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Compliance Question: Can you clarify the guidance around "show all plan options"?

August 13, 2024 11:17 AM | Robin Paoli (Administrator)

**Compliance Q&As represent volunteered member experience and knowledge and are not formal legal advice.**

Member Question: Can you clarify the guidance around "show all plan options"? 

First response quotes CMS: 

It depends on the Entity. There are different requirements for web-brokers and issuer Entities.

Web-brokers that are approved EDE Entities must display all qualified health plan (QHP) (including stand-alone dental plans (SADPs) offered through the Marketplace) standardized comparative information provided by the Marketplace or directly by QHP issuers.

The standardized comparative information that must be displayed includes the following, at a minimum: 

  • Premium and cost-sharing information (total and net premium based on advance payments of the premium tax credit and cost-sharing reductions)
  • Summary of benefits and coverage
  • Identification of whether the QHP is bronze, silver, gold, or platinum level plan, or catastrophic plan
  • Provider directory
  • The results of an enrollee satisfaction survey
  • Quality ratings (in applicable states)

Web-brokers are required to display all standardized comparative information. To the extent an approved web-broker’s website does not provide enrollment support for a specific QHP, the website must prominently display a disclaimer provided by the Department of Health & Human Services (HHS) and provide a link to HealthCare.gov.

Approved issuers must display all QHP standardized comparative information for each QHP offered by the issuer. Issuers are only required to display QHPs they offer in the respective Marketplace.

Second response interprets and shares links:

I believe this only applies to web brokers.  Having said that, some individual state-based exchanges may be stricter than the FFM or may have additional web broker rules. 

Unlike traditional brokers and agents, web brokers must display all QHPs, regardless of appointment or compensation arrangements.  If a consumer wishes to enroll in a plan for which the web broker does not have an appointment, the web broker must direct the consumer to the exchange website for enrollment.  

Although from 2013, this Health Affairs post is still a good summary.

And here is the CMS training link for web brokers - see slide 29:  https://www.cms.gov/sites/default/files/2019-12/Processes-Becoming-Web-broker.pdf

Although there is no specific requirement for an agent or broker assisting individuals, they should be cautious if only steering individuals to those carriers for whom they get paid.  Should anything negative transpire this could be deemed as an unfair trade practice. 

In sum: in addition to complying with regulations, "showing all options" is a best practice that can protect the broker or benefits firm from potential liability.

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