The health plans don’t recognize the invoiced amount of the health care services from out-of-network providers as either accruing toward the deductible or for their cost-sharing of 50% before the maximum out-of-pocket amount is met. The health plans apply a Usual and Customary Rate (UCR) or the Allowable Amount. This limits their responsibility for payment and increases the health plan members costs.
The health plans and Covered California may give lip service to the value of the agent community, but it is not reflected in the compensation we receive. I’m not trying to get rich as an insurance agent. My net revenue listed on my Schedule C for 2016 was $34,000. If the new compensation schedules significantly erode my insurance revenue then I will have to find other income streams. Maybe Covered California will hire me to answer phone calls; I hear they have a great benefits package.
The Department of Managed Health Care (DMHC), who regulates most of the individual and family plans offered through Covered California, has developed a website to allow consumers to compare health insurance companies. The Health Plan Dashboard website does not assign any performance review ratings. But it does give consumers a high level view of some of the data collect on the health plans such as enrollment, complaints, and enforcement actions for medical, dental, and vision plans.
There was time when an insurance agent could make a decent living enrolling individuals, families and small groups into health insurance plans. With the advent of the Affordable Care Act and the subsequent downward pressure on commission rates, agents can still earn a living selling health insurance but it is not without its challenges. The […]
California Department of Insurance Commission Dave Jones excoriated Aetna in a news release on December 18th over Aetna’s planned small group premium increases but he was noticeably silent when Health Net submitted a similar rate increase for individuals and families. The average increase for the 2015 Health Net IFP PPO plans is 10.8% while the Aetna small group […]
Health Net is reporting that Covered California has cancelled 4,100 members for no apparent reason. This information was sent to all Health Net brokers on December 19, 2014. The coverage for these members will end December 31st unless the member or agent takes action to renew the health plan by Sunday December 21, 2014. Health Net […]
While Covered California was preparing a large press announcement with the California Medical Association (CMA) about extolling the number of physicians that are participating in Covered California individual and family health plans, Health Net was releasing their list of providers in their new narrow network Exclusive Provider Organizations (EPO) and Health Service Plans (HSP). A search […]
One of the great pleasures of hosting my own website and blog are the numerous people who have contacted me about Covered California and the new health plans being offered to individuals and families. One gentleman has done an astounding amount of research in response to the health plan changes proposed by Health Net. He has written a […]
Covered California will be hosting bi-monthly webinars for agents, enrollers and navigators on the 2015 renewal and open enrollment period. The first presentation was on the automatic enrollment for existing consumers and some of the technical issues that might occur. The webinar itself, Sales Partner Renewal Webinar October 8th 2014, was approximately 48 minutes long. […]
Consumers who purchased a health plan through Covered California 2014 may lose their monthly tax credit in 2015 if they don’t give permission to allow the state exchange to verify their income through the federal hub. The sudden loss of the Advance Premium Tax Credit in 2015 applies to consumers who did not give Covered […]