Health insurance agents would face penalties and customer consent checks

Agents and brokers would face fines for incorrect enrollment information and possible prison time for deliberate fraud. The penalties cover required health enrollment information and other application information specified by federal health officials. Negligence or disregard of federal rules would carry a civil fine of $10,000–$50,000 per affected applicant. Knowingly providing false or fraudulent information would carry a civil fine of up to $200,000 per affected applicant. Knowing and willful violations could bring a criminal fine, up to 10 years in prison, or both.

Federal health officials would require proof of customer consent for covered enrollments and coverage changes. The checks cover federally run marketplaces and submissions by agents or brokers eligible for commissions. Commissions would wait until customers resolve all conflicting application information. Customers would receive timely notices of account changes with instructions for canceling unauthorized activity. The process must protect continued coverage and care, including by preventing removal without consent even when an agent, broker, or insurer violates these requirements. The checks 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 set standards that states use to decide who may help market and enroll people in marketplace health plans. The standards cover agents, brokers, and marketing businesses involved in marketplace enrollment. Participants would register with federal officials, meet applicable licensing and marketing rules, and avoid confusing or misleading practices. Marketing materials would go to federal officials for review and approval as officials consider appropriate. Payments for referrals or related services could go only to people or organizations meeting these standards. Covered marketing businesses would report agent and broker terminations and the reasons to state and federal officials. 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 agents and brokers and refer possible fraud to state insurance departments. The oversight covers agents and brokers involved in marketplace health coverage. Periodic audits would consider customer complaints, enrollment patterns suggesting fraud, and other factors federal officials choose. Officials would share audit results and refer possible fraud to the relevant state insurance department. Insurers, marketplaces, and states would regularly receive lists of suspended and terminated agents and brokers. The audit process would apply to plan years beginning on or after a date federal health officials choose, no later than January 1, 2029.