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Brokers & Agents

What does it mean to me?

Information for you and your clients

The Affordable Care Act was signed into law on March 23, 2010, and many of the major provisions impact the private health insurance industry.  The foundation of the ACA requires every American to carry health insurance or face a tax penalty.

Brokers were not immune to ACA changes. In fact, you are required to take training courses and obtain a CMS certification to sell products on the state exchange. We will continue to review ACA regulations and new rules as the final provisions go into effect, and post relevant frequently asked questions so you can better understand what healthcare reform changes to expect.

HCR Broker ToolkitBlue Cross of Idaho created an ACA toolkit specifically for brokers. Please select the image on the left to download this important resource guide. We also have a dedicated web portal for brokers. Please visit to register. You have access to a wealth of information, including a quoting tool, forms and you can track a client’s application status.

The following questions and answers are informational and not the equivalent of legal advice. Consult legal and tax experts to understand how the law will affect your individual or business circumstances.

Questions and Answers

How does the ACA impact my clients who are Blue Cross of Idaho members?

Any client who does not carry a qualified health plan (QHP) faces a penalty. This is called the individual mandate. In 2014, the penalty is $95 for adults at $47.50 for children or 1 percent of family income, whichever is greater. The penalty increases over the next two years.

Besides the individual mandate, the ACA changed the types of plans you can sell, provides more options for your clients and created a marketplace for Idahoans to purchase health insurance. You may have clients that have a grandfathered health plan. This means he/she bought a plan before March 23, 2010, and it avoids some of the requirements of the ACA.

If your client purchased a plan after March 23, 2010, their plan is non-grandfathered. Idahoans were allowed to keep a non-grandfathered plan through 2014. Now is a great time to check with your clients who kept their plans. They may want to purchase a new qualified health plan during the upcoming open enrollment.

If you have any more questions about impacts to your clients, please review the Broker Tool Kit, or call your local district office at 800-365-2345.

How did the ACA change the role of brokers and agents?

The ACA requires all brokers to create a user ID, take online training and get certification through CMS to sell insurance on the Idaho Health Insurance Exchange. You can access this training at If you want to continue to sell Blue Cross of Idaho products on or off the exchange, it is important you complete this certification process.

Blue Cross of Idaho relies on the Idaho Department of Insurance as the system of record to determine broker certification. Please double check that you completed all the state requirements, and the system lists you as a certified broker. We cannot pay your sales commission for any QHP — no matter if you sell on or off the exchange — if you are not a certified broker.

To ensure your certification, please check the Idaho Department of Insurance’s Health Insurance Exchange certification list at If you are not certified, or your name does not appear as certified, please contact the Idaho Department of Insurance.

Blue Cross of Idaho offers short training sessions to help you learn more about our products and services, the ACA and its impact on your individual and group lines of business. You can access the training here:

How have insurance plans changed?

All plans sold with effective dates on or after January 1, 2014 must cover essential health benefits in the following categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services

Special enrollment and qualifying events

While the open enrollment period ended on March 31, there are life events that allow people to enter a special enrollment period (SEP). We have listed some of the more common events that trigger an SEP, allowing your clients to change or purchase a new QHP. This information is a general overview of the rules and regulations. It may not address every specific situation you face with a client, and is not intended to be legal advice.

Qualifying events:

  • Marriage
  • Birth/adoption/placement of foster child
  • Loss of minimum essential coverage
  • Covered dependent turns 26
  • Death of a subscriber
  • Divorce of a subscriber
  • Change in work hours causes a loss of eligibility for employer coverage
  • Loss of employer-provided coverage
  • New citizenship
  • Change in or loss of subsidy eligibility
  • Moving to a new service area
  • Member with catastrophic coverage turns 31
  • Individual policy renewal