If you’re an agent participating in the HealthSherpa Enrollee Assistance Program (EAP), you’re required to collect and provide consent prior to submitting the consumer’s policy to HealthSherpa. This guide will help you ensure you meet all necessary requirements for consent documentation and retention as you assist consumers with enrollment, in accordance with (45 CFR § 155.227). All consent documentation records must be retained for a minimum of ten (10) years.
In this article, we’ll cover:
Consent overview
According to CMS, "consent" includes two parts:
Consumer Consent indicating a consumer has granted permission for an agent to provide assistance with their Marketplace enrollment, and
Eligibility Application Review detailing application data and plan selection have been reviewed and approved by the consumer, and attestations have been shared.
Consumer Consent indicates a consumer has granted permission for an agent to provide assistance with their Marketplace enrollment. Consumer Consent is required before collecting a consumer’s PII in order to provide a quote, search the Marketplace on behalf of a consumer, check the status of a consumer's coverage, help a consumer apply or enroll, or make any updates to a consumer’s application.
Eligibility Application Review is the piece of consent that details application data and plan selection have been reviewed and approved by the consumer, and attestations have been shared. An eligibility application review is required for new applications when making new plan selections or updating existing applications.
Key components of consent documentation
In the HealthSherpa EAP Shared-Service Model, agents are responsible for collecting and uploading consent authorizing them (the agent) and HealthSherpa to provide support before they proceed. EAP consent documentation checklist.
Consumer Consent
Consumer Consent documentation must include:
Date consent is given by the consumer
Name of the consumer
If consent is granted by an authorized representative, include documentation of said authorization and the authorized representative’s relationship to the consumer
If consent is granted on behalf of minors or other adult dependents, additional documentation is not required
Name of agent or agency being granted consent
If consent is granted to multiple individuals within an agency, without naming the agency, all individuals must be listed
Consent to search for existing Marketplace application
Consent to complete/update application on behalf of consumer
Consent to submit application on behalf of consumer
Description of scope, purpose, and duration of consent provided by the consumer
The process through which the consumer may rescind such consent, which includes mention that it can be done at any time
Consent to provide ongoing maintenance (i.e. updates to application or plan selections)
In the event there are any application changes, agents must collect new Consumer Consent & Eligibility Application Review documentation from the member for each additional change
Written signature, e-signature, or verbal consent of consumer
Consumer Consent documentation for enrollments submitted using HealthSherpa’s Enrollee Assistance Program must also include:
Consumer acknowledgement that the enrollment will be submitted with a HealthSherpa National Producer Number
A list of the potential HealthSherpa National Producer Numbers which may be appended to the enrollment
Consumer acknowledgement that the enrollment is still accessible and serviceable by the agent
Eligibility Application Review
Eligibility Application Review documentation must include:
Date information was reviewed by the consumer
Name of the consumer
If consent is granted by an authorized representative, include documentation of said authorization and the authorized representative’s relationship to the consumer
If consent is granted on behalf of minors or other adult dependents, additional documentation is not required
Attestation that the consumer has reviewed the application and has confirmed its details (e.g. household members, income reported, coverage status) to be accurate
Attestation that the consumer acknowledges all attestations at the end of the Eligibility Application (e.g.non-Medicaid coverage, automatic termination of Marketplace coverage if duplicate coverage is detected, accuracy of application, consumer’s responsibility to update the application, Healthcare.gov’s non-discrimination policy)
Attestation that the consumer has reviewed the plan information and confirmed accuracy (e.g. issuer, plan name, start date, members enrolled, premiums)
Written signature, e-signature, or verbal consent of consumer
Additional recommendations
While not required, additional recommendations for maintaining comprehensive consent documentation include:
Agent or agency contact information
Consumer contact information
Data Matching Issues (“DMIs”) presented in eligibility letter, and any steps taken to resolve said DMIs
Communication records
Document how the agent obtained consumer information, engaged in outreach, and any communication receipts between the agent and the consumer.
Methods of consent documentation
There are no explicit requirements for how you document consent; however, it’s a best practice to maintain comprehensive, consumer-driven records. It’s important to note that one document can be used to satisfy both the Consent Review and Application Review portions of this requirement, but it must contain all components listed above and has two sections that distinguish between Consent Review and Eligibility Application Review.
To ensure complete and compliant records, documentation should include both agent engagement and a clear, explicit confirmation indicating approval from the consumer. Documentation without the consumer’s approval or response will not meet EAP consent requirements. Note: Documentation which only requires the consumer to check a box or fill out a form without agent engagement to confirm that they provided consent is unlikely to meet the requirements. Learn more about acceptable forms of consent here.
Methods of obtaining consent documentation include verbal (i.e. recorded phone call) and written. Note: Agents are not currently able to email a digital consent form to clients or text a consent form to clients directly from HealthSherpa when using the HealthSherpa Enrollee Assistance Program.
Verbal documentation
Record the entire call, including the complete sales process.
If the entire call cannot be recorded, verbal records meeting all consent documentation requirements should be recorded at a minimum.
Written transcriptions do not meet verbal consent requirements.
Written documentation
Written documentation must meet all consent documentation requirements
Feel free to utilize HealthSherpa’s Enrollee Assistance Program Standard Consent Form. Please note that this form only meets the Consumer Consent requirement and does not meet the requirement for Eligibility Application Review.
If electronic signatures are collected, supporting documentation which shows that the consumer took action to sign must be provided (e.g. date, time, IP address, device used by the consumer to sign).
Emails or text messages used as written documentation must show communications from the consumer responding to a communication from the agent, and must meeting all consent documentation requirements
Additional Resources
If you are having any technical issues using HealthSherpa, please contact our Agent Support team at (888) 684-1373, at agent_support@healthsherpa.com, or via chat from within your account.
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