TALLAHASSEE, Fla., July 16,
2024 /PRNewswire/ -- In a significant step toward
protecting consumers and ensuring the integrity of health plan
enrollments, industry leaders have come together to launch Member
Defense Network™ (MDN). MDN is a secure enrollment
registry designed to prevent Unauthorized Plan Switching (UPS) in
the Affordable Care Act (ACA) Marketplace.
Unauthorized Plan Switching in the ACA
Insurance agents play a crucial role in the growth and success
of the ACA Marketplace. Of the more than 16 million people who
enrolled in marketplace coverage for Plan Year 2024, nearly 80%
worked with an agent to navigate the complexities of the health
insurance enrollment process.
Alongside this growth, a significant problem has emerged in the
form of Unauthorized Plan Switching (UPS), a form of
fraud where consumers are unknowingly switched to
another plan or have their agent of record changed without their
consent. This practice can lead to lapses in coverage, loss of
access to preferred providers, and unexpected costs for
consumers.
Introducing Member Defense Network
MDN is a secure enrollment registry that identifies duplicate
submissions across insurers, identifies the consumer's desired
coverage based on what they consented to, and reports potential
fraud to regulators and law enforcement. MDN
intelligently enforces existing CMS consent regulations and
utilizes 'smart' 2-factor authentication to validate member intent
with minimal enrollment friction, ensuring those who need coverage
have access to it. If potential fraud is detected, MDN
prevents the payment of commissions for fraudulent enrollments,
removing the financial incentive for unauthorized changes.
When an enrollee has worked with multiple brokers resulting in
confusion, MDN establishes clear, consistent and transparent rules
to resolve conflicts and ensure consumers have uninterrupted access
to the correct coverage and appropriate enrollment support.
Participants
Participating insurers representing over half of ACA enrollment
during Open Enrollment 2024 include but are not limited to:
Ambetter, BlueCross BlueShield of North
Carolina, CareSource, CHRISTUS Health, Group Health
Cooperative of South Central Wisconsin, Highmark BlueCross Blue
Shield, Molina Healthcare, and Mountain Health Co-Op.
MDN will launch in Florida in
July with the support and cooperation of the Florida Department of
Financial Services ahead of a national launch in the fall.
Agencies representing over 45,000 insurance agents and brokers
are also participating in the launch.
MDN has been developed based on input and best practices from
existing fraud prevention registries in other lines of
insurance and has the goal of reducing Unauthorized Plan Switching
by 90% for participating insurers by January
1, 2025.
Initial technical integration and agent support will be provided
by HealthSherpa.
About Member Defense Network
Member Defense Network is a coalition of stakeholders
participating in the Affordable Care Act (ACA) Marketplace
dedicated to removing fraud and protecting consumers'
privacy and their access to healthcare. We are dedicated to
removing fraud and protecting consumers' privacy and
their access to healthcare. MDN members include insurers and
insurance agencies covering over 50% of ACA Marketplace
enrollment.
For more information about Member Defense Network, please visit
www.memberdefense.org.
Insurers, agencies and technology providers interested in
learning more about participation in the Member Defense Network
should contact info@memberdefense.org.
For press inquiries, please contact press@memberdefense.org.
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SOURCE Member Defense Network