plans available in the Marketplace
–Knows about key differences between one company and another, such as provider networks, formularies, disease management programs, etc.
–Knows which companies are easy to work with.
–Will be available throughout the year to answer questions and fix problems that may develop.
•It is the professional agent’s job to maintain client satisfaction throughout the life of each insurance policy. Research dating back decades continually shows that policies where there is an agent of record have better client satisfaction and retention rates, as well as fewer issues with health insurance claims.
•Consumers do not have to be limited to working with one type of assister! Agents and brokers can, and do, work in great partnership with navigators and other community-based assister.

35. Professional Distinctions of Agents and Brokers
•Agents and Brokers are licensed by each state.
–There is a long-established system of non-resident licensing for those that operate in multiple states and a national database to track the licenses they hold and their conduct.
–State departments of insurance regulate marketing practices of insurers and insurance producers through regular market-conduct examinations and other means.
–In addition to any exchange training or certification, agents and brokers are subject to extensive and separate state-level continuing education requirements.
•In addition to any exchange privacy requirements, Health insurance agents and brokers must abide by significant federal and state privacy and data security requirements. These include:
–Federal Gramm Leach Bliley Act (GLBA) financial privacy requirements
–Federal Health Insurance Portability and Accountability Act(HIPAA) health privacy requirements
–Federal Health Insurance Technology for Economic and Clinical Health (HITECH) data security requirements
–Federal Do Not Call requirements
–State-specific privacy laws and regulations
•Health insurance agents are required by the insurers and state laws to carry professional liability insurance to protect consumers, which is known as “errors and omissions” insurance.
•Health insurance agents and brokers have a personal legal and financial liability to follow all of these laws and requirements.

36. Exchange Participation by Brokers in 2014
•There is no definitive data source for broker participation and enrollment assistance in the exchanges in 2014, but a variety of indicators show that broker interest was high and that client satisfaction was great.
–Almost 75 percent of NAHU leaders surveyed in the summer of 2013 indicated they were obtaining marketplace certification.
–Former HHS Secretary Kathleen Sebeliustestified that approximately 70K agents were certified by the FFM.
–State exchange data shows the certification of at least 30k more agents and brokers.
•A recent Urban Institute Study shows that at about half of all exchange enrollees used sources other than the websites to enroll in coverage.
–One-third (29.1 percent) used other sources in addition to a website, and one-fifth (20.6 percent) used other sources instead of a website.
–Certain groups preferred direct assistance more than others. Hispanic and low-income adults, for example, were less likely to rely on a website and more likely to rely on direct assistance.
–Of those who used other assistance for exchange coverage, insurance agents and brokers had the highest rating; 83.9 percent of adults who used them found them very or somewhat helpful.

37. Broker Exchange Participation in 2015
•Broker participation in 2015 is unknown at this time.
•Broker recertification for the exchanges in ongoing now, and despite the challenges from last year, HHS indicates that early interest is high.
•A June survey of NAHU leaders indicated that 69 percent plan to sell and service individual exchange policies in 2015, which is only a slight decrease from June 2013

38. Opportunities and Challenges with Open Enrollment 2015
•Agents and brokers see many opportunities with the health insurance marketplaces ahead, but also remain concerned about potential challenges.
•Opportunities include:
–Technological improvements to federal and state-based exchange websites and operations
–New market entrants and new health insurance market exchange products for consumers
–Online availability of the FF SHOP
–Increased broker services for the FF SHOP
•Concerns include:
–Reenrollment and redeterminations for existing consumers
–Accuracy of health premium tax-credit determinations
–Challenges and much greater than anticipated time spent physically enrolling individual through all approved means last year.
–Ongoing authorization issues to act on a client’s behalf with the marketplace.
–Ongoing payment difficulties, and related liability concerns because lack of payment/client relationship means that they are not covered by their errors and omissions insurance policies but are still legally liable for advice given
–Lack of improvements to many broker needs planned for 2015 for the Individual FFM