OCI Bulletin: Use of NPN Override Function and Fraudulent ACA Plan Enrollment

WI Insurance Bulletins

Published March 14th, 2025

Detected March 19th, 2026

Summary

The Wisconsin Office of the Commissioner of Insurance (OCI) issued a bulletin clarifying that the use of the 'NPN Override' function on Enhanced Direct Enrollment (EDE) platforms for fraudulent Affordable Care Act (ACA) plan enrollment violates state law. The bulletin outlines specific statutory and administrative code violations.

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What changed

The Wisconsin Office of the Commissioner of Insurance (OCI) has issued a bulletin clarifying its stance on the use of the "National Producer Number (NPN) override" function within Enhanced Direct Enrollment (EDE) platforms. The OCI has received consumer complaints alleging fraudulent enrollment in Affordable Care Act (ACA) plans, often facilitated by the use of this override function, which allows an intermediary not appointed with an insurer to submit an application using the NPN of an appointed intermediary. The OCI asserts that this practice violates Wisconsin law, specifically citing misrepresentations related to insurance contracts and improper exchange of business, which bypasses appointment requirements.

This bulletin serves as a binding clarification for all agents, insurance intermediaries, and interested parties in Wisconsin. Intermediaries are prohibited from designating themselves as the agent of record without completing the enrollment or facilitating business through a single appointed intermediary to circumvent appointment rules. Compliance with Wis. Stat. § 628.034(1)(a), Wis. Admin. Code Ins § 6.66, and Wis. Stat. §§ 601.31(1)(n), 628.11, 628.40, and Wis. Admin. Code § Ins 6.57 is required. Failure to comply could result in regulatory action for misrepresentation and improper business practices.

What to do next

Review agency use of NPN override function on EDE platforms.
Ensure all enrollments are conducted by properly appointed intermediaries.
Cease any practices that circumvent appointment requirements for ACA plan enrollment.

Source document (simplified)

OCI > Bulletin, March 14, 2025, The Use of the “NPN Override” Function

Bulletin, March 14, 2025, The Use of the “NPN Override” Function

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Last Updated: March 14, 2025

Date: March 14, 2025
To: All Agents, Insurance Intermediaries, and Interested Parties
From: Nathan Houdek, Commissioner of Insurance
Subject: The Use of the “NPN Override” Function

Bulletin20250314NPN.pdf

The Office of the Commissioner of Insurance (OCI) has received a number of consumer complaints directed at insurance intermediaries, alleging fraudulent enrollment in Affordable Care Act plans offered through the federally facilitated marketplace (the Marketplace). OCI determined that, in many cases, the intermediary used the “National Producer Number (NPN) override" function on an Enhanced Direct Enrollment (EDE) platform to submit the application. EDE platforms are non-governmental websites that allow intermediaries to enroll consumers in the same Qualified Health Plans available on the Marketplace and state-based exchanges. The “NPN override" function allows an intermediary who is not appointed with a given insurer to submit an application to that insurer by using the NPN of an appointed intermediary.

It is OCI's position that this practice violates Wisconsin law. An intermediary who designates themself as the agent of record, without having completed the enrollment, violates Wis. Stat. § 628.034(1)(a) prohibiting misrepresentations relating to insurance contracts. In addition, under OCI's appointment and “proper exchange of business" provisions, it is improper for intermediaries to exchange business in this manner. Exchange of business is subject to the constraints of Wis. Admin. Code Ins § 6.66 and cannot routinely be used as a method for bypassing the appointment requirements of Wis. Stat. §§ 601.31(1)(n), 628.11, 628.40, and Wis. Admin. Code § Ins 6.57.

For the same reasons, intermediaries and agencies may not otherwise exchange or facilitate business in this manner, for example, by routing agency sales through a single appointed intermediary.

Questions regarding this bulletin may be directed to Chief Legal Counsel Lauren Van Buren, Lauren.VanBuren@wisconsin.gov.