Web-Broker API: Technical Validation Session
Federally Facilitated Exchanges and Application Interfaces An Overview for Discussion Purposes
25 January 2013
Overview
• Presenters today: – Peter Nakahata and Andrew Rumin – CCIIO, CMS
– Mark Oh – OIS, CMS
• Purpose: Provide walkthrough of API design, and receive technical comments from industry experts
• Background and context for the web-broker API
• Overview solution approach
• Consumer workflow
• Key Interaction Scenarios
• Receive feedback and answer questions
2
3
Background
• Consumers can shop for Health Insurance on the FFE, or on a
Web-Broker or Issuer’s website
• To extent permitted by a state, HHS intends to work with web-
brokers that meet applicable requirements to help consumers
select QHPs online.
• API allows for consumer to approach web-broker website and:
• receive an eligibility determination from FFE;
• select QHP on the web-broker’s website; and
• enroll in a QHP through the FFE.
Background – Federal Rules (45 CFR 155.220)
• Like other agents/brokers, web-brokers must be registered with FFE, receive training, be licensed and execute an agreement with HHS.
• Web-broker specific requirements: – Meet all standard for disclosure/display of QHP information;
– Provide consumers the ability to view all QHPs offered through the Exchange;
– Not provide financial incentives (e.g. rebates/giveaways);
– Display all QHP data provided by Exchange;
– Maintain audit trails for 10 years minimum;
– Provide consumers with ability to withdraw and use Exchange website.
• CMS will likely specify additional expectations.
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Solution Approach
• FFE will expose its business services to Partner Websites for Eligibility
determination, Searching and comparing QHPs, Enrollment, Disenrollment and
reporting changes
• Eligibility determination for financial assistance requires access to FTI. IRS
regulations prohibit access to FTI from Web Broker/ Issuer systems.
• Consumer will be routed to the FFE website for collecting personal and
financial information (Cannot use a web service since Partner Websites are not
allowed collect or display FTI)
• FFE will also capture pre-enrollment attestations directly from the consumer
• Given the above, the FFE API will include HTTP redirects and web services
• Account creation, Application submission, Eligibility determination and
attestations would be performed on the FFE via HTTP redirect
• QHP shopping, enrollment, enrollment changes and disenrollment would be
performed through web services
• All web services will be exposed through the Data Services Hub
6
Consumer Workflow
User Accesses PartnerWebsite
User Registers with Partner Website
User Decides toShop for QHP?
User Continues Shopping on
Partner Website
User Redirected to Landing Page of FFE
User Creates Account on FFE
User SubmitsFFE
Application
FFE TransfersAccount To State
Agency for Eligible Applicant
Partner WebsiteRetrieves Eligibility
Information
FFE Notifies User on Eligibility and
Account Transfer
Partner Website Stops Processing Applicant
FFE Notifies UserOn APTC/CSR
Eligibility
User Shops for QHPs/
Submits Enrollment
FFE Website
Partner Website
Popup #1
FFE EligibilityDetermination
Partner WebsiteRetrieves Eligibility
Information
User completes Enrollment
Attestations
Popup #2
Partner WebsiteRetrieves Eligibility
Information
User Continues Shopping on
Partner Website for Applicant
Partner Website calling FFE Web service
FFE Notifies UserOn Applicant
Ineligibility for QHP
Legend
Partner WebsiteCollects Initial Premium
Applicants Not Eligible for
QHP
Applicants Eligible for Medicaid/CHIP
Applicants Eligible for QHP
Yes
No
Key Interaction Scenarios
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Scenario # Scenario Title
1 New QHP Enrollment (with or without financial assistance)
2 Consumer returns to continue shopping
3 Consumer reports changes impacting eligibility
4 Consumer reports changes not impacting eligibility
5 Consumer reports changes resulting in Disenrollment
6 FFE Initiated Disenrollment
7 Voluntary Disenrollment by consumer
Interaction Scenario #1 – New Consumer
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New QHP Enrollment (with or without financial assistance)
Register on Broker/ Issuer
Website
EnterDemographics
EligibilityDetermination
Flow
RegisterWith Exchange
Plan Compare
FetchPlan List, Details,
Comparison
FetchPlan List, Details,
Comparison
Plan Select/Submit
Enrollment
ProcessEnrollment
ProcessEnrollment
RIDP
XML
Individual
Federally Facilitated Exchange
Issuer/ Broker Plan Shopping Site
Redirect/ Popup
Redirect/ Popup
CollectInitial
Premium
Redirect/Return
Collect Initial Premium(Issuer’s
Payment Portal)Retrieve
Household/ Eligibility Details
RetrieveHousehold/ Eligibility
Details
FetchHousehold/Eligibility
Details
FetchHousehold/Eligibility
Details
XMLXML
Send x12-834 To Issuer
Select QHP(s);Compose Coverage Household;Submit Enrollment
EnrollmentAttestations
AcceptEnrollment
AcceptEnrollment
Redirect/Return
Interaction Scenario #2 – Returning Customer
9 Consumer returns to continue shopping
Login To Broker/ Issuer
Website
EligibilityDetermination
Flow
LoginTo Exchange
Plan Compare
FetchPlan List, Details,
Comparison
FetchPlan List, Details,
Comparison
Plan Select/Submit
Enrollment
ProcessEnrollment
ProcessEnrollment
XML
Individual
Federally Facilitated Exchange
Issuer/ Broker Plan Shopping Site
Redirect/ Popup
CollectInitial
Premium
Redirect/Return
Collect Initial Premium(Issuer’s
Payment Portal)Retrieve
Household/ Eligibility Details
RetrieveHousehold/ Eligibility
Details
FetchHousehold/Eligibility
Details
FetchHousehold/Eligibility
Details
XMLXML
Send x12-834 To Issuer
Continue from previously completed step
Select QHP(s);Compose Coverage Household;Submit Enrollment
EnrollmentAttestations
AcceptEnrollment
AcceptEnrollment
Redirect/Return
Interaction Scenario #3 – Changes (1)
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Consumer reports changes impacting eligibility • Income, Addition or removal of household members
Login toBroker/ Issuer
Website
InitiateMid-Year Change
EligibilityDeterminationFlow (Changes)
Login to FFE
Plan Compare
FetchPlan List, Details,
Comparison
FetchPlan List, Details,
Comparison
Plan Select/Submit
Changes
AcceptEnrollment
Changes
AcceptEnrollment
Changes
XML
Individual
Federally Facilitated Exchange
Issuer/ Broker Plan Shopping Site
Redirect/ Popup
Redirect/Return
RetrieveHousehold/ Eligibility
Details
RetrieveHousehold/ Eligibility
Details
FetchHousehold/Eligibility
Details
FetchHousehold/Eligibility
Details
XMLXMLRedirect/Popup
Send x12-834 To Issuer
Select QHP(s);Compose/ Change Coverage Household;Submit Enrollment
ProcessEnrollment
Changes
ProcessEnrollment
Changes
EnrollmentAttestations
Interaction Scenario #4 – Changes (2)
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Consumer reports changes not impacting eligibility • Demographic changes, Income (if within same eligibility range)
Login toBroker/ Issuer
Website
InitiateMid-Year Change
EligibilityDeterminationFlow (Changes)
Login to FFE
Process Enrollment
Update
Process Enrollment
Update
Individual
Federally Facilitated Exchange
Issuer/ Broker Plan Shopping Site
Redirect/ Popup
Redirect/Return
RetrieveHousehold/ Eligibility
Details
RetrieveHousehold/ Eligibility
Details
FetchHousehold/Eligibility
Details
FetchHousehold/Eligibility
Details
XML
Send x12-834 To Issuer
No change in eligibility
Interaction Scenario #5 – Changes (3)
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Consumer reports changes leading to Disenrollment • Eligible for Medicaid/CHIP, Lost eligibility for QHP, Lost eligibility for APTC/CSR
Login toBroker/ Issuer
InitiateMid-Year Change
EligibilityDeterminationFlow (Changes)
Login to FFE
ProcessDisenrollment
ProcessDisenrollment
Individual
Federally Facilitated Exchange
Issuer/ Broker Plan Shopping Site
Redirect/ Popup
SubmitDisenrollment
Redirect/Return
RetrieveHousehold/ Eligibility
Details
RetrieveHousehold/ Eligibility
Details
FetchHousehold/Eligibility
Details
FetchHousehold/Eligibility
Details
XMLXML
Send x12-834 To Issuer
Interaction Scenario #6 – Disenrollment (1)
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FFE Initiated Disenrollment
Login toBroker/ Issuer
Website
ProcessDisenrollment
ProcessDisenrollment
Individual
Federally Facilitated Exchange
Issuer/ Broker Plan Shopping Site
SubmitDisenrollment
XML
Send x12-834 To Issuer
InitiateDisenrollment
Periodic Data Match/ Expired Inconsistency
Periodic Data Match/ Expired Inconsistency
Notice on Loss of APTC/CSR and option to Dis-enroll
Interaction Scenario #7 – Disenrollment (2)
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Voluntary Disenrollment by Consumer
Login toBroker/ Issuer
Website
ProcessDisenrollment
ProcessDisenrollment
Individual
Federally Facilitated Exchange
Issuer/ Broker Plan Shopping Site
SubmitDisenrollment
XML
Send x12-834 To Issuer
InitiateDisenrollment
Interfaces
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Interface Description
Transfer Consumer to FFE for Account Creation and Eligibility Determination
This HTTP redirect interface will transfer the consumer from the Partner Website to the FFE for account creation and eligibility determination. This will establish a link between the consumer’s accounts on the Partner Website and the FFE.
Transfer Consumer back to Web Broker/Issuer
This HTTP redirect interface will transfer the consumer from the FFE to the Partner website after completion of the eligibility determination process. This interface will also be used in other situations such as on the consumer’s intent to return or exceptions such as failure to create an FFE account due to failure in RIDP. The FFE will transfer the consumer to the Return URL provided by the partner website while transferring the consumer to the FFE.
Transfer Consumer to FFE to Continue Application
This HTTP redirect interface will transfer a returning consumer from the Partner website to the FFE. In this case the consumer would have already created accounts on the Partner website and the FFE and the link would have been established. The consumer will continue from the last step they were at during the previous session.
Transfer Consumer to FFE for Enrollment Attestations
This HTTP redirect interface will transfer the consumer from the Partner website to the FFE to collect pre-enrollment attestations.
Interfaces (Contd.)
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Interface Description
Fetch Household/ Eligibility Details
This FFE Web service will return details of all members in household requesting coverage along with their eligibility for financial assistance. Eligibility information returned will include Medicaid/CHIP eligibility and eligibility for APTC/CSR. Demographic information for the members required for enrollment will also be included.
Fetch List of QHPs This FFE web service will return a list of QHPs that match the search criteria specified by the consumer on the Partner website. Search criteria could include household composition, premium cost range and any special health coverage requirements.
Fetch QHP Details This FFE web service will return detailed plan information for a QHP selected by the consumer on the Partner web site.
Fetch Side by Side Compare of QHPs
This FFE web service will return a tabulated response with a side by side comparison of a list of selected QHPs on a variety of factors such as cost, coverage area and benefits.
Interfaces (Contd.)
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Interface Description
Submit Enrollment This FFE web service will process an enrollment request from the Partner website. The information included in this request will be used for sending the 834 enrollment transaction to the issuer.
Submit Enrollment Change This FFE web service will process an enrollment change request from the Partner website. Enrollment change requests include:
Adding or Removing a member
Changing QHPs
Change in eligibility status
The information included in this request will be used for sending the 834 enrollment change transaction to the issuer.
Submit Disenrollment This FFE web service will process a disenrollment request from the Partner website. The partner website will invoke this service for FFE initiated dis-enrollments, Consumer reported changes resulting in dis-enrollments and voluntary dis-enrollments by the consumer
The information included in this request will be used for sending the 834 dis-enrollment transaction to the issuer.
Questions and Comments
• Questions/comments and open discussion from industry experts
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