"United Healthcare’s pullout from the Georgia exchange “will be disruptive for consumers who are currently enrolled in a United plan and will need to switch during open enrollment,’’ said Cindy…
With the changing healthcare landscape, there are new words and phrases that the average consumer is unfamiliar with. Navigators….Certified application counselors (CACs)….and even Marketplace. As consumers try to gather as much information as they can to make informed health care decisions, Georgians for a Healthy Future will continue to demystify the changes and provide you the information you need to make the right decision for you and your family.
According to the Department of Health and Human Services (HHS), a navigator is defined as, “An individual or organization that’s trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.”
HHS allocated $3.8 million for navigator grants in Georgia; grants have been awarded to the University of Georgia, Cooperative Extension Services, and the Structured Employment Economic Development Corporation (SEEDCO).
The Human Resource Service Administration (HRSA) has also awarded $3.4 million in grants to federally qualified health centers (FQHCs) in Georgia for outreach and enrollment.
All navigators must:
CERTIFIED APPLICATION COUNSELORS:
According to HHS, a certified application counselor is, “An individual (affiliated with a designated organization) who is trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including helping them complete eligibility and enrollment forms. Their services are free to consumers.”
If your organization is a community health center or other health care provider, hospital, a non-federal governmental or non-profit social service agency, and your organization would like to help by training your staff to assist people applying for coverage through the Marketplace, you can apply to be a Certified application counselor (CAC) organization.
Check out the Center for Medicaid and Medicare Services (CMS), Common Questions and Answers on Designation of CAC Organizations in Federally-Facilitated Marketplaces for more guidance.
There are two main differences between CACs and Navigators.
- Funding: Navigators are specifically funded through either HHS or HRSA grants. CAC designated organizations and individual CACs will not be funded through the Marketplace. They may seek funding from outside sources, such as other available federal, state, or private funds.
- Roles and responsibilities: See chart below for activities and responsibilities for navigators, CACs and agents/brokers.
STATE REQUIREMENTS FOR OUTREACH AND ENROLLMENT ASSISTANCE:
In the 2013 legislative session, HB 198 was passed and signed into law. According to the law, any person serving as either a navigator OR certified application counselor must meet additional state requirements before assisting consumers with the enrollment process. According to Georgia’s Department of Insurance:
Under Georgia law (see H.B. 198) passed by the Georgia Legislature in 2013, Navigators, Certified Application Counselors, and In-Person assisters will need to obtain a license from this office before they begin operating. The functions of Navigators, Certified Application Counselors, and In-Person Assisters vary slightly under federal law. However there are not three separate Georgia licenses. Instead, each of those entities must simply obtain a license as a “Navigator”. http://www.oci.ga.gov/Navigators/
In order to obtain a state license, any person hoping to serve as a navigator, CAC or other outreach specialist who will directly assist consumers with enrollment must meet the following requirements.
Georgia Licensure Requirements:
- Navigators must complete 10 hours of prelicensing training from a state approved course provider and satisfy all federal training requirements. Click here for a list of state-approved course providers. Click here for information about how to obtain the federal training to become a Navigator and for information about how to register with the federal exchange.
- Pass Navigator examination. Contact PearsonVUE to make reservation for examination. Reservations can be made online athttp://www.pearsonvue.com/ga/insurance/ or by phone 1-800-274-0488.
- Submit electronic fingerprints. Fingerprint results are valid for 30 days. Click here for additional details
- Complete form GID369-AL and Citizen Affidavit. Click here to view all forms.
- Submit completed application, affidavit, course certificate and copy of exam results with $50 license fee made payable to Georgia Insurance Department to:
Georgia Insurance Department
P.O. Box 935132
Atlanta GA 31193-5132
THE ROLE OF AGENTS AND BROKERS
According to HHS, “An agent or broker is a person or business who can help you apply for help paying for coverage and enroll in a Qualified Health Plan (QHP) through the Marketplace. They can make specific recommendations about which plan you should enroll in. They’re also licensed and regulated by states and typically get payments, or commissions, from health insurers for enrolling a consumer into an issuer’s plans. Some brokers may only be able to sell plans from specific health insurers.” https://www.healthcare.gov/glossary/broker/
Their services are free to consumers.
See the chart above for roles and responsibilities of an agent or broker. Please also note that agents and brokers can also be CACs.