Benefits Buzz

Reminder: Client Consent Required to Assist with Marketplace Enrollments

Posted on November 23rd, 2022

The Centers for Medicare and Medicaid Services (CMS), the federal agency that largely oversees the Health Insurance Marketplace (Marketplace), has indicated that agents and brokers who assist with Marketplace enrollments must obtain client consent before assisting with enrollments and other Marketplace functions.

CMS does not have (and appears will not have) a standard form or format that is required to be used to capture the consent. This is to provide flexibility to agents and brokers as to how they will obtain the consent. There is no specification that any document or form needs to be signed by the consumer either.

While a form could be created by an agent or broker and used to obtain client consent, other means could also be utilized. For example, consent could be provided over the phone, in person, or electronically (such as through an email exchange). The agent or broker will at a minimum want to maintain documentation that consent was provided (e.g., notes in a client’s file). Of course, a signed form or other proof that a client gave their consent would be a stronger way of proving that consent was provided in case that is ever contested.

The record of the consent should include the following:

Name of the individual(s) or the employer in the event of SHOP coverage.
Date consent was provided.
Name of the agent/broker or agency for whom consent was provided.
Acknowledgement that the consumer or employer has been informed of the functions and responsibilities that apply to the agent’s or broker’s role in the Marketplace.

As a best practice, CMS recommends the consent also include the following:

Agents or brokers can conduct a search for the application using approved Marketplace websites.
Agents or broker can assist with completing an eligibility application.
Agents or brokers can assist with plan selection and enrollments.
Agents or brokers can assist with ongoing account/enrollment maintenance.

The consent may last indefinitely unless a client chooses to revoke their consent. Any consent documents that are obtained must also be maintained for 10 years.

For more information, please refer to this CMS presentation (slides #23-27) or this Overview of Marketplace Requirements for Agents and Brokers.


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