Dos and Don’ts of Partnering with Health Insurers on Enrollment Activities

Visit Families USA’s Enrollment Assister Resource Center for more materials to help make this open enrollment a success. 

In addition to typical partners such as community groups, this open enrollment some assister and navigator organizations are coordinating with health insurance companies to improve their outreach to consumers. These partnerships offer many advantages, such as plan benefit information and health literacy resources. However, as this blog explains, assisters should develop partnerships while following existing regulations and ethical guidelines.

Assisters and health insurers can coordinate on consumer outreach and education about health insurance options

By working in partnership with health insurers, enrollment assisters and navigators can benefit in many ways. Chief among these for assisters is having a direct line for quickly obtaining information about the specifics of available marketplace plans. For their part, insurance companies gain access to consumers they might otherwise not have been able to reach. They also gain a broader perspective of how their state’s marketplace is functioning.

Health insurers can add outreach and public education capacity and fill in resource gaps

Assisters face new challenges this year as they deploy limited resources to conduct outreach, enroll new consumers, and help renew coverage for other consumers—all in half the time of last enrollment period. By working with insurers, enrollment assisters will be in a better position to quickly and accurately answer questions from consumers enrolling for the first time and renewing.

Insurers can help assisters with enrollment in the following ways:

• Provide assisters with answers to specific benefit questions: This year, consumers who are already enrolled in health insurance may have complex plan/benefit questions about plan networks, benefit coverage, providers, etc. When assisters have an established relationship with an insurer, it’s easier for them to contact plans with specific questions.
• Help consumers understand notices they are receiving from their health plans: This open enrollment period is the first time that consumers who bought coverage in the marketplaces will have to renew their coverage. They will likely be receiving notices from a variety of places—from insurance companies, the marketplace, and possibly the state’s insurance department. By working together, language can be simplified and enrollment assisters can aid consumers by knowing what information insurers are placing in the notices.
• Provide assisters with health literacy resources:  To keep costs down (and keep their customers), insurers do not want consumers to overuse or under use their health insurance. Many plans have created consumer-friendly materials to help consumers understand both basic health insurance concepts and how to use health care.

Regulations and guidelines to follow when partnering with health insurers

Enrollment assister must follow their state’s rules—and use good judgment—when partnering with insurers. Above all, navigators and assisters must remember their mandate to provide fair and impartial information about health plans. It’s essential to not steer consumers toward a specific plan, or give the impression of it.

At least 19 states have enacted legislation that regulates navigators and assisters within the state. Enrollment assisters should check the rules for the state where they are working. In addition to specific regulations, assisters should follow these guidelines.

Dos and Don’ts for Partnering with Insurers

Do:

• Abide by all terms and conditions of any grants received from CCIIO or your state’s marketplace.
• Know your state’s rules about partnering with insurers. If there are additional conflict of interest or licensure requirements, be sure that any partnership follows those requirements.
• Put protocols in place for working with insurers. Make sure staffers are trained on how to work with insurers and the parameters of such relationships.
• Fulfill all required duties, including public education and outreach. Ensure that any relationship or partnership doesn’t interfere with these duties and responsibilities.Remain impartial and do not favor (or appear to favor) any insurer over another. Any partnerships assisters form with insurers should not create bias or the appearance of bias toward a particular company or product.
• Be fair and impartial. If you are planning an event that will involve insurers, to avoid conflicts of interest, invite all insurers in the state to participate. If there are insurers that aren’t attending your event, ask them for materials that can be distributed. That way, consumers will be able to see information on all the plans that are available.
• Refer consumers to an agent or broker when appropriate.

Do not:

• Work directly for an insurer.
• Receive any kind of payment from an insurer for enrolling consumers.
• Lobby for insurers.
• Provide consumers with gifts, gift cards, or cash worth more than $15.00 from third parties, such as insurers.
• Provide consumers with gifts of any value that market or otherwise promote enrollment with a particular insurer.
• Favor or appear to favor any insurer over another.

With these guidelines, enrollment assisters can think about how to build creative partnerships to expand their reach and enroll consumers in health coverage. Success during this open enrollment period requires an “all hands on deck” effort to ensure that we are all reaching consumers to help them get covered and stay covered.

Next month look for an issue brief from Families USA that describes in more depth the different ways that assisters can work with insurers and offers examples of successful partnerships from the states.