Health Insurance Distribution Glossary
Plain-language definitions of the terms agents, agencies, GAs, MGAs, and FMOs use every day — from TPMO call recording and 834 EDI to downline hierarchy and Medicare enrollment workflows.
834 EDI
The ANSI X12 834 is the standard electronic data interchange (EDI) format used to transmit health plan enrollment and maintenance data from an agency or distributor to a carrier. Aiva Quote supports 834 EDI submission so enrollments move to carriers without manual re-keying.
ACA (Affordable Care Act)
Federal law governing the individual and small-group health insurance markets, including the Health Insurance Marketplace (Healthcare.gov and state exchanges). ACA quoting and enrollment involves metal tiers (Bronze, Silver, Gold, Platinum) and subsidy eligibility.
AEP (Annual Enrollment Period)
The Medicare Annual Enrollment Period, running October 15 to December 7 each year, when beneficiaries can enroll in or change Medicare Advantage and Part D plans. AEP is the highest-volume sales season for Medicare-focused agencies.
BAA (Business Associate Agreement)
A HIPAA-required contract between a covered entity (or business associate) and a vendor that handles protected health information (PHI) on its behalf. Aiva Quote processes PHI as a Business Associate and makes a BAA available on request.
Downline
The network of agents and sub-agencies that sit beneath a general agency (GA), MGA, or FMO in the distribution hierarchy. Managing downline production, contracting, and compliance visibility is a core function for upline organizations.
EDE (Enhanced Direct Enrollment)
A CMS program that lets approved partners host the full ACA Marketplace enrollment experience on their own platform — including eligibility and subsidy determination — without redirecting consumers to Healthcare.gov. EDE certification requires passing CMS security and business audits.
FMO (Field Marketing Organization)
A top-level distribution organization that contracts directly with carriers and recruits, supports, and manages a network of downline agencies and agents. FMOs need network-wide visibility into production, contracting, and compliance.
GA (General Agency)
A mid-level distribution entity that manages contracted agents and sometimes sub-agencies beneath it. GAs need oversight of their downline agents’ production and compliance without losing day-to-day quoting capability.
Medicare Advantage (Part C)
Medicare coverage offered by private carriers as an alternative to Original Medicare, often bundling Part D drug coverage. Selling Medicare Advantage involves Scope of Appointment (SOA) documentation and TPMO call recording requirements.
MGA (Managing General Agency)
A distribution organization with delegated authority from carriers, typically managing a regional network of agencies and agents. MGAs sit between GAs and FMOs in many hierarchy structures and require multi-level downline analytics.
NPN (National Producer Number)
A unique identifier assigned to licensed insurance producers through the National Insurance Producer Registry (NIPR). Aiva Quote requires a valid, active NPN for agent accounts that quote and submit enrollments.
PHI (Protected Health Information)
Individually identifiable health information protected under HIPAA. Platforms handling PHI must apply safeguards such as encryption, access controls, and audit logging. Aiva Quote encrypts PHI in transit and at rest with tenant isolation.
SOA (Scope of Appointment)
A CMS-required document capturing a Medicare beneficiary’s consent to discuss specific product types before a sales appointment. Capturing and storing SOAs is part of a compliant Medicare sales workflow.
TPMO (Third-Party Marketing Organization)
A CMS designation for organizations that market or sell Medicare plans on behalf of carriers, including many agencies and FMOs. TPMOs are subject to CMS marketing rules, including the requirement to record and retain Medicare sales calls.
TPMO Call Recording
The CMS requirement that TPMOs record and retain all marketing, sales, and enrollment calls with Medicare beneficiaries (including virtual connections) for at least 10 years. Aiva Quote provides compliance-aware workflows with call recording reference linkage and audit-ready export.
OEC (Online Enrollment Center)
The centralized CMS system beneficiaries use to submit online applications for Medicare Advantage and Prescription Drug Plans.
OEC Specification
The specification standardizes the electronic enrollment form so that all participating insurance carriers collect the exact same base information required by Medicare, regardless of which individual plan is selected.
Aiva Quote is the AI-native broker portal built around these workflows — for individual agents and the GAs, MGAs, and FMOs who support them.
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