This article is for informational purposes only. Please visit the CMS website for specifics regarding any of the requirements.
IN THIS ARTICLE
What is Consent to Contact?
The Centers for Medicare & Medicaid Services (CMS) Understanding Marketplace Compliance Rules & Regulations presentation laid out additional requirements for life and health insurance brokers to obtain consent to contact before assisting with Marketplace plans.
When do I need to get consent?
The consent to contact guidelines include: “Agents and brokers should only make updates to a consumer's application or policy at the direction of the consumer. The Marketplace standards of conduct specify that agents and brokers must obtain the consent of an individual, employer, or employee prior to providing assistance to Marketplace consumers.
This includes but is not limited to:
- Conducting a search for consumer applications using an approved Classic Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE) website.
- Helping the consumer apply for Marketplace coverage or financial assistance or enrolling the consumer in a Marketplace-qualified health plan (QHP).
- Checking the status of the consumer’s coverage and making updates throughout the year via HealthCare.gov, approved DE or EDE websites, and/or the Marketplace Call Center.”
How do I obtain consent?
- Verbally. You can gather this consent over the phone. It’s best practice to use a line that is recorded, which will also allow your agency to comply with other regulations of the CMS Final Rule 2023. The CMS recommends that brokers read “a script that contains, at a minimum, the required elements, and they should memorialize that the required consent was obtained.”
- Electronically. You can gain this consent via email or through an electronically submitted form.
- In Person. A client may verbally state their consent or sign a form. It’s best practice to record their consent (written or verbal) and retain it for your records.
What information do I need?
The Centers for Medicare & Medicaid Services (CMS) does not prescribe a standard format or process for obtaining consent or for maintaining this record, so you have the flexibility to determine how you will meet the consent requirement.
As a general rule, however, the record of the consent should include the following information:
- The individual’s, employer’s, or employee’s name
- The date the consent was given
- The name of the agent(s) or broker(s) to whom consent was given
How long do I need to store consent information?
A record of consent does not expire except at the request of the individual, employer, or employee. However, obtained records must be securely stored and accessible for a minimum of ten (10) years.
How can I use AMS+ to obtain and store consent documentation?
Gather consent from your individual and group clients electronically with AMS+:
- Use Email Marketing to send a mass email to all of your qualifying clients to introduce the new regulations, share the form, and obtain their consent. You can link directly to your agency’s form or the BOR form. This helps you gather consent records from your existing client base.
- Use Email Forwarding and Outlook Email Sync to automatically attach any signed consent to contact records from your agent’s email to the contact’s profile in AMS+.
- Use Automated Workflow tool to create tasks to remind agents to obtain consent whenever they begin working with a new individual or client. This allows your team to integrate these new regulations into your existing processes seamlessly.
- Leverage our Zapier integration to send signable documents from customizable document tools, like DocuSign, directly to your clients. Once signed, the record will automatically attach to your client’s profile in AMS+.
The regulations cover all individuals, employers, and employees regardless if they’re a current client or a prospect. Leverage Automated Workflow to ensure you obtain their consent! Here’s an example workflow you can use:
Trigger: Individual’s status updates to Needs Consent
Filter: Individual’s type = Prospect
- Day 0: Send a welcome email with a link to the consent form
- Day 3: Create a task for the agent to reach out and check in on the consent
- Day 7: Create a task for the agent to reach out and check in on the consent
Once the prospect has filled out the form and returned it, attach it to their client profile for easy access.
Optional messaging for email templates (includes variable data)
**Insert a personal note about being excited to help them through their upcoming enrollment process**
Before we get started, we need to document your willingness to work with us through this process.
If you agree to the following message, please reply to this email with "Yes, I, [IndFirstName] [IndLastName] give my permission to you to serve as the health insurance agent or broker for myself and my entire household". If you do not wish to be contacted about this, reply with "No, I do not consent."
I, [IndFirstName] [IndLastName], give my permission to [AORFirstName] [AORLastName], to serve as the health insurance agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace. By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by telephone only for the purposes of one or more of the following:
- Searching for an existing Marketplace application;
- Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums;
- Providing ongoing account maintenance and enrollment assistance, as necessary; or
- Responding to inquiries from the Marketplace regarding my Marketplace application.
I understand that the Agent will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my PII is kept private and safe when collecting, storing, and using my PII for the stated purposes above.
I confirm that the information I provide for entry on my Marketplace eligibility and enrollment application will be true to the best of my knowledge. I understand that I do not have to share additional personal information about myself or my health with my Agent beyond what is required on the application for eligibility and enrollment purposes. I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by contacting [AOREmail].
Name of Primary Writing Agent: [AORFirstName] [AORLastName]
Agent National Producer Number: [AORNPN]
Phone Number: [AORCellPhone]
Again, if you agree to the following message, please reply to this email with "Yes, I, [IndFirstName] [IndLastName] give my permission to you to serve as the health insurance agent or broker for myself and my entire household". If you do not wish to be contacted about this, reply with "No, I do not consent."
I look forward to working with you,