Section 4500.150  Agent and Broker Standards for Assisting with Enrollment in QHPs

To enroll qualified individuals, qualified employers, or qualified employees in a manner that constitutes enrollment through the Illinois Exchange, or assists individual market consumers with submission of applications for APTCs and CSRs through the Illinois Exchange, an agent or broker must comply with:

a)         45 CFR 155.220 (Jun. 25, 2025) (no later editions or amendments), including the provisions referencing Federally-facilitated Exchanges. When the Exchange operates as a State-based Exchange, this Section incorporates the provisions referencing agents and brokers in 45 CFR 155.220 with "State-based Exchange" substituted for "Federally-facilitated Exchange" and "Illinois Exchange" substituted for "HHS";

b)         45 CFR 155.260(b);

c)         State insurance producer licensing requirements under Article XXXI of the Code; and

d)         when the Exchange operates as a State-based Exchange, the following requirements to receive and maintain an annual certification from the Exchange:

1)         The agent or broker must complete an initial or renewal application on a form developed or accepted by the Exchange and must declare under penalty of refusal, suspension, or revocation of the Exchange certification that the statements made in the application are true, correct, and complete to the best of the agent or broker's knowledge and belief.  Before approving the application, the Exchange must find that the agent or broker:

A)        complies with subsection (c);

B)        is not disqualified for having committed any act that would be a ground for denial, suspension, or revocation of an Exchange certification;

C)        has not had an insurance producer license, Navigator certification, In-Person Counselor certification, or Certified Application Counselor certification, or equivalent license or certification denied, suspended, or revoked in any state, province, district, or territory or by the United States Department of Health and Human Services; and

D)        for individual insurance producers, the agent or broker demonstrates successful completion of the applicable training curriculum for agents or brokers described in subsection (d)(4).

2)         The agent or broker must maintain and provide documentation required by the Exchange to verify the information contained in an Exchange certification application. The agent or broker must retain the certificate of completion from each course or training curriculum completed under subsection (d)(4) for 3 years from the date of successful completion.

3)         An Exchange certification will be valid through October 31 of the plan year for which the certificate holder successfully completed the applicable training curriculum. The agent or broker may file an application for renewal 60 days before the end of the certification period.

4)         An individual agent or broker seeking to obtain or renew an Exchange certification must register for the Get Covered Illinois Learning Management System (GCILMS) application at https://getcovered.illinois.gov and must successfully complete the Director-approved training modules prescribed in GCILMS.

A)        The courses will be designed to increase the agent or broker's knowledge and understanding of private and public insurance principles, QHP options, applicable laws and regulations governing insurance affordability programs, eligibility, and benefits, Marketplace and Medicaid policies and operations, and outreach and education skills. The curriculum may contain modules covering topics that include, but are not limited to:

i)          the needs of underserved and vulnerable populations;

ii)         eligibility and enrollment rules and procedures;

iii)        the range of QHP options and affordability programs; and

iv)        privacy and security of personally identifiable information applicable under 45 CFR 155.260.

B)        Each course in GCILMS will:

i)          require an examination at its end;

ii)         allow the student to go back and review any unit at any time before, but not during, the examination; and

iii)        require each student to affirm that the student, and only that same student, completed the course.

C)        No credit will be given for a course if the student does not demonstrate successful completion of the examination.

5)         The Exchange may deny, suspend, or revoke an Exchange certification for cause.

A)        "Cause" means any of the reasons specified in Section 500-70 of the Code, including violations of any applicable rules the Director has adopted under this Part or failure to demonstrate successful completion of the applicable training curriculum. Additionally, the Exchange may deny, suspend, or revoke an Exchange certification for providing incorrect, misleading, incomplete, or materially untrue information in an application for Exchange certification, or for obtaining or attempting to obtain an Exchange certification through misrepresentation or fraud.

B)        If the Exchange determines that cause for denial, suspension, or revocation exists, the Exchange or its designee will send a written notice to the agent or broker identifying the nature of the disciplinary action to be taken, the specific reasons for the action, an effective date 10 days from the date the notice is issued, and information about how to request a hearing on the decision. The agent or broker may appeal by submitting a request for hearing to the Department within 10 days. The appeal will stay the effective date of the disciplinary action pending the outcome of the hearing and any further administrative review. The hearing will be conducted in accordance with 50 Ill. Adm. Code 2402.

C)        Action against an agent or broker's Exchange certification or application for certification does not, by itself, affect the status of an agent or broker's insurance producer license under the Code. Nothing in this subsection prevents the Exchange from cooperating with the Department's regulatory divisions on enforcement actions under the Code.

D)        Notwithstanding any other provision of this subsection, an agent or broker's Exchange certification will terminate no later than the actual effective date of termination of the agent or broker's insurance producer license under Article XXXI of the Code.

(Source:  Amended at 49 Ill. Reg. 14672, effective October 28, 2025)