BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 615
S
AUTHOR: Calderon
B
AMENDED: April 13, 2011
HEARING DATE: May 4, 2011
6
CONSULTANT:
1
Chan-Sawin
5
SUBJECT
Health care service plans: accident and health agents:
licensure
SUMMARY
Requires, as of July 1, 2012, all sales of health care
services plans (health plans). licensed and regulated under
the Department of Managed Health Care (DMHC), to be
conducted by licensed insurance agents, subject to
Department of Insurance (CDI) licensing, education and
disciplinary authority.
CHANGES TO EXISTING LAW
Existing federal law:
Existing law, the federal Patient Protection and Affordable
Care Act (PPACA), (Public Law 111-148), among other things,
requires each state, by January 1, 2014 to establish an
American Health Benefit Exchange that makes qualified
health insurance products available to qualified
individuals and qualified employers. If a state does not
establish an exchange, the federal government administers
the exchange.
Requires, pursuant to PPACA, that state exchanges establish
a navigator program that will help people who are eligible
Continued---
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to purchase coverage through the Exchange learn about their
new coverage options and enroll, and
Requires any entity that serves as a navigator to meet
specific duties, including:
Conducting public education activities to raise
awareness of the availability of qualified health
plans (QHPs);
Distributing fair and impartial information
concerning enrollment in QHPs, and the availability of
premium tax credits and cost-sharing reductions;
Facilitating enrollment in QHPs;
Providing referrals to any applicable health
insurance consumer assistance or health insurance
ombudsman office, as specified, or any other
appropriate state agency or agencies; and
Providing information in a manner that is
culturally and linguistically appropriate to the needs
of the population being served by the exchange.
Requires the federal Secretary of Health and Human Services
(Secretary) to establish standards for navigators,
including provisions to ensure that any private or public
entity that is selected as a navigator is qualified and
licensed, if appropriate, to engage in the navigator
activities established in PPACA and to avoid conflicts of
interest.
Requires the Secretary to establish procedures under which
a state may allow agents or brokers to enroll individuals
and employers in any qualified health plans in the
individual or small group market, as specified; and to
assist individuals in applying for premium tax credits and
cost-sharing reductions for plans sold through an Exchange.
Specifies that a navigator shall not be a health insurance
issuer, or receive any consideration directly or indirectly
from any health insurance issuer in connection with the
enrollment of any qualified individual or employees of a
qualified employer in a QHP.
Requires the Secretary, in collaboration with states, to
develop standards to ensure that information made available
by navigators is fair, accurate, and impartial.
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Existing state law:
Provides for the regulation of health plans by DMHC, under
the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene Act), and for the regulation of health insurers
by CDI.
Establishes the California Health Benefit Exchange
(Exchange) within state government, and specifies the
duties and authority of the Exchange, including to
facilitate, by means of an organized and competitive
insurance marketplace, the ability of individuals and small
businesses to compare plans and buy health insurance on the
private market.
Licensure and regulation of agents and brokers
Provides for the transaction of accident and sickness
insurance, and health insurance, by life and disability
insurance companies.
Defines "health insurance" to mean individual or group
disability insurance policies providing coverage for
hospital, medical or surgical benefits. Benefits under
these lines of insurance are provided on the basis of
indemnification or reimbursement for medical expenses
incurred by their policyholders.
Requires an individual transacting the business of life,
accident and health insurance to meet certain specified
requirements, including licensure requirements, continuing
education requirements and subjects them to disciplinary
measures for failure to meet the licensing requirements and
obligations under the Insurance Code.
Defines "transact" to include the solicitation and
execution of a contract of insurance, negotiations
preliminary to execution, and transactions of matters
subsequent to execution of the contract and arising out of
it.
Defines an "insurance broker" as a person who, for
compensation and on behalf of another person, transacts
insurance other than life, disability, or health insurance
with, but not on behalf of, an admitted insurer.
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Defines a "life licensee" as a person who is authorized to
act as a life agent for placement of life, and/or accident
and health insurance policies.
Requirements under the Knox-Keene Act
Specifies that health plans may only provide health care
services. This means health plans may not offer auxiliary
types of disability coverage, such as income protection,
credit disability coverage, or accidental death and
dismemberment coverage. Such auxiliary lines of coverage,
while excluded from the statutory definition of "health
insurance" under the Insurance Code, are classes of
disability insurance.
Defines "solicitation" as any presentation or advertising
conducted by, or on behalf of, a plan, where information
regarding the plan, or services offered and charges
therefor, is disseminated for the purpose of inducing
persons to subscribe to, or enroll in, the plan.
Defines "solicitor" as any person who engages in the act of
solicitation.
Requires that solicitors, solicitor firms, and principal
persons engaged in the supervision of solicitation for
plans that meet such reasonable and appropriate standards
with respect to training, experience, and other
qualifications as the director finds necessary and
appropriate in the public interest or for the protection of
subscribers, enrollees, and plans. For such purposes, the
director may require individuals to pass examinations
prescribed by the Director of DMHC.
Authorizes the Director of DMHC to:
Enforce prohibitions on the use of any advertising
or solicitation which is untrue or misleading, or any
form of evidence of coverage which is deceptive;
Oversee market conduct, including enforcing a
prohibition on any plan, or solicitor, or
representative using or permitting the use of any
verbal statement which is untrue, misleading, or
deceptive or make any representations about coverage
offered by the plan or its cost that does not conform
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to fact. All verbal statements are held to the same
standards as those for printed matter; and,
Administer a system of prior approval of
advertising concerning plan terms and conditions.
Administer a system of standardized disclosures
concerning plan features and coverage.
Navigators in the California Health Benefits Exchange
Requires the Exchange board to take specified actions
required of Exchanges by PPACA including, among other
things, establishing the navigator program to conduct
public education and facilitate enrollment in QHPs.
Specifies that any entity chosen by the Exchange as a
navigator shall meet the five specific duties established
in PPACA.
This bill:
Prohibits, as of July 1, 2012, for purposes of both the
Knox-Keene Act and the Insurance Code, any person from
soliciting, negotiating or selling of health plan
contracts, specialized health plan contracts, Medicare
Advantage Plans under Medicare Part C, or Medicare
Supplement contracts unless the person is licensed by the
Insurance Commissioner as an accident and health agent.
Effective July 1, 2012, revises the scope of a life
licensee under the Insurance Code to include authority to
transact health plan contracts, specialized health plan
contracts, Medicare Advantage Plans under Medicare Part C,
or Medicare Supplement contracts.
Specifies that applicants for initial licensure and license
renewal as an accident and health agent are subject to the
same pre-licensing education standards and continuing
education requirements, respectively, as all other accident
and health agents.
Authorizes the Insurance Commissioner to adopt necessary
rules and regulations to implement these requirements.
Gives the Insurance Commissioner sole authority to enforce
the licensure requirement added by this act. Further
precludes the Director of the DMHC from enforcing these
provisions.
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Notwithstanding the exclusive enforcement authority,
requires the Insurance Commissioner and the Director of
DMHC to share information with regard to investigations,
discipline and enforcement of violations.
Provides that this Act shall not affect the application or
enforcement by the Director of the DMHC of standards and
requirements imposed on solicitors established in state
law, or any other provision of the Health and Safety Code
that relates to solicitors and that is not intended to
supersede any other requirement or regulation that applies
to solicitors or solicitor firms.
Specifies that nothing in the bill shall apply to
qualifications for navigators to conduct public education
activities to raise awareness of the availability of
qualified health plans.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, a consumer's purchase of health
insurance, whether a health insurance product or a health
plan, is a serious matter with serious consequences. For
this reason, consumers need a basis for confidence in those
persons selling health plans. All 49 other states require
that only licensed agents sell health insurance products or
health plans. In California, one must be a licensed agent
in order to sell health insurance products, but there is no
such requirement for health plans.
Senate Bill 615 would address the licensure gap of
California law by requiring all persons who transact health
plan and related products to be licensed by CDI as an
accident and health agent. The author contends that the
bill would also provide the same protections to those in
the health maintenance organization (HMO) marketplace as
currently provided to consumers purchasing other types of
health insurance.
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Agents versus brokers
Health insurance agents and brokers, collectively called
"producers" by insurance companies, assist consumers and
small employers in choosing and enrolling in health
insurance products, and are licensed and regulated by the
states. An agent is an individual or company who acts on
behalf of the health plan or insurer to market, sell, and
service insurance. The agent has a contract with the plan
or insurer in order to transact this business and has a
fiduciary responsibility to the plan or insurer. In
comparison, a broker is a person who also contracts with
health plans or insurers, but officially acts on behalf of,
and has a fiduciary responsibility to, the client.
All 50 states have licensure requirements for individuals
selling insurance products. Licensure also provides a
process for consumer complaints, and allows the Insurance
Commissioner to ensure that anyone not meeting state
licensure requirements be disciplined or have his or her
license revoked.
According to the Bureau of Labor Statistics, there were
approximately 434,800 agent and broker jobs across the U.S.
in 2008, with about 73 percent being independent, meaning
that they are either self-employed or working for an
independent agency or brokerage, and about 21 percent being
captive agents that are direct employees of a plan or
insurer. The remainder work for banks and other financial
services companies that have an insurance business segment.
Captive agents may also receive a salary, but all agents
and brokers are generally paid sales commissions that are
usually higher in the first year of a new sale. Although
commissions on subsequent years are generally lower than
the first year, the agent or broker continue to accrue
commissions each year the individual or family remains
enrolled. A recent article in Kaiser Health News noted
that plans and insurers tend to directly compensate agents
and brokers, usually paying six to eight percent of annual
premiums in the plan's first year as agent commissions, and
four to six percent of premiums in subsequent years in the
large group market. In the individual market, first-year
commissions are typically higher, and can be as high as 20
percent of the annual premium.
California law requires insurance agents and brokers, in
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general, to be licensed and regulated by the state.
California law also requires insurance products be marketed
and sold by licensed agents or brokers. State law also
requires agents and brokers to be knowledgeable and
ethical, to take continuing education courses, and to meet
minimum licensure standards, both initially and ongoing.
According to CDI, it currently licenses approximately
203,000 accident and health agents. State law does not
currently allow for the licensure of health insurance
brokers.
Health insurance in California
The business of health insurance in California is subject
to a complex patchwork of federal and state regulations.
Different rules apply, depending on whether insurance
coverage is purchased directly by individuals or on behalf
of a group, as in job-based health insurance. Among groups,
rules differ depending on group size.
California has a bifurcated legal and regulatory system for
health insurance products. Regulation and oversight of
fully insured employee health benefit plans is split
between two state departments, CDI and DMHC. DMHC
primarily regulates HMOs under the Knox-Keene Act, but also
has jurisdiction over some Preferred Provider Organization
(PPO) plans. CDI has jurisdiction over all other types of
health insurance, including plans that offer traditional
health insurance products, such as indemnity plans, and
some PPO plans. Some companies have subsidiaries licensed
by both departments, which adds to the complexity that
confronts consumers. The two regulatory models, and their
deficiencies and strengths, are the result of history,
changing political circumstances, and sweeping marketplace
trends over a half-century.
According to a July 2003 California Health Care Foundation
report, the two departments approach regulation from
different legal and regulatory perspectives. DMHC focuses
on the accessibility and adequacy of health plan provider
networks; internal quality systems; health plan financial
solvency; consumer rights and disclosure requirements; and
complaint resolution, including complaints related to the
adequacy of the care provided. CDI focuses on the
financial ability of insurers to pay claims; market
conduct; consumer rights and disclosure requirements; and
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consumer complaints, primarily related to the payment of
claims. CDI has no legal authority to resolve complaints
related to the quality of care. A key distinction between
the two regulatory approaches is that the Knox-Keene
regulatory framework is based on direct involvement of the
health plan in providing or arranging for the delivery of
health services. The insurance regulatory framework, in
contrast, focuses primarily on a system of payment or
reimbursement for services once they have been delivered.
Impact of federal medical loss ratio requirements
PPACA requires health plans and insurers offering coverage
in the large group market to meet a medical loss ratio
(MLR) of 85 percent, and health plans and insurers offering
coverage in the small group market or in the individual
market to meet a MLR of 80 percent, or such higher
percentage as a state may by regulation determine. The
amount of money that a health plan or health insurer spends
on medical care versus administrative expenses and profit
is referred to in the health care industry as a MLR, or a
minimum loss ratio.
According to the October 2010 report by the Congressional
Research Service, the federal MLR provisions in PPACA may
provide an incentive for health insurance companies to
reduce their compensation to, and use of, agents and
brokers as they seek to reduce their administrative costs
in relation to their medical costs. Moreover, the MLR
requirements will place downward pressures on
administrative expenses, including the use of insurance
agents. This provides an incentive for insurance companies
to cut back on the use of agents or reduce their
commissions in order to rein in their administrative
expenses, as has occurred recently. Insurance commission
schedules that took effect this year sliced commissions by
as much as half.
State health exchanges
PPACA requires each state, by no later than January 1,
2014, to establish an American Health Benefit Exchange that
facilitates the purchase of QHPs, and provides for the
establishment of a Small Business Health Options Program
(or SHOP Exchange) that is designed to assist small
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employers in facilitating the enrollment of their employees
in QHPs offered in the small group market in the state.
Pursuant to federal and state law, the Exchange is also
charged with several duties, including screening and
enrolling individuals in other public programs,
establishing a toll-free hotline and website, assigning a
quality and price rating to each health plan, granting
exemptions from the federal requirement to have health
insurance, providing an online calculator to determine the
actual cost of coverage after federal tax subsidies are
considered, and awarding grants to navigators to conduct
public education and facilitate in QHPs.
State exchanges represent a new market for health insurance
agents. However, their role in the exchanges is not
guaranteed by law, and other information sources, such as
the mandated consumer web portal, could provide
alternatives to the traditional relationship between agents
and health insurance consumers. The exchange is intended to
standardize information on insurance options and to provide
independent help for prospective enrollees in the form of
navigators. Given the role and duties of the exchange to
make it easier to shop for different health insurance for
individuals and small employers, the exchange itself may
reduce the demand for assistance from agents and brokers.
California was the first state in the nation to pass
legislation to establish a state exchange. Currently, four
out of five Exchange board members have been appointed.
Although the fifth member has yet to be named, the Exchange
board conducted its first meeting on April 20, 2011.
Federal guidance on state exchanges and navigators
According to the White House website on health reform, the
navigator provisions in PPACA will be implemented by the
federal Health and Human Services Agency (HHSA) as part of
its overall implementation of state health insurance
exchanges. HHSA issued a request for information (RFI) in
August, 2010. In this RFI, the HHS Office of Consumer
Information and Insurance Oversight (OCIIO) noted that the
navigator standards would be developed by the HHS Secretary
in collaboration with states. OCIIO specifically sought
comments on the types of consumer education and outreach
states expected to conduct, the types of federal supports
that would be useful, and the extent to which existing
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state programs could be adapted to perform navigator
functions. OCIIO also sought input on how to coordinate
Exchange outreach with outreach for other forms of public
assistance.
In addition, HHSA has released initial guidance on state
exchanges. The guidance stated that the first Notice of
Proposed Rulemaking, which will address many of the basic
federal requirements, is scheduled for publication in the
spring of 2011. Additional federal regulations are
scheduled for publication later in 2011 and in 2012.
Other federal efforts
Introduced by Representatives Mike Rogers (R-Michigan) and
John Barrow (D-Georgia), the U.S. House of Representatives
is expected to consider a bill this year (H.R. 1206) that
would exempt insurance agent and broker's commissions from
being classified as administrative costs under federal MLR
rules.
Related legislation
SB 51 (Alquist), among other things, would require health
plans and insurers to meet federal MLR requirements in
certain provisions of the federal health care reform law,
as specified. Pending hearing in Senate Appropriations
Committee.
AB 736 (Calderon), among other things, would authorize a
person licensed to transact accident and health insurance
to be an agent, a broker, or both, and removes the
restriction that a life licensee only be a life agent.
Pending hearing in Assembly Appropriations Committee.
Prior legislation
SB 900 (Alquist), Chapter 659, Statutes of 2010,
established the Exchange as an independent public entity
within state government, required the Exchange to be
governed by a board composed of the Secretary of California
Health and Human Services, or his or her designee, and four
other members appointed by the Governor and the Legislature
who meet specified criteria.
AB 1602 (J. Perez), Chapter 655, Statutes of 2010,
specifies the powers and duties of the Exchange, including
directing the Exchange board to establish the navigators
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program to conduct public education and facilitate
enrollment in QHPs.
AB 720 (De Leon), Chapter 270, Statutes of 2007,
establishes two new insurance agent license types, a
life-only agent license and an accident and health agent
license, in place of the current life agent license
allowing the licensee to transact both life and
disability/health insurance. Defines the authorities of
each license type, and specifies the requirements for
licensure and post-licensing continuing education, as
specified.
AB 393 (Scott), Chapter 321, Statutes of 2000, requires
insurers to comply with the insurance agent licensing laws
with regard to employees or contractors who solicit,
negotiate, or effect insurance; prohibits a person from
soliciting, negotiating or effecting contracts of insurance
without a valid license; and, creates a personal lines
broker-agent license and a credit insurance agent license.
Arguments in support
According to the California Association of Health
Underwriters (CAHU), co-sponsor of SB 615, PPACA requires
that all navigators be trained and licensed, if
appropriate, to enroll individuals and small groups in the
Exchange. The Insurance Commissioner currently regulates
the specific curriculum for a health and accident insurance
license, as well as the institutions that provide the
actual courses. The current requirement is 20 hours of
pre-licensing course work and an additional 12 hours of
ethics and code. In addition, the applicant must complete
an exam administered by the Insurance Commissioner and pass
a background check. This ensures that all applicants
actually have the requisite knowledge to place an
individual or employer in a health insurance product and
are in compliance with the consumer protection
requirements. Everything is already in place to provide
the necessary training and licensing as required by the
PPACA
The National Association of Insurance and Financial
Advisors (NAIFA), also a co-sponsor, states the bill will
ensure that consumers receive the best possible services
when they are purchasing health care coverage. SB 615 will
require that all persons who sell any health care coverage
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- whether an insurance policy or a health plan - must be
trained and licensed, and will conform California law to
the licensing requirements of the other 49 states - all of
which require (unlike California) a license to sell health
plans. NAIFA also indicates that purchases of health care
coverage are life-impacting acquisitions, so it is
essential that consumers be secure in the knowledge that
the persons who are facilitating the purchase be competent
and accountable for the advice they give to consumers. SB
615 will prevent the nightmare scenario of a consumer being
sold useless insurance coverage by someone who bears no
accountability for that transaction.
Insurance Brokers & Agents of the West (IBA West) supports
the bill, stating that many large health plans require
licensees to sell HMO products, and that such a requirement
is good consumer protection, as most consumers do not
readily understand the difference between PPO and HMO
products. Insurance professionals provide a valuable
service in assisting their customers in choosing from both
traditional insurance products and HMO plans.
Arguments in opposition
Health Access argues that it is unclear what problem is
being fixed by SB 615, and states that requiring health
plans regulated by DMHC to use licensed agents or brokers
who are regulated by CDI would be a "recipe for regulatory
confusion about which department has responsibility."
Health Access further notes the CDI has no expertise in the
requirements of the Knox-Keene Act, which Health Access
states is as a very different body of law than the
insurance law. Health Access states that it would support
requiring solicitors regulated by DMHC to have regulatory
standards and training comparable to the standards and
training for insurance agents and brokers, but since the
Knox-Keene Act includes tough standards for marketing as
well as tough scrutiny of marketing materials, Health
Access is opposed to SB 615 unless it is amended to require
that agents and health insurers are subject to the same
marketing standards and scrutiny of marketing materials
that is currently required for health plans and their
solicitors.
The 100% Campaign, a coalition to increase health access
for children which includes the Children's Partnership,
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PICO California, the California Children's Health
Initiatives, Children Now, the Children's Defense Fund -
California, and the United Ways of California, states that
this legislation could unnecessarily restrict the ability
of Californians to access health insurance coverage through
managed care plans, and believes the bill fails to
sufficiently consider opportunities that will be available
as California implements PPACA and its Exchange. The 100%
Campaign states California is moving quickly to implement
PPACA by expressing its interest in creating a "culture of
coverage" and by establishing the first-in-the-nation
Exchange under PPACA. This will require moving roughly 4.7
million Californians into health coverage, either through
Medi-Cal or coverage delivered through the Exchange by
2014. The Campaign asserts most of these newly eligible
Californians will be enrolled in health plans, and it is
important not to impede efforts to provide consumers with
information in this process.
The Congress of California Seniors (CCS) argues that, under
current law, insurance agents and brokers sell health
insurance coverage that does not include maternity
coverage, and then directs those consumers who become
pregnant to public programs. CCS states that this is
deliberate steering of consumers to public programs, and
the compensation of agents and brokers must be designed to
eliminate or minimize steering of risk that tends to reward
adverse selection against the Exchange. If insurers or
plans are allowed to pay agents and brokers better for
healthier patients than the Exchange pays, then agents and
brokers will face significant finical incentives to steer
risk.
The California Pan Ethnic Health Network (CPEHN) states
that recent estimates suggest that more than two-thirds of
the subsidized individual enrollees in the Exchange will be
persons of color and that about a third will have limited
proficiency in English. CPEHN argues for provisions
specifically addressing the need for cultural and
linguistic expertise if the needs of California's
ethnically and linguistically diverse population is to be
adequately served.
Local Health Plans of California argues that the
requirement to use licensed agents would disproportionately
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hurt non-profit health plans, such as the local
initiatives, which may wish to participate in California's
Exchange. Local health plans currently do not use licensed
agents, and SB 615 would place them at a disadvantage with
commercial plans that already have these relationships in
place. Additionally, the fees that must be paid to
licensed agents can be absorbed by multi-state, for-profit
health insurers, but are unsustainable for non-profit
health plans.
COMMENTS
1. Should all health coverage be purchased through an
agent? Agents and brokers provide a service to those
seeking to purchase individual or group health coverage
products. Agents and brokers serve as the de facto
benefits offices for many small businesses, providing firms
with a range of services, including assistance with health
insurance, disability coverage, life insurance, and other
ancillary lines of coverage. Many businesses rely on
agents and brokers to sort through their health coverage
options, provide health plan recommendations at the time of
renewal, and serve as their agent in dealing with insurers.
However, over time, internet portals and general education
efforts associated with the Exchange and health reform
undertaken by governments and many other stakeholders will
provide purchasers with more information to make decisions
about their health care coverage. Although there continues
to be a role for agents and brokers, it is unclear why an
educated consumer or employer should not be allowed to
purchase health coverage directly without going through an
agent.
2. Implications for county eligibility workers, certified
application assistors, and Maximus employees processing
applications for state-funded programs. California has a
diverse set of local and regional education, outreach and
enrollment networks, varying substantially across
communities, including county social service offices, local
initiatives, community clinics, consumer organizations,
health insurance agents, hospitals, local health plans,
legal service providers, and other providers of care.
Currently, many such entities employ individuals to help
families and consumers access health care coverage,
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particularly for local and state coverage programs such as
Healthy Families and Medi-Cal Managed Care. It is unclear
if such individuals would be required to be licensed agents
under SB 615.
3. Role of agents in PPACA unknown. PPACA establishes a
federal role in developing standards for agents in the
exchanges by requiring that the Secretary promulgate
procedures under which a state may allow agents to enroll
individuals and employers in QHPs and assist eligible
individuals in applying for premium tax credits and
cost-sharing reductions for plans sold through an exchange.
PPACA also requires that the Secretary promulgate
regulations establishing criteria for the certification of
health plans as QHPs, including marketing requirements.
Thus, federal standards for agents may be established by
regulating how QHPs use them for marketing purposes. A
state may also establish additional rules for its exchange,
but the state rules may not conflict with or prevent the
application of regulations promulgated by the Secretary.
The federal guidelines in this area are not expected to be
published until sometime in 2011, possibly 2012.
4. Definition and regulation of navigators unknown. In
addition to pending federal guidance further defining the
roles of navigators and agents related to the Exchange and
QHPs, the Exchange itself has not yet been established.
Furthermore, AB 1602 (J. Perez) directs the Exchange Board
to determine the requirements and roles of navigators. It
is not clear at this point whether and how the role of the
navigator differs from that of an agent, particularly in
relation to the Exchange.
5. Should agents have a primary fiduciary responsibility
to the consumers instead of the plan or insurer? Advocates
argue that the first duty of any individual or entity
selling coverage should be to the consumer, not to the
insurer or the health plan and that this should be the
standard applicable to insurance licensees. Under SB 615,
the duty of an accident and health agent continues to be to
the plan or insurer he or she represents.
6. Ensuring adequate training. Advocates have raised
concerns that the training requirements of insurance agents
are centered on commercial insurance products. If brokers
and agents are intended to transact coverage in the
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Exchange, it may be appropriate to require them to be
trained in public programs, in a manner that matches the
training currently provided with respect to insurance.
Further, if agents and brokers are authorized to provide
assistance within the Exchange along with navigators, it
may be possible to have a misalignment in training between
two groups providing similar services to the same
population.
7. Clarifying amendment. Recent amendments exempt
navigators from the provisions of the bill, but the
amendment that was drafted provides a more narrow exemption
than intended, by only applying to navigators in the
context of providing public education activities to raise
awareness of the availability of QHPs.
a. On page 4, lines 37, strike-out:
"paragraph (1) of"
POSITIONS
Support: California Association of Health Underwriters
(co-sponsor)
Insurance Brokers & Agents of the West
(co-sponsor)
National Association of Insurance and Financial
Advisors-California (NAIFA) (co-sponsor)
Oppose: 100% Campaign
American Federation of State, County and
Municipal Employees
California Children's Health Initiatives
California Pan-Ethnic Health Network
CALPIRG
Children Now
Children's Defense Fund California
Community Health Councils, Inc.
Congress of California Seniors
Consumers Union
Health Access California
Local Health Plans of California
PICO California
The Children's Partnership
United Ways of California
Western Center on Law and Poverty
STAFF ANALYSIS OF SENATE BILL 615 (Calderon) Page
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