After Open Enrollment

[mschlange]

If someone enrolled through a web broker like health Sherpa and they truly did not have a sep or not eligible who is responsible
Could the agent who never saw the client be held responsible or is the insured liable

 

[RayNY]

"Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. I am applying for coverage for myself, my spouse and my eligible dependent children named on this application. All statements made within this form are true and accurate to the best of my knowledge."

Standard disclaimer above the signature area. Client is attesting that the information is true and accurate to the best of their knowledge, and the responsibility for false information falls on them. Broker signature does not attest to this, as we have no way of knowing if what they tell us is true.

Basically, to go after you, they'd have to prove that you knew it was false info (aka, you lied or advised them to lie). If you never saw it and they just threw your name on there, it's not on you. (You might have to prove that in court, but you'd win.)

 

[healthman1]

Check your E/O does it cover third party vendor sites?
When your client puts in 50k gross and in reality they only make 10k MAGI guess whats going to happen.

Where they mislead on how they asked for what income they make.
Just remember you are charged an application fee regardless if the policy issues it does matter.

 

[Yagents]

Check your E/O does it cover third party vendor sites?
When your client puts in 50k gross and in reality they only make 10k MAGI guess whats going to happen.

Where they mislead on how they asked for what income they make.
Just remember you are charged an application fee regardless if the policy issues it does matter.

MAGI = AGI37 + SS20a-20b + TE13 - zer35 (+ tru35 - BFD) / 1/12th

Everyone gets it........don't you?

 

[russelltw]

When your client puts in 50k gross and in reality they only make 10k MAGI guess whats going to happen.

Evidently nothing will happened if they make under 100%...

You should read my post here:
http://www.insurance-forums.net/for...form-8962-no-clawback-under-100-a-t72096.html

The IRS instructions say to treat those under 100% the same as those at 100% FPL as long as they are legal resident and a tax payer. I think the trouble is when someone gets a subsidy who makes 401% or they have group coverage that was not disclosed. The full claw back will be tough. I have heard from clients that agents are selling a fully subsidized plan to anyone, no matter the income. That's the stuff that pisses me off. Agents (most are new) running around selling stuff that is going to hurt people when they do their taxes. I hope those agents lose their licenses. I have seen two instances where an agent made up the entire app/income once they had the basic info from the client. Client never picked a plan, a bill just showed up in the mail.

I personally feel good about all those I helped. I showed them what happens when their income is over 400% and under 100% on HS. They saw how it worked. Whether they told me the truth or not, well the tax man will sort that out. Good luck to you all.

R

 

[bluediamond]

Evidently nothing will happened if they make under 100%...

You should read my post here:
http://www.insurance-forums.net/for...form-8962-no-clawback-under-100-a-t72096.html

The IRS instructions say to treat those under 100% the same as those at 100% FPL as long as they are legal resident and a tax payer. I think the trouble is when someone gets a subsidy who makes 401% or they have group coverage that was not disclosed. The full claw back will be tough. I have heard from clients that agents are selling a fully subsidized plan to anyone, no matter the income. That's the stuff that pisses me off. Agents (most are new) running around selling stuff that is going to hurt people when they do their taxes. I hope those agents lose their licenses. I have seen two instances where an agent made up the entire app/income once they had the basic info from the client. Client never picked a plan, a bill just showed up in the mail.

I personally feel good about all those I helped. I showed them what happens when their income is over 400% and under 100% on HS. They saw how it worked. Whether they told me the truth or not, well the tax man will sort that out. Good luck to you all.

R

I have several instance's where agents made up number's and this is why (just like med advantage) there will be more regulation's on us agents in year's to come. Most agents who have been in the business a while played it straight, but it's all the newly licensed agents that were fed a line of bs by GA's that they could make a ton of money and then turned them lose with no knowledge or monitoring. All about the almighty dollar.

 

[bill3173]

I have several instance's where agents made up number's and this is why (just like med advantage) there will be more regulation's on us agents in year's to come. Most agents who have been in the business a while played it straight, but it's all the newly licensed agents that were fed a line of bs by GA's that they could make a ton of money and then turned them lose with no knowledge or monitoring. All about the almighty dollar.

Do you think any of these agents will get into any real trouble this year..trying to figure if playing it straight was worth it.

 

[bluediamond]

The sad part Bill is most if not all will ever get caught. I have found that when another agent calls the dept of insurance that the dept won't take a complaint from another agent because they look upon it as an crying that someone stole their business. The normal consumer I have also found will not file a complaint because of fear of retaliation from the agent. So it goes on until those agents fizzle out.

 

[G.Gordon]

The end result will be this market being heavily regulated like the Medicare market.

 

[houcoogster]

The end result will be this market being heavily regulated like the Medicare market.

You don't say?

Will there be enrollment periods?

SEP's?

CMS running the show?

That'll be the day!.................lol