It only takes one drop of red dye number two to completely color a glass of water. Such is the situation when the general public thinks about working with an insurance agent. Just a few agents have engaged in enough pushy sales tactics and questionable presentations to poison the perception of consumers about the whole glass of the insurance sales industry.
Agent Code of Conduct Pledge protects consumers
With the launch of open enrollment for the Affordable Care Act, now more than ever, consumers who seek out the knowledge, professionalism and experience of a licensed insurance agent need to be reassured that they aren’t drinking from a poisoned glass. In a modest attempt to help guide consumers to agents who won’t engage in misrepresentation or questionable sales tactics, I have developed a pledge and code of conduct surrounding the sales of ACA compliant health plans by agents.
Holding agents to a higher Medicare standard
Any agent, in addition to me, who wishes to add their name to the pledge and code, will be accommodated. I will add their name and link to their website so they can be found by health insurance consumers in their region. The pledge and code of conduct has its roots in the very strict regulations governing the sale of Medicare Advantage plans by agents. The Centers for Medicare and Medicaid has strict guidelines for the marketing and sales of Medicare Advantage and Part D Prescription drug plans for the protection of Medicare beneficiaries. From my stand point, equally ethical restrictions should apply to the sale of health plans that may have tax credit subsidies attached to them.
ACA is great, but health insurance is still confusing
The ACA has gone a long way to simplify the confusing landscape of available health plans. Just being able to compare plans side by side in the state exchanges with just four easy to understand plan types (Bronze, Silver, Gold and Platinum) is a monumental consumer friendly step forward. But there are still plenty of obscure and confusing language and acronyms to navigate such as HMO, PPO, EPO, copayment versus coinsurance, Advanced Premium Tax Credit, pediatric dental, to name a few.
Consumers vulnerable to unethical sales practices
Simply put, the confusion surrounding health insurance can put the consumer in a very vulnerable position. Unscrupulous agents will take advantage of this vulnerability to sell either the wrong health plan for the consumer or pitch other insurance products that may or may not be appropriate. At the core of the pledge and code is the concept that the agent is meeting with the consumer to focus solely on the health insurance needs of the individual or family.
As an agent certified to sell new ACA health plans I pledge to:
- Focus only on health, dental and vision insurance products during the client meeting discussing ACA health plans.
- Fully disclose which plans I am appointed with to the client.
- Not represent health plans outside of state or federal exchange as being better if there is no material difference.
- Not engage in any cross selling of other insurance products like life, auto, home, indemnity or long term care insurance plans. Any discussion of those products will be at another meeting.
- Not “up sell” health plans for the purposes of increasing my commission.
- Not “down sell” health plans for the purpose of reducing monthly premiums for the sale of another insurance product.
- Not encourage clients to use the savings from any reduction in the monthly health insurance premium from ACA tax credits be applied to new insurance products I represent during a subsequent meeting.
- Not set up an appointment under the pretext that I am certified to sell Covered California, federal or state based exchange health plans when I am not.
- Research whether the client’s doctors and hospital preference are “in-network” with the available health plans.
- Determine if the client’s prescription medications are covered and at what copayment level
- Assist with transferring of any necessary documents Covered California, federal or state based health exchange may request for determining premium assistance eligibility.
- Assist with transferring of any necessary documents Covered California or other state based health exchange may request for determining immigration status and premium assistance.
- Assist the client with any necessary income adjustments during the year that will impact the tax credit to the health insurance premium.
Kevin Knauss
Consumers need information, not games
I developed this pledge and code of conduct from the viewpoint of how an unethical agent might exploit the marketing of the ACA health plans unbeknownst to the client. It might need to include other provisions or clarifications and I welcome suggestions. In general, a consumer who works with an agent following the code of conduct should have a high level of confidence that the agent isn’t playing any games to the agent’s advantage when presenting health plans and options.
Putting the consumer first
As a consumer, you can always ask agents if they are willing to adhere to the ACA Agent Code of Conduct Pledge. Most reputable health insurance agents will have no problem with agreeing or signing the pledge. Heck, you might just ask the agent if they even support the ACA. That might be a good indicator to determine if they are just looking to make a buck from something they dislike or if they really help you select a health plan that is best for you. The Affordable Care Act is a tremendous opportunity to extend vital health insurance to millions of Americans in the U.S. It also presents an opportunity for some agents to exploit the individual mandate and general confusion over health insurance and take advantage of people. The ACA is too important for America for it to be colored with the unethical behavior by a few bad agents.
Foundation of ACA Agent Code of Conduct Pledge
Here is just a portion of the marketing rules an agent must follow when representing Medicare Advantage and Part D Drug Plans
Medicare Marketing Rules Personal/Individual Marketing Appointments
During individual appointments, marketing representatives may:
- Distribute plan materials –either an enrollment kit or information on how to access enrollment materials
- Discuss various plan options (as agreed to in the Scope of Appointment)
- Provide educational content
- Provide and collect enrollment forms
During individual appointments, marketing representatives may not:
- Discuss plan options that were not agreed to in the Scope of Appointment
- Market non-health care related products
- Ask for referrals
- Solicit /accept an enrollment request for a January 1st effective date prior to the start of the Annual Election Period on October 15.
Required Practices: Scope of Appointment
- Marketing representatives must:
- Market only health care related products during any MA or Part D sales activity or presentation.
- Prior to any marketing appointment, clearly identify the types of product(s) that will be discussed, obtain agreement from the beneficiary and document that agreement.
- Documentation for appointments resulting from a sales presentation must be in writing using a “Scope of Appointment” form .
- For appointments made over the phone, required documentation is a recording of the call. The call must be placed by the plan sponsor, NOT the marketing representative/agent/broker.
- During appointments scheduled in response to a reply card, only discuss the products included in the reply card in which the beneficiary has indicated interest.
- A plan sponsor or agent may not agree to the scope on behalf of the beneficiary.
