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Brokers required to gain consent from clients under new rule

Under a new federal rule, guided by the Centers for Medicare & Medicaid Services, health insurance agents, brokers, and web-brokers assisting consumers who use the federal Marketplace are required to comply with a new consent rule called the 2024 Payment Notice.

In essence, the rule says agents, brokers, and web-brokers must show that clients have given consent for the agent or broker to make changes on behalf of the consumer if the agent or broker uses the federal platform, which includes state exchanges on the federal platform.

The 2024 Payment Notice went into effect on June 18, 2023, and is required for all applicable 2024 plans.

Among the requirements for documenting that a consumer or consumer’s authorized representative has given consent to the changes are:

  • Obtaining the signature of the consumer or an authorized representative. Electronic signatures are valid;
  • Verbal confirmation by the consumer or an authorized representative that is captured in an audio recording;
  • A written response (electronic is permitted) from the consumer or an authorized representative to a communication sent by the agent or broker.

Along with a proper form of consent, other requirements from the 2024 Payment Notice require:

  • Date the information was reviewed;
  • Name of the consumer or an authorized representative;
  • An explanation of the attestations at the end of the eligibility application;
  • The name of the assisting agent, broker, or web-broker.

There are also rules for maintaining a copy of the record. According to the requirements, an agent or broker must maintain documentation of the consent for a minimum of 10 years and be able to produce the documentation upon request in response to monitoring, auditing, or enforcement.

The exception to the 2024 Payment Notice is for consumers who simply renew their health insurance plans on the Marketplace, rather than selecting new plans.

“If an existing client’s plan renews automatically and there are no changes to the Marketplace application, the new documentation requirements adopted in the 2024 Payment Notice would not be triggered until such time that the consent provided by the consumer (or an authorized representative) expires or is otherwise rescinded…,” reads the rule from CMS.

The consent must also be given if there is “a need to update and make changes to the consumer’s marketplace eligibility application information.”

For complete information about the requirements, agents and brokers are encouraged to carefully read Title 45 of the Code of Federal Regulations.