Agents and Brokers
Agents and brokers can help enroll qualified individuals in Qualified Health Plans (QHPs), through the Virginia Health Benefit Exchange at Healthcare.gov. Agents and brokers can assist individuals with applications for advance payments of the premium tax credit and cost-sharing reductions. Agents and brokers can also help employers review their options for enrolling in SHOP coverage and assist them through the application and enrollment process.
Centers for Medicare and Medicaid Services (CMS) Information for Agents and Brokers:
Small Business Health Options Program (SHOP)
Virginia will remain on the Federally-facilitated SHOP during the transition. To participate in SHOP, agents and brokers must complete a Marketplace Learning Management System (MLMS) profile and execute the SHOP Privacy and Security Agreement. Agents and brokers are strongly encouraged to complete the associated training and exams, but it is not required. Review more information about SHOP Registration and Training.
During Virginia’s transition to a State-Based Exchange, agents/brokers will continue to follow the CMS standards for registration and training.
Agents and brokers must:
- Apply for a license in Virginia
- Create a CMS Enterprise Portal account
- Request the FFM Agent Broker role
- Complete remote identity proofing through the Enterprise Identity Management (EIDM) System
- Complete an agent/broker profile on the MLMS on the CMS Enterprise Portal
- Complete Marketplace training on the MLMS or through a Health and Human Services (HHS) approved vendor on the CMS Enterprise Portal.
- Returning Agents and Brokers Guide
- Agents and brokers who completed plan year 2022 Individual Marketplace registration and training will be eligible to complete a shorter training program for plan year 2023, as well as optional review modules. You will be able to take Individual Marketplace training either through the Marketplace Learning Management System (MLMS) or an HHS-approved vendor. No additional state training is required this year.
- New Agents and Brokers Guide
- Agents and brokers who are new to the Marketplace this year, or who did not complete plan year 2022 registration and training, will be required to take the full Individual Marketplace training program for plan year 2023. You will be able to take Individual Marketplace training either through the MLMS or an HHS-approved vendor. No additional state training is required this year.
- Understanding Marketplace Compliance Rules and Regulations
- Returning Agents and Brokers Guide
- Read and accept the applicable Marketplace Agreement(s) on the MLMS.
- Confirm completion of all registration steps by logging back into the “Agent Broker Registration Status” page on the CMS Enterprise Portal and printing your completion certificate.
A web-broker is an individual or group of agents and brokers, or a company that is interested in providing a non-Federally-Facilitated Marketplace (FFM) website. Web-brokers assist consumers in the QHP selection and enrollment process as described in 45 CFR § 155.220 (c) (3).
Web-brokers are required to follow the steps outlined in the “Register and Complete Required Training as an Agent or Broker with the Virginia Exchange” section above.
Web-brokers are required to provide Virginia insurance licensing information to CMS if they intend to assist consumers with selecting and enrolling in QHP’s though the Federally-facilitated Exchange (FFE).
CMS requires agents and brokers to sign a privacy and security agreement with the Federally-facilitated Marketplace during Virginia’s transition to a State-Based Exchange in accordance with 45 CFR § 155.220(d).
Additionally, agents and brokers are required to sign agreements for SHOP with CMS during Virginia’s transition to a State-Based Exchange.
Agents and brokers will not need to sign a separate agreement with the Virginia Exchange during the transition to a State-Based Exchange.