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The purpose of completing this form is to begin the Kentucky Health Benefit Exchange (KHBE) on-boarding process for certified application counselors (CACs) to access the KHBE enrollment system. Entities interested in participating on KHBE must designate up to ten (10) existing employees or established volunteers to complete training and certification. Additional employees or volunteers may be designated at a later time if designation slots are available or if an entity can show good cause by submitting a request to KHBE. Requests can be sent to KHBE Program.

CAC training consists of two parts:  Federally Faciliated Marketplace (FFM) and KHBE Medicaid Training.  Both require passing an exam and sending a certificate of completion to KHBE Program.  CACs should start training on the FFM training site and complete all federally dictated training before starting KHBE Medicaid training.

Upon completing and submitting the participation form to KHBE, designated CACs will be sent an email with instructions to access our public share point site. The site will provide interactive training and all training materials for participation with KHBE. After completing the training and passing the exam please contact your organization administrator for an invitation to the organization and access to the assister dashboard.

Certified Application Counselors Requirements to Participate

Under federal law Section 155.225, Certified Application Counselors may be individual staff members or volunteers of designated organizations that must be trained and enter into an agreement with the Kentucky Health Benefit Exchange (KHBE).

Specifically, KHBE is looking for organizations that have processes in place to screen staff and volunteers who are certified to ensure they will protect personal information; engage in services that position them to help connect people to coverage; and have experience providing social services to the community.  The KHBE will limit CAC entities to the following:

  • Community Health Centers (such as FQHCs)
  • Hospitals
  • Health care providers
  • Indian Health Services and providers
  • Ryan White HIV/AIDS providers
  • Behavioral or mental health providers
  • Agencies with experience providing social services such as SNAP outreach, energy assistance, or tax assistance, which are:
    • Non-federal government entities
    • 501(c) organizations
    • Local government agencies such as health departments and libraries

All designated individuals or volunteers must agree to:

  • Disclose to the organization or to KHBE and potential applicants any relationships with Health Insurance Plans (also referred to as Qualified Health Plans or QHPs), insurance affordability programs or any other potential conflicts of interest;
  • Comply with Federal and KHBE privacy and security standards consistent with Section 155.260, and applicable authentication and data security standards;
  • Refer to the appropriate consumer assistance personnel or call center when applicable;
  • Provide information in a manner that is accessible to individuals with disabilities, as defined in the Americans with Disabilities Act;
  • Agree to act in the best interest of the applicants assisted;
  • Comply with the requirements of 45 C.F.R. 155.225; and
  • Not collect fees or accept any form of payment from applicants for applications or other assistance with KHBE.

Certified Application Counselors are certified to:

  • Provide information to individuals and employees about the full range of Health Insurance Plans (HIPs) and insurance affordability programs for which they are eligible;
  • Assist individuals and employees to apply for coverage in a HIP through the FFM and other insurance affordability programs;
  • Help facilitate enrollment of eligible individuals in QHP and insurance affordability programs.

CAC Reporting Template Instructions

CAC Reporting Template