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EXCHANGE ASSISTERS IN PENNSYLVANIA

Exchange Assisters help individuals to obtain quality health insurance through the Federally Facilitated Exchange (FFE). 

WHAT IS AN EXCHANGE ASSISTER?

In Pennsylvania, an Exchange Assister is an individual or organization, including a Navigator, Navigator Organization or Certified Application Counselor (CAC) who provides public education or assists consumers for or on behalf of an exchange. This term does not include a licensed insurance producer. This term also does not include an individual employed to provide insurance enrollment or coverage assistance by a health care facility as defined in section 103 of the act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act. 

**Please note that according to Pennsylvania law, Exchange Assisters are registered with the state and not licensed. Exchange Assisters may help consumers with the insurance marketplace but may not sell, solicit, or negotiate insurance contracts. 

* Exchange Assister services are free.

WHAT IS A NAVIGATOR?

Since 2013, Navigators have helped Pennsylvanians understand their health insurance options and facilitated their enrollment in health insurance through the FFE. Entities and individuals cannot serve as federally certified Navigators without receiving federal cooperative agreement funding, authorized in the Patient Protection and Affordable Care Act, to perform the required Navigator duties. 

WHAT IS A CERTIFIED APPLICATION COUNSELOR (CAC)?

A CAC is an individual staff member or volunteer who is certified by a CAC designated organization (CDO) and who is trained and able to help consumers as they look for health coverage options through the Marketplace, including helping them complete the Marketplace eligibility and enrollment process. 

To learn more about Navigators, CACs, and outreach partners, click here

 

DO NAVIGATORS AND CACs RECEIVE TRAINING?

According to the Centers for Medicare and Medicaid Services (CMS), before carrying out any required or authorized Navigator or CAC functions, certain requirements must be met: 

Navigators must: 

1) Complete training that has been approved by CMS. 

2) Achieve a passing score on all approved certification examinations. 

3) Obtain continuing education and be certified and/or recertified on at least an annual basis. 

4) Meet any licensing, certification, or other standards prescribed by the State, if applicable, so long as such standards do not prevent the application of the provisions of title I of the Patient Protection and Affordable Care Act (PPACA). 

Certified Application Counselors (CACs) must: 

1) Successfully complete Exchange-approved training. 

2) Achieve a passing score on all Exchange-approved certification examinations. 

3) Obtain a certification from their CDO after successfully completing Exchange-approved CAC training. 

 4) Meet any licensing, certification, or other standards prescribed by the State, if applicable, so long as such standards do not prevent the application of the provisions of title I of PPACA. 

Click here to learn more about the necessary training for Navigators, CACs, agents, brokers and other assisters.

 

WHO IS REQUIRED TO BE REGISTERED IN PA?

Any individual or organization who provides public education or assists consumers for or on behalf of an exchange must be registered with the state of Pennsylvania as an Exchange Assister. This does not include licensed insurance producers or individuals employed to provide insurance enrollment or coverage assistance by a “health care facility.” 

To learn more about becoming registered as an Exchange Assister click here.

HOW DO I APPLY?

To apply, please read How to Apply.

If you are ready to apply, click here.

OTHER INFORMATION 

If you are a consumer looking for an Exchange Assister, click here.

Exchange Assisters can be verified by name or registration number.

If you have questions, please contact the Insurance Department at ra-in-producer@pa.gov.