Re-visiting the primary functions of Health Insurance Exchanges navigators
Accessibility and affordability constitute two of the top healthcare insurance concerns that consumers cite as obstacles to getting insured. The Affordable Care Act that was proposed to tackle these two chief problems, made provisions in the health insurance exchanges to help individuals gain insurance easily.
Through a network of exchange navigators,
brokers and agents, community outreach managers, the health insurance exchange administrators can assist health insurance consumers’ access accurate and relevant health coverage related information and enroll in the best fit health insurance plan.
Health insurance exchange navigators can be a team or network of qualified agents, brokers, and community workers, etc., who would be responsible for providing technical support and guidance to exchange consumers to ensure a smooth insurance enrollment experience to these customers. The Exchange navigators would be responsible for carrying out several important tasks
• Individuals, employers and employees looking to participate in the health insurance exchange or SHOP exchange would need to ensure that they meet the eligibility criteria for participating in the insurance exchanges and health plans. Navigators would be responsible for submitting eligibility determination forms and initiating exchange enrollment process, as applicable, on behalf of the exchange applicants. They would also be responsible for providing all the supporting exchange qualification documents on behalf of the applicants
• If it so happens that the individual or employer is dissatisfied with the Exchange eligibility criteria, individuals or employers can appeal again for reconsideration. Navigators would be responsible for initiating these eligibility appeals
• Navigators would also be responsible for providing accurate, necessary and relevant information to candidates to help them enroll in the best fit health plan or service. The health insurance exchange navigators would be responsible for providing all necessary information on behalf of the consumers as may be required for completing plan enrollment for a consumer
• Once enrolled, a navigator may be responsible for updating all consumers’ exchange profile in case of the event of important life changing events or other changes
• The navigator would also be responsible for managing the consumers’ application and inform both the Exchange and the health plan in case a consumer opts to dis-enroll from a plan. Navigators would be responsible for any renewals or plan upgrades requests that the consumers submit.
• For any other requests, such as, applying for exemption from individual responsibility requirements etc., consumers can interact with navigators and seek their help and guidance.
A health exchange navigator would serve as an intermediary between the Exchange and the health insurance exchange consumers. With a strong, reliable and expansive navigator network, health insurance exchange managers can help make health insurance application process easier for consumers and help increase accessibility to health insurance for millions of uninsured health consumers.
