Per the Federally-facilitated Marketplace (FFM) standards of conduct, you must obtain the consent of an individual, employer, or employee prior to helping them:
- Apply for Marketplace coverage or financial assistance;
- Enroll in a Marketplace qualified health plan; and
- Check the status of their coverage and make updates throughout the year.
You may only access consumer information and make updates to consumer accounts with the explicit consent and direction of the person you are assisting.
The Centers for Medicare & Medicaid Services (CMS) does not prescribe a standard format or process for obtaining the consent or for maintaining this record, so you have flexibility to determine how you will meet the consent requirement. While CMS does not provide a form, or specify that a form must be signed, you can use a Broker of Record (BOR) form from an issuer or state Department of Insurance (DOI) to satisfy this requirement. Additionally, you may obtain consent verbally (such as over the phone), electronically (such as via email), or in person. At a minimum, the consent should acknowledge that you have informed the individual, employer, or employee of the functions and responsibilities that apply to your role in the FFM. As a best practice to avoid misunderstandings for compensation purposes, agents and brokers are encouraged to obtain consent in writing and retain a record of the documentation.
The record of the consent should include the following:
- The individual’s, employer’s, or employee’s name;
- The date the consent was given; and
- The name of the agent(s) or broker(s) to whom consent was given.
Note that this could include additional names of agents or brokers if the consenter authorized multiple agents or brokers within the same organization. If you are assisting verbally (such as over the phone), you may obtain consent by reading a script that contains, at a minimum, the required elements summarized above, and should record in writing that the required consent was obtained.
CMS does not specify an automatic expiration date for the consent because it could become burdensome for anyone consistently seeking services from the same agent or broker to have to repeatedly renew the consent. Therefore, the consent may last indefinitely, unless the individual, employer, or employee revokes it. Consent documents must be appropriately secured and retained for 10 years.