Covered California has finally admitted that their system has not been properly attributing agent designation by Certified Agent clients to insure the agent is listed as the Broker of Record with the insurance company for compensation. At the same time, the Covered California health plans continue to stonewall agents wanting to get appointed with them and one health plan is demanding agents work for free.
Covered California admits agent designation was broken
It’s been a persistent problem that when a California resident designates an agent to represent them that specific information has not been transferred to the respective health plan the resident has chosen. After several calls to Covered California seeking resolution to the issue and hearing a deafening silence on the other end of the phone, Covered California has finally acknowledge the problem and issued a statement saying that they are working on a fix.
Another CalHEERS program fix
Covered California is implementing a system improvement tonight, 12/17/13 that will allow health plans to verify an agent’s delegation or attachment to an application. All affiliated health plans will be provided with updated 834 transaction files that provide the appropriate, corresponding agent names associated with each application. Each health plan will then process the reconciliation through their system. This transaction record serves as the documentation that allows health plans to pay Certified Insurance Agents according to their respective applications submitted to Covered California. – Email to Certified Agents 12/17/2013
Certified Agents and afterthought at Covered California
This doesn’t seem to be an issue when the agent initiates the application through the agent side of the Covered California CalHEERS website. The prospect of juggling all the existing and new applications for clients only to be confronted with no paper trail to receive compensation for the work has left many agents bewildered at the operations of Covered California. This is in light of the fact that Covered California has actively courted the involvement of agents to enroll thousands of Californians after their Certified Enrollment Counselor program stalled early in the open enrollment period.
Health plans ignore agents
Of course, an agent can only receive compensation from the health plan if that organization appoints the agent to represent it. Several of the health plans will not even return emails or phone calls from agents asking to be appointed: Contra Costa Health Services, Valley Health Plan, L.A. Care, and Molina. The health plans are suppose to have a system in place to appoint agents to represent them in Covered California to the public.
Model contract calls for agent appointments
3.29 Agents in the Individual Exchange.
(c) Agent Appointments. Contractor shall maintain a reasonable appointment process for appointing agents who contract with Contractor to sell Contractor’s QHPs to individuals through the Exchange. – COVERED CALIFORNIA QUALIFIED HEALTH PLAN CONTRACT FOR 2014
One agent forced to work for free
One agent that was successful in getting appointed with Contra Costa Health Services had to sign an agreement that he would receive no compensation.
Contra Cost Health Services, a qualified health plan (QHP) being offered through Covered California is asking agents to work for free. At the very least this is breaking the spirit of their agreement between CCHS and Covered California and at worst it is a violation of the signed contract. A Certified Enrollment Counselor gets paid $58 for enrolling someone in CCHS. At least give agents that much.
Model contract calls for agent compensation
3.29 Agents in the Individual Exchange.
(a) Compensation. The provisions of this Section 3.29 apply to agents who sell Contractor’s QHPs though the Individual Exchange.
(i) Compensation Methodology. Contractor shall be solely responsible for compensating agents who sell Contractor’s QHP through the individual market of the Exchange. Contractor shall use a standardized agent compensation program with levels and terms that shall result in the same aggregate compensation amount to agents whether products are sold within or outside of the Exchange. Contractor shall provide the Exchange with a description of its standard agent compensation program on an annual basis. – COVERED CALIFORNIA QUALIFIED HEALTH PLAN CONTRACT FOR 2014
Broker of Record change forms
Covered California went all “Gung-Ho” to rally health insurance agents to drive up enrollment numbers when their In-Person Assister/Certified Enrollment Counselor program flopped. They haven’t shown the same level of enthusiasm to support the agents for our work. I’m happy to see that the agent designation might be fixed so we don’t’ have to mail out form letters to our clients asking to send in a Broker of Record form to the carriers. But I hope Covered California isn’t too surprised that the enrollment numbers are skewed toward the established insurance carriers and the regional health plans are showing little enrollment.
Poor enrollment tied to poor information
Poor enrollment numbers for the regional carriers such as Contra Costa Health Services, Valley Health Care, L.A.Care, and Molina will be a result of agents having very little information about these plans. Why should I or any other agent take the time to learn about these regional carriers if they won’t appoint us? I applaud the one agent that signed the agreement for $0 compensation with Contra Costa Health Services.
Covered California needs to crack down on health plans
Unfortunately CCHS is just trying to exploit the knowledge and talent of agents for their own bottom line. Maybe if the insurance agents formed a union CCHS would offer fair compensation like a real health plan. I’ll gladly enroll someone in Contra Costa Health Services, just like I do for Medi-Cal, but I can’t talk intelligently about their health plans if they haven’t given me access to the details of their plans like Anthem Blue Cross, Blue Shield, Health Net and Kaiser have done.