Here are some quick ways to strengthen your relationship with your clients and ensure you remain compliant as you help them select coverage during the Open Enrollment Period (OEP):

1.    Be sure to obtain and document consumer consent prior to assisting with or facilitating an enrollment for an Affordable Care Act (ACA) plan or assisting an individual with applying for advance premium tax credit or cost-sharing reduction.

2.    Prior to application submission, remember to obtain and document that eligibility application information has been reviewed and confirmed to be accurate by the consumer. Note that this is separate from the consumer consent documentation and requirements outlined above.

3.    Conduct a thorough Needs Assessment at the time of enrollment. Talk with the consumer about what’s important to them and what may have changed in their life since last year (e.g., Have their priorities changed? Has their family grown?). Be sure to check if they qualify for Medicaid, as well – if they do, enrolling in an ACA plan is likely not in their best interests because they won’t be eligible for additional savings.

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4.    Check that all providers are in-network for the recommended plan by using the Provider Search tool under the Quick Access links on the Jarvis homepage. Provider networks can change over time, so it’s important to ensure the consumer’s primary and specialty care providers are in-network for the recommended plan.

5.    Check that all medications specific to the consumer’s needs are covered in the recommended plan by checking the Drug Formulary (Prescription Drug List) when performing a plan search on uhc.com/exchange. The consumer’s medication needs may change, so be sure to check coverage within the recommended plan. Note: For questions regarding medication information, reach out to the Producer Help Desk (PHD).

6.    Ensure that all social security numbers (SSNs) for all applicants (adults and children) have been entered on their applications. The Centers for Medicare & Medicaid Services (CMS) will not accept ACA Marketplace applications that do not include a verifiable SSN. If a consumer does not have an SSN or is unwilling to provide it to you, CMS has recommended that brokers and agents work side-by-side with consumers to help them complete the application on HealthCare.gov or suggest that the consumer contact the Marketplace Call Center.

Doing these things can make a real difference in the lives of your clients by helping them find the right plan for their needs. Furthermore, by taking these steps, you can help prevent or resolve consumer complaints related to incorrect information on their eligibility applications or unauthorized enrollments, as well as disputes between agents and consumers, or between multiple enrolling entities.

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