MHBE-Overview-of-the-Producer-Authorization-Process - Maryland ...
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MHBE-Overview-of-the-Producer-Authorization-Process - Maryland ...
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<strong>Producer</strong> Information Session<br />
<strong>Maryland</strong> Health Connection Update:<br />
Steps to Become an Authorized <strong>Producer</strong><br />
A service <strong>of</strong> <strong>Maryland</strong> Health Benefit Exchange
Today’s Agenda<br />
<strong>Producer</strong> Information Sessions – <strong>Overview</strong><br />
Background on <strong>Maryland</strong> Health Benefit Exchange<br />
<strong>Maryland</strong> Health Connection<br />
– Individuals & Families<br />
– Small Business Health Options Program (SHOP)<br />
SHOP Policies<br />
Consumer Assistance<br />
Authorized Carriers<br />
TPA Certification Program<br />
<strong>Producer</strong> <strong>Authorization</strong> – “3 Step <strong>Process</strong>”<br />
Ways to Get More Information
<strong>Producer</strong> Information Sessions<br />
The <strong>Maryland</strong> Health Benefit Exchange (<strong>MHBE</strong>) is hosting a series <strong>of</strong><br />
<strong>Producer</strong> Information Sessions to help producers prepare for steps<br />
that are required to become authorized to sell plans on <strong>Maryland</strong> Health<br />
Connection.<br />
Topic #1: <strong>Overview</strong> <strong>of</strong> <strong>the</strong> <strong>MHBE</strong> <strong>Producer</strong> <strong>Authorization</strong> <strong>Process</strong><br />
– June 28 th<br />
– July 3 rd<br />
Topic #2: The <strong>Producer</strong> <strong>Authorization</strong> Application<br />
– July 24 th<br />
– July 26 th
Background<br />
4
<strong>Overview</strong> <strong>of</strong> <strong>Maryland</strong> Health Connection<br />
The Patient Protection and Affordable Care Act requires each state<br />
to establish a “health insurance exchange” by 2014<br />
A marketplace where individuals and small businesses explore,<br />
compare and enroll in health insurance and public assistance<br />
programs as well as access federal tax credits and cost-sharing<br />
subsidies<br />
States had a choice to establish a state-based exchange, join a<br />
partnership or <strong>the</strong> federally-facilitated exchange; <strong>Maryland</strong> opted to<br />
establish a state-based health insurance exchange<br />
<strong>Maryland</strong>’s exchange is called <strong>Maryland</strong> Health Connection<br />
5
Why It’s Important to <strong>Maryland</strong><br />
Expands access to health insurance for 730,000<br />
<strong>Maryland</strong>ers (13% <strong>of</strong> <strong>Maryland</strong>) currently without health<br />
insurance<br />
– Gives individuals access to primary care physicians,<br />
preventive services<br />
Provides federal subsidies for individuals up to 400% <strong>of</strong> FPL<br />
to pay for health insurance premiums<br />
– Infuses $600 million in federal subsidies into <strong>the</strong> State <strong>of</strong><br />
<strong>Maryland</strong> by 2015 NEW funds in health care system<br />
Lowers uncompensated care costs in <strong>the</strong> healthcare system<br />
6
Stakeholder Engagement<br />
Policy decisions have been made through an open, public and<br />
transparent process with stakeholders representing <strong>Maryland</strong>’s<br />
diversity from across <strong>the</strong> state<br />
Advisory Committees have been leveraged to address key<br />
topics:<br />
– Navigator and Consumer Assistance / Advertising<br />
– Market Rules and Risk Selection / Operating Model<br />
– SHOP Exchange<br />
– Financing <strong>the</strong> Exchange<br />
Stakeholder representation included: producers, health<br />
insurance industry, providers and associations, community<br />
members, advocates, community-based organizations,<br />
academia, business owners and leaders, local chamber <strong>of</strong>ficials,<br />
consumers, consultants
Enabling Legislation<br />
<strong>Maryland</strong> Health Benefit<br />
Exchange Act <strong>of</strong> 2011<br />
• GOVERNANCE MODEL & STUDY<br />
PROCESS<br />
• Established <strong>the</strong> <strong>Maryland</strong> Health<br />
Benefit Exchange as a public<br />
corporation and independent<br />
unit <strong>of</strong> state government<br />
• Established Nine-member Board<br />
<strong>of</strong> Trustees<br />
• Created Executive Director<br />
position<br />
• Required <strong>the</strong> public study<br />
process<br />
<strong>Maryland</strong> Health Benefit<br />
Exchange Act <strong>of</strong> 2012<br />
• POLICY & INFRASTUCTURE<br />
• Operating Model<br />
• Design <strong>of</strong> Small Business Health<br />
Options Program (SHOP)<br />
• Outreach and Consumer<br />
Assistance Program<br />
• Insurance carrier rules<br />
• Financing study process<br />
<strong>Maryland</strong> Health Progress Act<br />
<strong>of</strong> 2013<br />
• IMPLEMENTATION<br />
• Medicaid expansion<br />
• Dedicated funding stream for<br />
financing<br />
• Gradual transition <strong>of</strong> MHIP<br />
enrollees into <strong>Maryland</strong> Health<br />
Connection coverage<br />
• Flexibility for State reinsurance<br />
wrap-around program<br />
• SHOP rules for employer<br />
premium contributions<br />
• Continuity <strong>of</strong> care for<br />
<strong>Maryland</strong>ers<br />
• Continued public engagement<br />
8
<strong>Maryland</strong> Health Connection –<br />
a service <strong>of</strong> <strong>the</strong> <strong>Maryland</strong> Health Benefit Exchange
What is <strong>Maryland</strong> Health Connection<br />
One single entry point for a variety <strong>of</strong> insurance<br />
options<br />
– Medicaid<br />
– Commercial insurance<br />
“No wrong door” approach to insurance coverage as<br />
defined by CMS<br />
Insurance options for individuals, families and<br />
small businesses<br />
10
<strong>Maryland</strong> Health Connection<br />
Marketplace for Individuals & Families<br />
Individuals and families have access to Medicaid and<br />
commercial plans<br />
Offers tax subsidies and cost sharing reductions to<br />
individuals and families to make commercial plans affordable<br />
– Only place individuals can access subsidies<br />
– Federal government will pay a portion <strong>of</strong> costs for health<br />
insurance for people who earn up to 400% <strong>of</strong> FPL<br />
– Cost sharing reductions are available to individuals under<br />
250% <strong>of</strong> FPL<br />
Individual Open Enrollment: October 1, 2013 - March 31, 2014<br />
– Coverage Effective: January 1, 2014<br />
– Annual open enrollment occurs starting in October <strong>of</strong> each year<br />
11<br />
11
Individual Marketplace: Enrollment Flow<br />
Application<br />
Eligibility<br />
Determination<br />
Tax Credit<br />
Eligibility<br />
Plan<br />
Shopping<br />
Initial<br />
Payment<br />
Collection<br />
Confirmed<br />
Coverage<br />
Notify<br />
Carriers<br />
Consumer completes<br />
online application for<br />
insurance coverage.<br />
Streamlined<br />
application to allow<br />
for a “no wrong door”<br />
approach.<br />
If not eligible for<br />
Medicaid,<br />
Consumer is<br />
evaluated and<br />
notified <strong>of</strong><br />
eligibility for tax<br />
credits.<br />
Consumer is able to<br />
select from available<br />
plans based on<br />
personal<br />
preferences.<br />
Consumer is able<br />
to make <strong>the</strong> initial<br />
premium payment<br />
directly through<br />
<strong>Maryland</strong> Health<br />
Connection.<br />
<strong>Maryland</strong> Health<br />
Connection will<br />
display a message<br />
to <strong>the</strong> consumer<br />
for coverage start<br />
date.<br />
<strong>Maryland</strong> Health<br />
Connection will<br />
send a file to<br />
carrier (s) to<br />
notify <strong>the</strong>m <strong>of</strong><br />
enrollment<br />
information and<br />
<strong>of</strong> premiums<br />
collected<br />
Individual Exchange Administration<br />
• Initial Premium billing<br />
• Carrier payment<br />
• On-going eligibility / enrollment management<br />
• Enrollment and funds flow reconciliation<br />
12
<strong>Maryland</strong> Health Connection<br />
Marketplace for Small Businesses<br />
<strong>Maryland</strong> Health Connection will have a Small Business Health<br />
Options Program (SHOP) for small businesses and <strong>the</strong>ir<br />
employees<br />
The Small Business Health Options Program (SHOP) is a<br />
competitive private health insurance marketplace where small<br />
businesses and <strong>the</strong>ir employees will have access to affordable<br />
coverage and a choice <strong>of</strong> insurance plans<br />
Small businesses with up to 50 employees may participate<br />
– In 2016, <strong>the</strong> ACA modifies <strong>the</strong> definition <strong>of</strong> small group to 100<br />
employees<br />
SHOP supplements <strong>the</strong> existing market…SHOP does not<br />
replace it!!<br />
– Small employers will still be able to purchase insurance outside <strong>of</strong> <strong>the</strong><br />
SHOP<br />
13<br />
13
<strong>Maryland</strong> Health Connection<br />
Marketplace for Small Businesses<br />
Employer Benefits<br />
– Simple, streamlined administration<br />
• Online Adds & Drops<br />
• Online Billing & Payment<br />
• Phone & Online Support<br />
– Online tools available to help employers predict costs<br />
– The ability to continue to work with brokers and TPAs<br />
– Many small employers will qualify for tax credits<br />
Employee Benefits<br />
– A wider range <strong>of</strong> plans to choose from<br />
– Comparison tools to help select plans<br />
– Online plan enrollment and account management<br />
SHOP Open Enrollment: January 1, 2014<br />
– Coverage Effective: March 1, 2014<br />
– Annual open enrollment is based on <strong>the</strong> renewal date <strong>of</strong> <strong>the</strong> small business<br />
14<br />
14
Tax Credit Eligibility<br />
2010-2013: Maximum tax credit for small employers is 35% <strong>of</strong><br />
<strong>the</strong> qualified premium for health insurance for employees<br />
– Maximum tax credit for small tax-exempt employers<br />
(charities) is 25%<br />
January 1, 2014, rate increases to:<br />
– 50% tax credit for small employers<br />
– 35% for small tax-exempt employers (charities)<br />
Can be carried back and forward to o<strong>the</strong>r tax years<br />
15
Tax Credit Eligibility Examples<br />
Fewer than 25 full-time equivalents, with average wages <strong>of</strong> less<br />
than $50,000 per year<br />
Provide 50% <strong>of</strong> single (not family) coverage for each employee<br />
Calculations are made on a sliding scale<br />
Tool available on IRS website<br />
– http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-<br />
Small-Employers<br />
16
SHOP Marketplace: Enrollment Flow<br />
Eligibility<br />
Determination<br />
Employer<br />
Plan Set-up<br />
Estimated<br />
Quote<br />
Employee<br />
Enrollment<br />
Validate<br />
Group<br />
Notify<br />
Carriers<br />
Employer is evaluated<br />
for eligibility to<br />
purchase from SHOP<br />
based on<br />
demographic<br />
information.<br />
Employer selects a<br />
metal level (Employee<br />
Choice) or a carrier<br />
(Employer Choice)<br />
and sets defined<br />
contribution amount.<br />
SHOP provides an<br />
estimated quote<br />
based on employer<br />
choices and employee<br />
census (age, income,<br />
etc.)<br />
Employees make<br />
plan selections<br />
with information<br />
on employer<br />
contribution and<br />
<strong>the</strong>ir expected<br />
cost<br />
Validate that all<br />
requirements for<br />
<strong>the</strong> employer (e.g.<br />
minimum<br />
participation,<br />
creditable coverage<br />
for employees)<br />
have been met<br />
Notify carriers to<br />
contract with<br />
employer and<br />
start coverage<br />
for employees<br />
SHOP Administration<br />
• Premium aggregation and billing<br />
• Carrier payment<br />
• On-going eligibility / enrollment management<br />
(employee adds, deletes, life changes, etc.)<br />
• Enrollment and funds flow reconciliation<br />
17
SHOP Policies
SHOP Marketplace<br />
Open Enrollment & Effective Dates<br />
Open enrollment for <strong>Maryland</strong>’s SHOP will begin<br />
January 1, 2014.<br />
– March 1, 2014 will be earliest effective date available<br />
to employees <strong>of</strong> small businesses that purchase<br />
insurance through <strong>the</strong> SHOP marketplace.<br />
– SHOP annual open enrollment will <strong>the</strong>n be based on<br />
each group’s renewal date.<br />
19
Two Options for Small Employers:<br />
Employer Choice vs. Employee Choice<br />
Carrier<br />
A<br />
Carrier<br />
B<br />
Carrier<br />
C<br />
Carrier<br />
D<br />
Carrier<br />
E<br />
Carrier<br />
F<br />
Platinum<br />
Gold<br />
Silver<br />
Employer Choice<br />
Employee Choice<br />
Bronze<br />
20
SHOP Eligibility<br />
Counting Methodology<br />
Small businesses with up to 50 employees may participate in <strong>the</strong><br />
SHOP<br />
The employee counting methodology impacts whe<strong>the</strong>r a group will be<br />
eligible to purchase on <strong>the</strong> SHOP – <strong>Maryland</strong> Exchange Board<br />
approved <strong>the</strong> FTE aggregation method consistent with federal rules for<br />
tax subsidies<br />
Employers can decide whe<strong>the</strong>r to <strong>of</strong>fer coverage to full time employees<br />
or all employees<br />
21
SHOP Minimum Participation<br />
The minimum participation requirement is 75% in<br />
<strong>the</strong> SHOP for employer and employee choice.<br />
Waiver Reasons<br />
– <strong>MHBE</strong> will be soliciting public comment to help<br />
determine waiver reasons that should be used to<br />
exclude employees from <strong>the</strong> 75% participation<br />
count. Information about <strong>the</strong> public comments<br />
process will be located on www.<strong>Maryland</strong>HBE.com.
Employer Contribution<br />
The <strong>Maryland</strong> Health Progress Act <strong>of</strong> 2013 establishes three<br />
defined contribution options for small employers who purchase<br />
from <strong>the</strong> SHOP:<br />
– No Contribution<br />
– Percent defined contribution - Small employers could elect to<br />
make a percentage contribution based on a reference plan at <strong>the</strong><br />
desired metal level in <strong>the</strong> SHOP.<br />
– Employees pay <strong>the</strong> same amount - Small employers could select<br />
a reference plan and <strong>the</strong>n make a contribution to each employee<br />
that would ensure all employees contribute <strong>the</strong> same amount by<br />
coverage level and job class.<br />
23
Consumer Assistance Program
Projected New Enrollment<br />
SHOP<br />
New Medicaid<br />
Individuals/Families on<br />
<strong>Maryland</strong> Health Connection<br />
25 25
Consumer Assistance Program<br />
Multiple resources will be available for consumers who need assistance with<br />
understanding insurance options.<br />
Online at www.<strong>Maryland</strong>HealthConnection.gov<br />
– Shop & Compare Options<br />
– Enroll<br />
In-person Assistance:<br />
– Connector Program<br />
• Navigators<br />
• Assisters<br />
– Application Counselors<br />
– Insurance <strong>Producer</strong>s (Brokers/Agents)<br />
– Captive <strong>Producer</strong>s<br />
Consolidated Services Center (call center)<br />
– Customer service<br />
– Application and enrollment assistance<br />
– Translation services<br />
– TTY for <strong>the</strong> hearing impaired<br />
26
<strong>Overview</strong> <strong>of</strong> <strong>the</strong> Connector Program<br />
Formerly called <strong>the</strong> Navigator Program<br />
The Connector Program has two components<br />
– Navigators: made up <strong>of</strong> Certified Individual Navigators and Licensed<br />
SHOP Navigators<br />
– Assisters: made up <strong>of</strong> Assisters who will perform Outreach and Education<br />
duties and facilitate eligibility determinations and Non-certified personnel<br />
who will provide support services<br />
<strong>MHBE</strong> has awarded six Connector Entities in six distinct<br />
geographic regions to implement <strong>the</strong> Connector Program in <strong>the</strong>ir<br />
regions<br />
27
Consumer Assistance Roles<br />
Navigators will:<br />
– Conduct public education and outreach as required by <strong>the</strong> Affordable<br />
Care Act<br />
– Distribute fair and impartial information<br />
– Facilitate enrollment in health plans<br />
– Provide referrals for grievances, complaints and questions<br />
– Provide information in a culturally and linguistically appropriate manner<br />
– Maintain expertise in eligibility, enrollment and program specifications<br />
– Refer insured small groups and individuals back to producers<br />
Assisters will:<br />
– Conduct public education and outreach;<br />
– Facilitate eligibility determination for subsidies, Medicaid, and MCHP;<br />
– Facilitate and provide ongoing support<br />
29
Consumer Assistance Roles<br />
Application Counselors:<br />
– New role introduced by U.S. HHS to allow for additional resources to<br />
assist<br />
– Facilitate enrollment in health plans<br />
– Act in <strong>the</strong> best interest <strong>of</strong> <strong>the</strong> enrollee<br />
– Disclose any potential conflicts<br />
– Receive no funding from <strong>the</strong> <strong>MHBE</strong><br />
Insurance <strong>Producer</strong>s (Agents/Brokers):<br />
– Serve an important role in <strong>the</strong> Exchange<br />
– Continue to work directly with small group customers and Individuals<br />
– Register to become authorized to sell QHP inside <strong>the</strong> Exchange<br />
– Be compensated directly by <strong>the</strong> carriers (as <strong>the</strong>y currently are)<br />
– Receive training from <strong>the</strong> Exchange<br />
30
Consumer Assistance Roles<br />
Captive producers:<br />
– may transition carrier’s existing individual enrollees into <strong>Maryland</strong> Health<br />
Connection qualified plan, and may provide enrollment assistance to<br />
individuals who contact <strong>the</strong> carrier;<br />
– must act in best interests <strong>of</strong> consumer;<br />
– must disclose <strong>the</strong>ir employment with carrier;<br />
– are subject to same restrictions as navigators; and<br />
– are subject to same licensing and <strong>MHBE</strong> authorization requirements as<br />
authorized producers;<br />
– Carriers must:<br />
• document and retain records <strong>of</strong> such disclosures for three years;<br />
• provide disclosure records and updated lists <strong>of</strong> captive producers to Exchange;<br />
Non-compliance with requirements is grounds for sanctions for both captive<br />
producer and carrier;<br />
Program must be administered in non-discriminatory manner without adverse<br />
selection impact; and<br />
Program to be sunset after three years, with study and report in 2015 on its effect<br />
and whe<strong>the</strong>r or not it should be continued.<br />
31
Consumer Assistance Roles<br />
Consolidated Service Center:<br />
– Inbound Call Center (Toll-Free Hotline) linked from<br />
www.<strong>Maryland</strong>HealthConnection.gov<br />
– Language Line/Translation Services<br />
– TTY (Hearing Impaired)<br />
– Extended Hours During Open Enrollment<br />
– Coordination with Insurance Carriers and Connector Entities<br />
– Scheduled Opening: August 2013 (with launch <strong>of</strong><br />
advertising campaign and social media launch)<br />
32
Authorized Carriers
Authorized Carriers<br />
<strong>Maryland</strong> has adopted a strategy for 2014-2015 that allows any willing carrier to <strong>of</strong>fer<br />
qualified health plans on <strong>Maryland</strong> Health Connection as long as <strong>the</strong>y meet federal and<br />
state requirements. This approach will foster competition in <strong>the</strong> marketplace and help<br />
to build stability for <strong>Maryland</strong> Health Connection.<br />
Medical<br />
• Aetna<br />
• CareFirst<br />
• Coventry<br />
• Evergreen (CO-OP)<br />
• Kaiser<br />
• United HealthCare<br />
•Aetna Dental<br />
•BEST Life<br />
•CareFirst<br />
•Coventry<br />
•Delta Dental<br />
•DentaQuest<br />
•Dominion Dental<br />
•Guardian<br />
•Metropolitan Life<br />
•United Concordia<br />
Stand-Alone Dental<br />
List reflects names <strong>of</strong> carriers by parent company name.<br />
34
Product Summary<br />
Plans <strong>of</strong>fered on <strong>Maryland</strong> Health<br />
Connection will include:<br />
– Medical Only Plans<br />
– Medical Plans with Embedded<br />
Dental<br />
– Stand-Alone Dental Plans<br />
Carriers are required to obtain<br />
approval from <strong>the</strong> MIA on plans<br />
before <strong>the</strong>y can be certified by <strong>MHBE</strong>.<br />
Carrier applications indicate that <strong>the</strong>y<br />
intend to <strong>of</strong>fer PPO, HMO, EPO, POS<br />
products.<br />
Additionally, carriers have noted that<br />
<strong>the</strong>y intend to <strong>of</strong>fer plans across all<br />
metal tiers for <strong>the</strong> Individual and<br />
SHOP marketplaces.<br />
Essential Health Benefits<br />
Ambulatory Services<br />
Emergency Services<br />
Hospitalization<br />
Maternity and newborn care<br />
Mental health and substance use disorder<br />
services<br />
Prescription drugs<br />
Rehabilitative and habilitative services and<br />
devices<br />
Laboratory services<br />
Preventive and wellness services and chronic<br />
disease management<br />
Pediatric services including oral and vision care
Carrier Participation Update<br />
Multi-State Plan Program<br />
Section 1334 <strong>of</strong> <strong>the</strong> Affordable Care Act directs <strong>the</strong> U.S.<br />
Office <strong>of</strong> Personnel Management (OPM) to contract with<br />
private health insurance issuers to <strong>of</strong>fer at least 2 multistate<br />
plans to individuals and small business in each state.<br />
<strong>MHBE</strong> and MIA are working with OPM to develop<br />
procedures for authorizing multi-state plan issuers and<br />
certifying <strong>the</strong>ir plans.<br />
It is expected that <strong>Maryland</strong> will have at least one multistate<br />
plan issuer in year 1.<br />
36
TPA Certification Program
TPA SHOP Certification Program<br />
Third Party Benefit Administrators (TPAs) play a key<br />
role in ensuring <strong>Maryland</strong>ers have access to<br />
affordable coverage options.<br />
As part <strong>of</strong> <strong>the</strong> Small Business Health Options Program<br />
(SHOP), licensed TPAs can become certified by <strong>the</strong><br />
<strong>Maryland</strong> Health Benefit Exchange to perform several<br />
business functions including:<br />
– Qualified health plan comparison and selection by<br />
employers and employees<br />
– Administration <strong>of</strong> enrollment and eligibility changes<br />
– Premium billing and collections<br />
38
TPA Program Options<br />
Three distinct programs allow third party administrators choose<br />
how <strong>the</strong>y want to participate in <strong>the</strong> SHOP Exchange<br />
Program 1: SHOP Alternate Online Market Place and<br />
Back Office Services<br />
– The TPA will have <strong>the</strong>ir own system that will replicate<br />
<strong>the</strong> <strong>Maryland</strong> Health Connection online shopping<br />
flows in addition to management <strong>of</strong> back-<strong>of</strong>fice<br />
administration.<br />
Program 2: SHOP Back Office Administrative Services<br />
– The shopping experience will take place in <strong>Maryland</strong><br />
Health Connection and <strong>the</strong> TPA will be responsible<br />
for back-<strong>of</strong>fice administration in <strong>the</strong>ir own system.<br />
Program 3: SHOP Online Administrative Services<br />
– Both <strong>the</strong> shopping experience and <strong>the</strong> back <strong>of</strong>fice<br />
administrative activity take place in <strong>Maryland</strong> Health<br />
Connection.<br />
Program 3<br />
Program 2<br />
Program 1
TPA Certification Program<br />
Organizations that wish to become certified as TPA<br />
business partners with <strong>MHBE</strong> must be approved<br />
through <strong>the</strong> <strong>MHBE</strong> Certification <strong>Process</strong>.<br />
The certification process is under development in<br />
cooperation and will consist <strong>of</strong> four components:<br />
1) TPA Application Package<br />
2) Systems & business operations validation<br />
3) Training<br />
4) Certification from <strong>MHBE</strong><br />
The application package and agreements will be<br />
available on <strong>the</strong> <strong>MHBE</strong> website in July 2013.<br />
40
<strong>Producer</strong> <strong>Authorization</strong>:<br />
The 3-Step <strong>Process</strong><br />
41
The <strong>MHBE</strong> <strong>Producer</strong> Program<br />
<strong>Maryland</strong> has designed a prominent role for producers as it works to<br />
create <strong>Maryland</strong> Health Connection.<br />
<strong>Producer</strong>s will be key partners to help individuals and small businesses<br />
get access to plans <strong>of</strong>fered on <strong>Maryland</strong> Health Connection.<br />
<strong>MHBE</strong> is designing a <strong>Producer</strong> Program to ensure producers receive<br />
information and can provide input.<br />
Proactive<br />
Communication<br />
Planning &<br />
Feedback<br />
Training &<br />
<strong>Authorization</strong><br />
Book <strong>of</strong> Business<br />
Management<br />
Tools<br />
Service &<br />
Support
<strong>Producer</strong> Program<br />
Planning & Feedback<br />
– <strong>Producer</strong> Advisory Council<br />
Communication Tools<br />
– Newsletter<br />
– Website
<strong>Producer</strong> <strong>Authorization</strong><br />
Steps to <strong>Producer</strong> <strong>Authorization</strong><br />
<strong>MHBE</strong> is developing a 3-step process for <strong>Producer</strong> <strong>Authorization</strong>.<br />
<strong>Producer</strong>s must complete all 3 steps in order to sell plans <strong>of</strong>fered<br />
through <strong>Maryland</strong> Health Connection.<br />
1. Submit <strong>the</strong><br />
<strong>MHBE</strong><br />
Application<br />
2. Complete<br />
<strong>MHBE</strong> Training<br />
3. Receive <strong>MHBE</strong><br />
<strong>Authorization</strong>
<strong>Producer</strong> <strong>Authorization</strong><br />
Criteria for Applying<br />
Licensed Health <strong>Producer</strong>s can apply as long as <strong>the</strong>y meet <strong>the</strong> following criteria:<br />
– Holds a current license that qualifies <strong>the</strong> producer to sell health benefits in<br />
<strong>Maryland</strong><br />
– Is in good standing with no outstanding consumer complaints<br />
– Maintain a sufficient level <strong>of</strong> errors and omission coverage as required by carriers<br />
– Not excluded from participation in federal health programs<br />
– Not debarred from State contracts<br />
– Have completed <strong>MHBE</strong> required training and authorization process<br />
– Agree to present all plans from all participating carriers and disclose appointment<br />
status to consumers<br />
– Agree to privacy and security standards established by <strong>the</strong> <strong>MHBE</strong><br />
– Agree to work cooperatively with Connector Entities/Navigators, as applicable<br />
– Agree to immediately report concerns or complaints from employers, employees<br />
or individual consumers<br />
– Agree to complete re-training education requirements.<br />
Both resident and non-resident producers are eligible to apply
<strong>Producer</strong> <strong>Authorization</strong><br />
Requirements<br />
Every licensed producer who wants to discuss plans<br />
<strong>of</strong>fered on <strong>Maryland</strong> Health Connection with individuals<br />
and small businesses must complete <strong>the</strong> 3 steps <strong>of</strong><br />
authorization.<br />
Only <strong>MHBE</strong> <strong>of</strong>fered training will allow licensed producers to<br />
get authorized to sell plans <strong>of</strong>fered on <strong>Maryland</strong> Health<br />
Connection.<br />
Out <strong>of</strong> state exchange authorization will not be accepted as<br />
a replacement for <strong>Maryland</strong> authorization.<br />
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<strong>Producer</strong> <strong>Authorization</strong><br />
Application<br />
The <strong>Producer</strong> authorization application will be<br />
available online<br />
<strong>MHBE</strong> will send out notification once <strong>the</strong> authorization<br />
application is available<br />
Additional <strong>Producer</strong> Information Sessions will be<br />
conducted at <strong>the</strong> end <strong>of</strong> July regarding application<br />
procedures<br />
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<strong>Producer</strong> <strong>Authorization</strong><br />
Training<br />
The <strong>MHBE</strong> will begin to <strong>of</strong>fer training sessions for producers in August<br />
2013<br />
– Only training <strong>of</strong>fered by <strong>MHBE</strong> will be accepted for authorization<br />
– Details <strong>of</strong> <strong>the</strong> training are being developed<br />
– The training sessions will be up to eight hours and <strong>of</strong>fered in a<br />
conference format<br />
<strong>MHBE</strong> is working with <strong>Maryland</strong> Insurance Administration to determine if<br />
CE credits can be given for <strong>Maryland</strong> Health Connection <strong>Producer</strong><br />
training<br />
Information on available training sessions will be posted on<br />
www.<strong>Maryland</strong>HBE.com on <strong>the</strong> Insurance <strong>Producer</strong> page<br />
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<strong>Producer</strong> <strong>Authorization</strong><br />
Notification <strong>of</strong> <strong>Authorization</strong><br />
After a producer submits an authorization<br />
application and completes <strong>the</strong> required training,<br />
<strong>MHBE</strong> will provide written notification to<br />
producers indicating authorization<br />
The first round <strong>of</strong> notification will be going out in<br />
September<br />
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<strong>Producer</strong> <strong>Authorization</strong> Expiration<br />
<strong>Producer</strong> <strong>Authorization</strong> Expiration<br />
<strong>Producer</strong> authorization expires two years after <strong>the</strong><br />
date it is issued<br />
– <strong>MHBE</strong> will notify authorized producers 60 days<br />
before expiration<br />
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<strong>Producer</strong> Appointments<br />
Carrier Appointments<br />
Carrier appointments are NOT a pre-requisite <strong>of</strong> producer authorization.<br />
Interim procedures provide rules for carriers when appointing producers:<br />
– A carrier must appoint an authorized producer within 10 business days <strong>of</strong> receipt<br />
<strong>the</strong> request from <strong>the</strong> producer<br />
– A carrier must appoint every authorized producer<br />
• unless reasons specified under 31112(e)(1), Annotated Code <strong>of</strong> <strong>Maryland</strong><br />
– A carrier can not deny appointment based on production volume<br />
– A carrier can not impose a production requirement<br />
– A carrier must allow authorized producers to discuss all <strong>Maryland</strong> Health<br />
Connection plans with or without an appointment<br />
– A carrier must provide a basis for denial to <strong>the</strong> authorized producer within 10<br />
business days<br />
– Dispute resolution will be managed by <strong>the</strong> MIA<br />
• While <strong>the</strong> dispute is being reviewed by <strong>the</strong> MIA, <strong>the</strong> producer can continue to sell and<br />
enroll individuals and small businesses<br />
– A carrier can limit <strong>the</strong> scope <strong>of</strong> an appointment to only <strong>Maryland</strong> Health<br />
Connection<br />
– A carrier must provide information on <strong>the</strong>ir producer register upon request <strong>of</strong> <strong>the</strong><br />
<strong>MHBE</strong><br />
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<strong>Producer</strong> Compensation<br />
<strong>Producer</strong> Compensation<br />
Carriers will continue to be responsible for compensation <strong>of</strong> producers that sell<br />
plans on <strong>Maryland</strong> Health Connection.<br />
Carriers will continue to develop <strong>the</strong>ir own models <strong>of</strong> compensation for producers.<br />
Compensation models must not result in <strong>the</strong> disruption <strong>of</strong> consumers’ access to<br />
qualified plans, steering <strong>of</strong> consumers away from appropriate insurance <strong>of</strong>ferings,<br />
or threaten <strong>the</strong> viability <strong>of</strong> <strong>Maryland</strong> Health Connection.<br />
Carriers are expected to develop equivalent compensation and incentives for<br />
sales inside and outside <strong>of</strong> <strong>the</strong> state-based exchange.<br />
Carriers are required to collect and maintain producer compensation data<br />
including agreements, policies, procedures, programs and o<strong>the</strong>r information<br />
regarding producer compensation. Carriers must provide this information to <strong>the</strong><br />
<strong>Maryland</strong> Insurance Administration upon request.
Current Procedures under Discussion<br />
<strong>Producer</strong> <strong>of</strong> Record<br />
– Individual Exchange<br />
• <strong>Producer</strong> <strong>of</strong> Record change - only during open enrollment or at a<br />
special enrollment time<br />
– SHOP Exchange<br />
• Must be initiated by <strong>the</strong> group<br />
• One <strong>Producer</strong> <strong>of</strong> Record change per year<br />
Book <strong>of</strong> Business Management Tools<br />
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<strong>Producer</strong> Support Model<br />
The <strong>Producer</strong> Operations Team<br />
Rebecca G. Bayne – Manager, <strong>Producer</strong> Operations<br />
Christopher Yeiser – Business Operations Specialist<br />
Becky Smith – Business Operations Specialist<br />
Email us at <strong>Producer</strong>@<strong>Maryland</strong>HBE.com
Ways to Get More Information!<br />
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Online Resources<br />
<strong>Maryland</strong>HealthConnection.gov<br />
Sign Up for Email Updates<br />
Sign Up for Text Updates: Text “Connected” to<br />
69302<br />
Get information on insurance resources<br />
available to help now<br />
Plans Available<br />
Individuals – October 1, 2013<br />
SHOP – January 1, 2014<br />
<strong>Maryland</strong>HBE.com<br />
<strong>Producer</strong> Training &<br />
<strong>Authorization</strong> Information<br />
Meeting Information<br />
RFP Announcements<br />
Job Information<br />
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Thank you!<br />
For questions on <strong>the</strong> information contained in this presentation,<br />
please contact:<br />
Rebecca Bayne<br />
Manager, <strong>Producer</strong> Operations<br />
<strong>Maryland</strong> Health Benefit Exchange<br />
<strong>Producer</strong>@<strong>Maryland</strong>HBE.com<br />
www.<strong>Maryland</strong>HealthConnection.gov<br />
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