Compliance Reminders for Agents and Brokers

Please take a moment to read the below consent and application review documentation requirements for agents and brokers. 

The Centers for Medicare & Medicaid Services (CMS) would like to provide the following reminders about Marketplace requirements to agents and brokers:

Agents, brokers, and web-brokers are required to document the receipt of consent from the consumer or their authorized representative prior to providing enrollment assistance to clients. This requirement includes, but is not limited to, conducting searches for consumer applications using an approved Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE) website, helping consumers apply for financial assistance or enroll in a Marketplace Qualified Health Plan (QHP), or calling the Marketplace Call Center to ask about the status of a Marketplace enrollment or to make changes to an application.

Agents, brokers, and web-brokers are also required to document that eligibility application information has been reviewed by and confirmed to be accurate by the consumer or their authorized representative prior to submitting an application. 

• The documentation that a consumer has reviewed an application prior to submission must include: (1) the date the information was reviewed; (2) the name of the consumer or their authorized representative; (3) an explanation of the attestations at the end of the eligibility application; and (4) the name of the assisting agent, broker, or web-broker.
• The documentation of consumer consent must include: (1) a description of the scope, purpose, and duration of the consent; (2) the date consent was given; (3) the name of the consumer or their authorized representative; (4) the name of the agent, broker, web-broker, or agency granted consent; and (5) a process through which consent may be rescinded.
• The documentation must be maintained for a minimum of 10 years and provided to CMS upon request.

CMS has developed an optional model consent form that agents, brokers, and web-brokers may use to document consumer consent. The form can be found here.

Agents and brokers and any third party with which they have entered into a business relationship (e.g., for purposes of generating leads) may not release, publish, or disclose consumer PII to unauthorized personnel and must protect this information in accordance with federal laws and regulations regarding the handling of PII. 

Agents and brokers who are aware of others conducting a search for consumer applications using approved DE/EDE websites, enrolling consumers, making unauthorized changes to consumer applications without their explicit consent, or inappropriately accessing CMS systems, should report it to the Agent/Broker Email Help Desk at This email address is being protected from spambots. You need JavaScript enabled to view it.. 

For more information about maintaining compliance with Marketplace requirements, see these resources:

• Consent and Application Review Documentation Requirements FAQs
• Agent/Broker Frequently Asked Questions (FAQs)
• Understanding the Agent/Broker Agreements (Webinar Slides)
• Marketplace Compliance and Agent/Broker Regulations (Webinar Slides)

Have questions? Call us at 866-568-9649!