Siga las instrucciones aquí para traducir esta página a otro idioma usando Chrome.
Agents submitting Enrollee Assistance Program (EAP) enrollments using the Shared-Service Model (SSM) are required to document consent and provide the documentation to HealthSherpa.
In this article, we’ll cover:
EAP consent guidelines are not applicable for carrier-specific account or HealthSherpa Enrollee Assistance Full-Service account types.
Consent overview
According to Centers for Medicare & Medicaid Services (CMS), “consent” includes both Consumer Consent and Eligibility Application Review.
Consumer Consent
Consumer Consent
Indicates a consumer has granted permission for an agent to provide assistance with their Marketplace enrollment.
Required before collecting a consumer’s personally identifiable information (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
Eligibility Application Review
Details application data and plan selection have been reviewed and approved by the consumer, and attestations have been shared.
Required when completing new applications, updating existing applications, or when making plan selections.
All consent documentation records must be retained for a minimum of ten (10) years.
Key components of EAP consent documentation
When submitting enrollments through the HealthSherpa Enrollee Assistance Program (EAP) Shared-Service Model (SSM), agents are responsible for collecting consent that meets all of the requirements below.
Use the EAP consent documentation checklist to verify the documentation is complete.
Consumer Consent
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 or 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
Clear authorization that both the agent and HealthSherpa can provide support.
Consumer acknowledgement that the enrollment is still accessible and serviceable by the agent
Consumer acknowledgement that the enrollment will be submitted with a HealthSherpa National Producer Number (NPN)
A list of the potential HealthSherpa National Producer Numbers which may be appended to the enrollment
Written signature, e-signature, or verbal consent of consumer
Eligibility Application Review
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. carrier, plan name, start date, members enrolled, premiums)
Clear authorization that both the agent and HealthSherpa can provide support.
Consumer acknowledgement that the enrollment is still accessible and serviceable by the agent
Consumer acknowledgement that the enrollment will be submitted with a HealthSherpa National Producer Number (NPN)
A list of the potential HealthSherpa National Producer Numbers which may be appended to the enrollment
Written signature, e-signature, or verbal consent of consumer
Per CMS guidelines, documentation must show that the consumer actively took action to provide consent.
Additional recommendations
Additional recommendations
Documentation must show the consumer actively provided consent.
Best practices:
Use tools that include an audit trail (timestamp, IP address, device used).
Include direct communication with the member (email, text, or call recordings).
Use a handwritten signature whenever possible.
Practices to avoid:
Typed names in the signature field with no additional evidence of member action.
Copy/pasted emails or texts into Word or PDF files.
Use of Adobe PDF font-style signatures without an audit trail.
Use of Google or Crackwheel Forms with plaintext signatures or no signature at all.
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
Methods of obtaining consent documentation include verbal (for example, a recorded phone call) and written.
Verbal documentation
Verbal documentation
Verbal documentation must meet all consent documentation requirements.
Record the entire call, including the complete sales process, when possible.
Written transcriptions do not meet verbal consent requirements.
Written documentation
Written documentation
Written documentation must meet all consent documentation requirements
Use HealthSherpa’s Enrollee Assistance Program Standard Consent Form if desired.
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 must show communications from the consumer responding to a communication from the agent.
There are no explicit requirements for how EAP consent is documented as long as comprehensive, consumer-driven records are maintained.
Agents can document consent in the format that works for their process. Consent documentation can be stored as two separate documents, one for each part of the consent process, or as one combined document. If one document is used, it must include all components listed above and clearly separate Consent Review from Eligibility Application Review.
To meet EAP consent requirements, documentation must reflect agent engagement and include a clear, explicit confirmation of approval from the consumer. Documentation without the consumer’s approval or response will not meet EAP consent requirements. Consent documentation that only requires the consumer to check a box or fill out a form, without agent engagement to confirm consent, is unlikely to meet EAP consent requirements.
Collecting consent within the enrollment flow
Agents are required to upload consent documentation in the HealthSherpa for Agents account when submitting Enrollee Assistance Program (EAP) enrollments using the Shared-Service Model (SSM).
Agents can capture consent by emailing or texting a digital form to the consumer, or by uploading proof of consent that has already been documented. Training materials are available for each consent flow.
HealthSherpa also provides a downloadable Enrollee Assistance Program Consent Form that agents can use to capture consent, then upload as proof of consent in the HealthSherpa for Agents account.
There are instances when agents may also see “I already have proof of consent in my own records” displayed as a consent option. If this option is selected, the EAP enrollment will not be processed or be eligible for EAP compensation until proof of consent has been uploaded.
Frequently asked questions
If an agent emails digital consent to a consumer from HealthSherpa, can the agent continue with the EAP enrollment submission before the consumer has completed the consent?
No. If the agent chooses to email digital consent, the consumer must complete and submit the documented consent before the agent can continue with the EAP enrollment submission.
What if an agent sends digital consent to a consumer, but the consumer is unable to complete it, or the agent wants to collect consent a different way?
The agent can change the consent capture method at any time by selecting a different option.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.