ACA for Brokers, Navigators and CACs

DESCRIPTIONS AND RESPONSIBILITIES

Health Insurance Marketplace Broker

  • Is an accident, health and sickness insurance producer licensed by the Arizona Department of Insurance
  • If using a name that is not the person's genuine legal name, has filed the "assumed name" with the Arizona Department of Insurance using Form L–193, and to legally reserve the use of the name in Arizona, has filed the "trade name" with the Arizona Secretary of State
  • Has completed required training
  • Has been certified by the US Department of Health and Human Services to act as a Health Insurance Marketplace broker on the Federally Facilitated Marketplace ("FFM"). Click here to see if we have verified your registration with the FFM.
  • Helps individuals and small employers determine eligibility for public assistance, tax credits, and cost-sharing reductions;
  • Helps enroll consumers in health insurance coverage offered through the federally facilitated marketplace
  • Is authorized to sell, solicit or negotiate insurance both through and outside the Health Insurance Marketplace, and may receive a commission for selling insurance

Health Insurance Marketplace
Web Broker
*

*A Health Insurance Marketplace broker that allows a consumer to purchase individual health insurance through the broker's web site.
  • Must meet all the requirements of a Health Insurance Marketplace broker
  • If a business entity, both the entity and each individual who will sell, solicit or negotiate insurance on behalf of the business entity must also meet all the requirements of a Health Insurance Marketplace broker, and the entity must designate an insurance producer to be responsible for the entity's compliance with Arizona laws.
  • Must interface with the US Department of Health and Human Serivces to display and allow consumers to select from all qualified health plans available in a Marketplace
  • Must meet other requirements set forth by the US Department of Health and Human Serviceslearn more

Navigator

  • Informs insurance consumers about the Affordable Care Act;
  • Helps individuals and small employers determine eligibility for public assistance, tax credits, and cost-sharing reductions;
  • Helps enroll consumers in health insurance coverage offered through the federally facilitated marketplace.
  • Navigators are paid from federal government grants.
  • Navigators are not allowed to sell, solicit or negotiate insurance coverage and are not allowed to receive commissions or fees for providing navigator services.

More...

Certified Application Counselor ("CAC")

  • A CAC is typically a social services organization or hospital and is not paid (by grant, commission or fee) to provide services.
  • Performs many of the same functions as navigators,
    • Educates consumers
    • Helps individuals apply for public assistance and determine eligibilty for tax credits and cost-sharing reductions
    • Helps individuals complete applications for public benefits or health insurance coverage

More...


STEPS TO BECOME A HEALTH INSURANCE MARKETPLACE BROKER

  1. Each individual and each business entity involved in selling, soliciting or negotiating insurance through the Health Insurance Marketplace must be licensed in Arizona as an accident and health or sickness insurance producer. Use the Department of Insurance License Search web page to check your license status.
  2. An individual or business entity that conducts business under a name that is different from the genuine legal name must file the "assumed name" with the Department of Insurance using Form L-193.
  3. To legally reserve the use of the name in Arizona (to ensure that no one becomes legally formed under the name, which would cause you to lose the right to use the name), a person may also file the assumed name as a "trade name" with the Arizona Secretary of State.
  4. You must create an account with the Health Insurance Marketplace "Medicare Learning Network."
  5. You must complete required courses and pass required examinations through the Health Insurance Marketplace "Medicare Learning Network."
  6. You must create a user account on the Federally-facilitated Marketplace (FFM) through the CMS Enterprise Portal (click the "New User Registration" link on the right side of the page) and complete the identity verification process.
  7. To be a web broker (an entity that sells Health Insurance Marketplace insurance over the Internet), the entity must be licensed as an accident, health or sickness insurance producer by the Arizona Department of Insurance (and must file alias names with the Department), must have authority to operate a business in Arizona through the Arizona Corporation Commission, and must execute a web broker agreement with CMS.

For more information about becoming a Health Insurance Marketplace broker:

NAVIGATORS AND CERTIFIED APPLICATION COUNSELORS

Navigator and CAC License Application and Instructions (Form L-NAV). To act as a navigator or certified application counselor in Arizona after October 1, 2014, you must hold a license from the Arizona Department of Insurance in addition to meeting federal training and registration requirements.

New Funding Opportunity Announcement for Navigators. Obtain information about navigator standards and the process for applying to become a navigator.

Certified Application Counselor Organization. If your organization is a community health center or other health care provider, hospital, or local government or non-profit organization with experience providing social services to your community and you’d like to help by training your staff or volunteers to assist people applying for coverage through the Marketplace, you can apply to be a certified application counselor (CAC) organization.


HEALTH INSURANCE EDUCATION RESOURCES

Cover Arizona. Resources to help Arizonans connect to coverage through the health insurance marketplace.

CMS Training Materials and Presentations.

'The New Health Care Law and You' (Institute of Medicine) PDF

'Health Literacy: A Prescription to End Confusion' (Institute of Medicine)

'Developing a Measure of Health Insurance Literacy: Understanding Consumers' Ability to Choose and Use Insurance' (American Institute for Research) PDF

Glossaries

OTHER RESOURCES

Find an agent/broker, navigator or certified application counselor