California IFP Health Agents HBEX Reminder

[Dave020]

Live webcast of the HBEX board meeting today (July 19th) on Cal-Span at:

CAL-SPAN Streaming Video Home Page

Item VIII C of today's meeting will address Agent Payment Options in the CA Individual Exchange.

From the schedule I would expect this item to be addressed in later afternoon today.

 

[GreenSky]

Live webcast of the HBEX board meeting today (July 19th) on Cal-Span at:

CAL-SPAN Streaming Video Home Page

Item VIII C of today's meeting will address Agent Payment Options in the CA Individual Exchange.

From the schedule I would expect this item to be addressed in later afternoon today.

I'm considering playing golf this afternoon. So I'd appreciate a personal email from you letting me know what they say.

Rick

 

[taterpeeler]

I'm considering playing golf this afternoon. So I'd appreciate a personal email from you letting me know what they say.

Rick

I'll give you 10 strokes and we can play from viedo webcam... me at my course, you at yours.... deal? 100 bucks

 

[GreenSky]

I'll give you 10 strokes and we can play from viedo webcam... me at my course, you at yours.... deal? 100 bucks

So you're a scratch golfer and my index is about 19. Somehow you think I want to lose $100 bucks to you?

You can duck at golf and still enjoy it. Kind of like sex. Even if you're no good (not meaning you of course), it still is worth doing.

I would enjoy a round with you. If you get back to So Cal let's play.

Rick

 

[Dave020]

Looks like they are pushing all of Item VIII off to the August meeting due to time contraints. Da**, looks like we will have to wait until next month!

 

[russelltw]

Did any one see what California decided to do with compensation in the exchange?

 

[Dave020]

Sorry, Item VIII Part C was the agent compensation decision. It has been moved to August HBEX meeting in Sacto.

 

[insurehound]

Thanks Dave for the update. I'm betting this gets pushed off all the way up to August of 2013

 

[Dave020]

Actually it's really already been decided and the exchange recommendation is on file, just the final thumbs up or down and waiting for any further/final stakeholder feedback.

For California agents selling IFP, as of today this is the landscape quick summary for CA HBEX:

1. Agents will be paid commission direct from the insurance carriers (recommended by board) for QHPs sold inside of the CA exchange as well as plans sold outside of the exchange.

2. Carriers must pay on parity level both inside and outside of the exchange. Commission will be the same no matter whether a person buys and exchange plan or a plan outside of the exchange.

3. Agents are deemed "Direct Benefits Assisters (DBA)" along with hospitals, doctors offices and most other health providers.

4. Independent 'Assisters' are not allowed and any DBA must be associated with an Enrollment Entity (EE). For agents, the insurance carriers are the EEs and a contract with the carrier creates the association for agents. Providers are stuck because they can't contract with a carrier and therefore can't associate with an EE by sales contract. I am sure that they will address this and work something out.

5. Navigators are separate outreach and enrollment entities and those defined as DBA cannot be navigators. Interestingly, Community Health Centers ARE tagged as navigators and not DBAs so they can collect the navigator fee. Navigators are paid $58 per enrollment no matter if it's one person or a family on the enrollment.

6. Agents in CA selling IFP may not select specific carriers or plans to promote but must provide a "fair and balanced" review of all applicable exchange plans regardless of carrier or commission rate. No cherry picking for higher comp.

This issue came up in the meeting last week in relation to carrier direct sales units. The direct sales unit of today is history because they can't provide fair and balanced review of all available QHPs since they only know their own plans. As one member put it, direct sales units are now compromised.

7. As of today, agents selling IFP in CA would be required to provide enrollment assistance to those at the Medi-Cal and Healthy Families levels but would not be compensated for those enrollments. The CA Exchange feels that assisting low income without compensation is the "cost of doing business" in California and with the exchange. This may be changed later as some stakeholders have expressed concern that agents may blow off low income individuals & families because they receive not compensation on the sale to Medi-Cal or Healthy Families.

8. Agents must be certified by the CA Exchange in order to sell exchange plans. Part of the certification will be required training (currently looks like classroom only, no online).

9. Specific training will be required. Currently the proposed training would be a 2-day course. Some stakeholders have proposed a longer course. Other stakeholders have suggested the health insurance agent licensing and CE may allow for CDI to adopt a different training requirement for agents. Agents may have less requirement time-wise or possible carrier-specific or AHIP-like training.

10. No GA overrides on IFP products sold in the exchange, period.

Those are the highlights as of today. I have spend about 10 hours researching and there is a lot more that I am not going to type here both for IFP and the SHOP Exchange. First thing I did was throw away all 3rd party information and chicken little material and went straight to the source (HBEX). It's all there at the HBEX site but you have to dig through an enormous volume of documents. If nothing else, Peter Lee is big on transparency.

As far as commission rate from the carriers, we won't likely know until very late into this (just before the OEP in 2013). It has been suggested (though not promised) that since the larger carriers are operating under MLR no problem currently, 5% or slightly higher might not be unrealistic. I would not expect 10% ever again.

 

[Ann H]

Thanks for the research, Dave. I don't live in CA, but states may follow CA's lead in designing their own exchanges. You've done a tremendous amount of research and we appreciate it.