sharon1900
New Member
- 17
why am i not getting the quotes for the gold and platinum plans for cigna?
Health Insurance Agents in California
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sharon1900
New Member
- 17
but they are offering those plans directly to my clients.
maxherr
Expert
- 67
Are you talking about the individual market inside or outside the CoveredCA exchange? If so, you must not be aware of the fact that CIGNA, like UnitedHealthcare, left the individual market in California rather than accede to the demands of CoveredCA. They cannot return until at least the 2019 plan year.
CIGNA and UnitedHealthcare still offer group plans in health insurance and Medicare products for individuals.
- 3,384
Aetna and UHC left the market in CA. Cigna is selling right now IFP off-exchange in CA just like Assurant (which is defacto Aetna due to using the Signature Admin PPO network).
Sharon is correct, only quoting Bronze and Silver, no Gold nor Platinum.
The reason according to Quotit is that Cigna in CA has asked the quote services not to show Gold nor Platinum as they pay no commission to agents for those plans. That's why they are only offering them direct from the carrier.
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maxherr
Expert
- 67
My mistake. I stopped doing business with CIGNA several years ago, and haven't heard much about or from them since. Not wanting to pay agents a commission is a pretty poor excuse for not offering gold and platinum plans through them -- but I guess it does allow them to lower the premium a bit and still earn added profits within the 15% admin allowance under the MLR rules of the PPACA. Or keep the premiums higher and have more money for executive compensation and still stay within the MLR guidelines.
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I'm not sure I follow.
Are you faulting agents for not wanting to offer plans which do not pay a commission?
maxherr
Expert
- 67
My comment was directed at CIGNA's choice of how it wants to do business, not at agents. Kaiser-Permanente, for example pays me a one-time $100 flat fee, with $0 renewals, Blue Shield just lowered its 2015 commission rate to 3.8% first year, 3% renewals. HealthNet pays 4%, except that they back out all of the federal and state fees they are forced to pay before calculating commissions, so it ends up being about 3% or a little more of gross premium -- no other company I represent does that.
All of this is a far cry from the 15% to 25% commissions we once were paid for new business. But I don't concern myself with my commissions. They are what they are. If I need more commission income, then I need more clients. That's a pretty simple concept. There are other plans that pay higher commissions, but they also have higher premiums. I direct most business, however, to whichever health plan a person's current physician is a network provider, if at all possible. If not, then it's usually the plan with the lowest premium that the client chooses. If that's HealthNet, so be it. If it's LA Care, wonderful.
I don't steer anyone one way or another. I know how each plan works, I explain it to the client, and they make the choice that's best for them. When the numbers are such that a HealthNet Platinum plan is less costly than a Kaiser Silver plan, I show that to the client so they have a frame of reference. If they still want to choose Kaiser, I'm not going to argue or get upset about it. That decision is none of my business.
But now that you've asked, and don't take this as a comment about agents being faulted for anything, as a licensed person, if you or I were approached by a consumer who wanted a specific insurance plan, if appointed by that insurer, we have a public responsibility to assist the consumer whether we are paid or not. You don't have to like that, but that's the way it is (for sure in California, maybe not in some other states).
It's part of an agent's standard of care for consumers, along with the responsibility to put the best product into the hands of the consumer at the best price we have the ability to do. As a captive agent, you may only have one product to offer the consumer, and there is nothing wrong with that, even if lower priced products are available -- you should just be up front with the client if he/she asks if the same thing is available somewhere else for less money. The answer to that question is almost always yes, even if you're not a captive agent.
To do otherwise is considered "adverse selection" directed at the consumer, and is unlawful for this reason: it takes the insurer's underwriting department out of the equation, and no agent has authority to make those kinds of underwriting decisions.
So if I am appointed to transact health insurance for CIGNA, and a consumer wants a particular CIGNA plan, unless CIGNA has said to me, "You cannot assist a consumer with any IFP health plans other than Bronze and Silver," I have to help the consumer apply for his/her choice of plans, whether I get paid to do that or not. If I am not appointed by CIGNA, I can say to the consumer, "I don't represent that insurance company," and I have not committed any violation of the Commissioner's regulations or the Insurance Code. What no agent can say, appointed or not, is, "There is a $xx fee for me to assist you with your application," as a way to get paid when the insurance company won't pay us.
It's the same kind of thing with Medicaid (Medi-Cal). No agent is appointed by the state to enroll persons into Medicaid, but there is no reason not to assist someone even if you are not being paid for it. It just comes with the license the state grants you. On the P&C side, if you happen to be licensed as such, in most states, you don't need any special appointment to assist a consumer to obtain fire insurance through the FAIR plan or auto insurance through the Assigned Risk program (in most counties of California, we also have a "Low Cost Auto Insurance" program and any licensed P&C agent can submit an application and be paid a commission).
Having said all this, I know that many licensed agents do not follow the law in this regard. Nothing may ever happen to any of them because who's going to report it? But some of my best clients in 2014 have been referred to me by those whom I helped obtain health coverage through Medi-Cal via CoveredCA, for which I still have never been paid (the $58 per application payment is "supposed" to be paid this month -- but we were also told that previously in March, June, July, August, and November, too. And many California agents who wrote small business applications through the CoveredCA SHOP still have never seen one penny of commission for that business, so it's kind of like writing God or Platinum business for CIGNA I guess).
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My $58 check arrived yesterday. I only helped a few clients toward medi cal through covered ca because of the extra layer and delay. I gave them the number to call the county office, address and website. The system seemed to improve slightly this year. Less hiccup and delay between covered ca and social services.
- 3,384
I got a $58 check yesterday as well from the State Controller's Office (John Chiang). I wasn't even aware I enrolled anyone in Medi-Cal
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