All agents must follow the consumer consent and eligibility application confirmation requirements established by the Department of Health and Human Services (HHS) and The Centers for Medicare & Medicaid Services (CMS). These requirements were established on June 18, 2023 and detailed in the 2024 Notice Benefit and Payment Parameters (NBPP).

It is important to note that the consent and eligibility application confirmation requirements must be reestablished whenever eligibility changes are made on a consumer’s Marketplace application, including plan and enrollment changes.

1. Consumer consent requirements

Agents are required to obtain and document consumer consent prior to assisting with or facilitating an enrollment for coverage through Federally-facilitated Exchanges and State-based Exchanges or prior to assisting an individual with applying for advance premium tax credit or cost-sharing reduction.

CMS model consent form (English)

CMS model consent form (Spanish)

CMS consent requirements FAQ

2. Eligibility application confirmation requirements

Agents are required to obtain and document that eligibility application information has been reviewed by and confirmed to be accurate by the consumer prior to application submission for coverage through Federally-facilitated Exchanges and State-based Exchanges.

These requirements were established under the Patient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2024 and will assist with:

·       Resolving consumer complaints related to incorrect information on their eligibility applications or unauthorized enrollments

·       Resolving disputes between agents and consumers, or between multiple enrolling entities

Note that this is separate from the consumer consent documentation and requirements outlined above.

CMS eligibility documentation FAQ

For resources and more detailed information about these requirements, please click the buttons below. The Quick Reference Guide (QRG) and model consent form can be found on Jarvis by going to Knowledge Center > IFP Compliance.

Consent & eligibility QRG

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