CMS outlines federal HIX enrollment, customer service

By Anthony Brino
04:35 PM

CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) is giving insurers and other stakeholders a more detailed picture of the federally facilitated health insurance exchanges that will be set up in 26 states.

In a guidance letter published earlier this month, CCIIO outlined the federal exchange’s plans for essential health benefits compliance, rate review, health plan certification and — two of the largest IT challenges — enrollment and consumer service.

In addition to regulating health plans sold on the federal exchanges, CCIIO has a fairly mammoth task in managing the front and back ends of the exchange websites, identification and premium eligibility determination.

CCIIO officials have established a tentative consumer enrollment process. Individuals applying for coverage will learn their premium eligibility, compare products and select a plan on the federal exchange website. They’ll then be directed to the insurers’ websites, to pay premiums (based on their tax credits) and provide any needed information, like designating a primary care doctor.

On a daily basis, insurers and the federal exchange will share files on enrollments, updates and cancellations, with each consumer having a unique identifier that changes if and when s/he changes health plans. And on a monthly basis, the exchange and insurers will share full enrollment files, to prevent any record discrepancies.

For the federal exchanges’ customer service, CMS will be operating a call center, available in both English and Spanish, that will be a source for mostly basic information about the exchange, directing consumers with more detailed questions to either HIX navigators or the insurers.

While federal and state exchanges will have pretty extensive consumer support — with navigators and in-person assistance designed to serve as consumer advocates and mediators where there are problems — CCIIO is encouraging insurers to plan their own robust HIX customer service.

Insurers selling on the exchange have to publish provider directories and investigate and resolve consumer complaints. And as part of meaningful access provisions, they’re also being required to provide free oral interpretation and written translations for limited English-proficient speakers.

See also:

Consumer interest in HIXs growing, study finds

Arkansas proposes integrating Medicaid, HIX