Federal health insurance marketplaces would require consent checks for broker-assisted signups

Federal health officials would require agents and brokers to document customers' consent. These requirements would apply to federally run health insurance marketplaces. The process would cover new enrollments and coverage changes submitted by agents or brokers eligible for commissions. Commissions would be paid only after customers resolve all application inconsistencies. The requirements would apply to plan years beginning on or after a date federal health officials choose, no later than January 1, 2029.

Customers would receive change notices with plain instructions for canceling unauthorized activity. The process would cover federally run marketplace signups and coverage changes submitted by agents or brokers eligible for commissions. Customers would have access to account details through a customer website or toll-free hotline. The verification process could not remove customers from coverage without their consent, even if an agent, broker, or plan violated its requirements. The process would apply to plan years beginning on or after a date federal health officials choose, no later than January 1, 2029.

Agents and brokers would face civil penalties and possible criminal punishment for incorrect or fraudulent enrollment information. The penalties would cover required enrollment information and other information federal health officials specify. Errors caused by carelessness or disregard of federal health rules would carry civil penalties of $10,000 to $50,000 per affected applicant. Knowingly providing false or fraudulent information would carry civil penalties up to $200,000 per affected applicant. Knowingly and willfully providing false or fraudulent information could bring a criminal fine, up to 10 years in prison, or both.

Federal health officials would set standards states use to decide who may help with marketplace enrollment. The standards would cover marketplace agents, brokers, and marketing businesses involved in enrollment. Agents and brokers would have to act in customers' best interests. Participants would need federal registration and required licenses, follow marketing rules, and avoid confusing or misleading practices. Marketing businesses would report when their arrangements with agents or brokers end. Payments for referrals or related services could go only to people or businesses meeting the marketing, licensing, and registration standards. The standards would apply to plan years beginning on or after a date federal health officials choose, no later than January 1, 2029.

Federal health officials would audit marketplace agents and brokers and refer possible fraud to state insurance departments. Officials would also regularly give marketplace health plans, marketplaces, and states a list of suspended and terminated agents and brokers. Periodic audits would consider customer complaints, enrollment patterns suggesting fraud, and other factors federal health officials choose. Officials would share audit results with state insurance departments. The audit process would apply to plan years beginning on or after a date federal health officials choose, no later than January 1, 2029.