Date: November 27, 2013
From: Nick Gerhart, Iowa Insurance Commissioner
Subject: Certified Application Counselors in Iowa
The role of enrollment assistance for comprehensive major medical insurance in the State of Iowa has traditionally been provided by licensed insurance agents and producers. With the implementation of the Patient Protection and Affordable Care Act, the types of entities and individuals who may assist the general public in enrolling in health care coverage (prior to age 65) has expanded. As established by federal regulation 45 CFR 155.255, certified application counselors (CAC) were established to assist individuals in enrolling in the Health Insurance Marketplace (Marketplace). While the CACs serve a role in aiding Iowans in enrolling and selecting health care coverage through the Marketplace, the Iowa Insurance Division wants to ensure CACs fully understand their responsibilities and duties in order to remain compliant with applicable federal and Iowa laws.
What does a CAC organization do?
In the state of Iowa, all CACs must be affiliated with a Certified Application Counselor Organization (CACO). As a CACO, your staff and volunteers will help people understand, apply, and enroll for health coverage through the Marketplace. Your organization must agree to make sure that designated individuals complete required training, and that they comply with privacy and security laws, and other program standards.
Your organization must:
1. Ensure the individuals performing the CAC services are trained;
2. Have processes in place to screen your staff to make sure that they protect consumer information;
3. Engage in services that position your organization or CAC individual to assist the people your organization serves with health coverage issues; and
4. Have experience providing social services to the community.
ROLES AND RESPONSIBILITIES OF CACS
Certified ApplicationCounselors will assist individuals enroll in Qualified Health Plans in the Marketplace and assist eligible individuals enroll in Medicaid, Hawk I or the new Iowa Health and Wellness Plan. This includes:
Providing information about insurance affordability programs and coverage options;
Assisting individuals and employees to apply for coverage in a QHP through the Marketplace and for insurance affordability programs; and
Helping to facilitate enrollment of eligible individuals in QHPs and insurance affordability programs.
In the State of Iowa the CAC program is handled by the federal government entirely. Therefore, any individual or entity that violates the newly enacted law provisions may be subject to administrative action including restitution or revocation of licensure or registration. In addition, any person acting in the capacity of a CAC may not violate the provision of Iowa Code 522(B) duties of an insurance agent. Individuals or entities that provide enrollment assistance or selection into a health insurance policy without obtaining a license from the State of Iowa or certification from the federal government will be in violation of 522B.