Square Peg in a Round Hole – Compliance in the Modern World of Health Insurance

The world of insurance is changing rapidly. We are seeing traditional insurance arrangements being replaced with new and innovative solutions. Gravie is part of this brave, new frontier. We’re constantly working to help keep our employer customers compliant and it’s a big job. Despite the fact that insurance products and how they are purchased have changed dramatically in the past few years, many of the regulations in the industry have been in place for decades. Most of these laws were put into effect when buying insurance was an entirely different process.

This presents compliance teams at these new and innovative companies with a unique challenge. How do you fit new concepts and products into an existing regulatory framework?

Below are a few Gravie examples:

• Agency and Producer Licensing
  Gravie provides a year round service to its members called Gravie Care. This means that anyone who has purchased a policy through Gravie can get help any time during the year with questions regarding their insurance coverage and other benefits. In order to do this, Gravie is required to hold insurance agency licenses in all fifty states. Additionally, the Gravie advisors that provide the Gravie Care services hold producer licenses that require them to take continuing education and renew each year.

• Electronic Signatures
  Do you remember a time when you met with your insurance agent and you applied for insurance on a paper application? For the most part, applications are now completed electronically and laws that permit electronic signatures have changed over the years to help make this commonplace. However, Gravie is still required to use the application form (even if it is in electronic form) that each insurance carrier has received approval for from the state Insurance Department.

• Web Broker and CMS
  Finally, because many people now prefer to shop for their insurance online, the Federally Facilitated Marketplace (FFM) created something called a “web broker.” This is a licensed insurance producer/agency that signs an agreement with the Centers for Medicare & Medicaid Services (CMS) that allows them to help individuals shopping on the Marketplace. Yes, you guessed it; Gravie is also a web broker.

As health insurance and the healthcare industry continue to evolve, Gravie’s approach will reflect both innovation, as well as the required compliance in order to provide our employer customers with the best experience possible.

Sue Eaton is a compliance officer at Gravie. She’s responsible for making sure the services and products we offer comply with state and federal laws. Because we understand the importance of compliance and staying on top of ever changing rules and regulations, Sue will be contributing her wisdom regularly to the Gravie Blog. Check out her last post on HIPPA & MARS-E Compliance.