Web-Based Entities

Requirements for Integration of WBEs

The Affordable Care Act allows states to partner with WBEs to support enrollment efforts. In order for web-based entities to interface with a state exchange, the exchange must share the following:

  • Eligibility and enrollment determination services
  • Health plan information data

These communications should be managed through fully secured connections in compliance with regulatory requirements.

45 CFR § 155.220 lays out certain conditions for authorization of WBEs. Of these conditions, three require integration processes between an exchange and WBE systems.

  Regulation Integration Requirement
45 CFR § 155.220(c)(3) "When an Internet Web site of the agent or broker is used to complete the QHP selection, at a minimum the
Internet Web site must:
(i) Meet all standards for disclosure and display of QHP information contained in § 155.205(b)(1) and (c) ; and ...
(iv) Display all QHP data provided by the Exchange;"

Health Plan Information – WBEs will need access to QHP data provided by the state exchange in order to meet standards for disclosure of QHP information.
45 CFR § 155.220(c)(1) "The agent or broker [must ensure] the applicant's completion of an eligibility verification and enrollment application through the Exchange Web site as described in § 155.405;" Eligibility Determination – WBEs will need integration with the state exchange for the purpose of determining eligibility for affordability programs.
45 CSR § 155.220(c)(2) "The Exchange [must transmit] enrollment information to the QHP issuer as provided in §155.400(a) to allow the issuer to effectuate enrollment of qualified individuals in the QHP." QHP Enrollment Transactions – WBEs will need integration with the state exchange for the purpose of enrollment through a state exchange once a QHP is selected.