UHC ICA Vs. FMO Pros & Cons

[CALTCAgent]

Hello,

What are the advanatges and disadvanatges of being an ICA with UHC versus going with an FMO?

I have been considering UHC as an ICA but wondering if going through and FMO would be better. The sales manager sold me on getting leads, now I am starting to feel they are over promising and that for a few leads (unknown quantity) the contract might be too constricting, what do you think?

1. In the contract if you replace any UHC policyholders after you leave, whether or not they gave you that lead, you forfeit any other renewal business you have with them. Is this correct?

** Note I am not trying to replace business but it appears that in the senor health market your commissions are "back end loaded" 1 through 6 and walking away and not helping the client makes no sense.

2. How much would you think of the MA business through UHC would need to be replaced after the first year? (Where they would leave on their own if you don't find a better plan. Example you write 100 policies first year, how many will stick in years 2 through 6?)

3. If you write business under the ICA contract, even from your own leads, if you replace, this could cancel your renewals on all business with them. Is this true? I am assuming whether or not this business model makes sense all depends on how many leads they give you, is that true?

4. So how many leads do you think they give a new agent and how much of that business needs to be replaced? I know they won't let you, but trying to figure out if I'm better off through an IMO versus ICA.

5. Who is a good FMO that can answer these questions?

Thanks in advance!

 

[smalltown]

I am also considering this change, from FMO with current UHC clients to an ICA relationship. I really do need some guidance on this. Thanks in Advance

 

[AJAX]

Hello,

What are the advanatges and disadvanatges of being an ICA with UHC versus going with an FMO?

An Independent Career Agent (ICA) means that you are captive for certain products, you can only sell their MA plans or PDP plans. I believe supplements are not captive.

You are still Independant for non-medicare products: Individual health, Life, LTC, Annuities, Dental etc. You can represent multiple companies for non-medicare products.

UHC has a strong portfolio (Med supps, PDP, MA/MAPD, SNP, Dual plans) look over their brochure it will list the variety of plans they offer, for different needs.

You should really ask the advantages and disadvantages to the UHC Supervisor or Manager, by phone. I'm sure they will give you the inside scoop of the advantages.

I have been considering UHC as an ICA but wondering if going through and FMO would be better. The sales manager sold me on getting leads, now I am starting to feel they are over promising and that for a few leads (unknown quantity) the contract might be too constricting, what do you think? The contract is not constricting if the plans in your area are competitive, or the best.

I suggest going to medicare.gov and comparing plans in your area. That way you will know what the best plans are. Or send me your zipcode, and I can give you my opinion.

In the contract if you replace any UHC policyholders after you leave, whether or not they gave you that lead, you forfeit any other renewal business you have with them. Is this correct? Incorrect.

Your contract should state that you keep the renewals for as long as the client is on the books (their plan). It's like that for all companies, with the new changes MIPPA made through Medicare commission regulation. Remember you are an Independant agent as an ICA, you keep the renewal commissions, you are "fully vested." EEven if down the road you decide to no longer write business for UHC as an ICA.

** Note I am not trying to replace business but it appears that in the senor health market your commissions are "back end loaded" 1 through 6 and walking away and not helping the client makes no sense, whether in the contract or not. Send me a private e-mail about this.

How much would you think of the MA business through UHC would need to be replaced after the first year? (Where they would leave on their own if you don't find a better plan. Example you write 100 policies first year, how many will stick in years 2 through 6?) Depends on your market.

If you write business under the ICA contract, even from your own leads, if you replace, this could cancel your renewals on all business with them. Is this true? No. Not all, just the ones you replaced.

I am assuming whether or not this business model makes sense all depends on how many leads they give you, is that true? Compare that to what leads an FMO can offer.

4. So how many leads do you think they give a new agent and how much of that business needs to be replaced? Depends on how many agents they have, as they are shared amonth the total number of agents in your area, in Florida we have too many agents. So, few leads.

I know they won't let you, but trying to figure out if I'm better off through an IMO versus ICA.

5. Who is a good FMO that can answer these questions? Try career builder, or search for FMO's that specialize in the senior market

6. Can anybody out there give me the straight scoop? If so I need to talk to you. Send me aprivate message, to exchange phone #'s and we can talk by phone.

Thanks in advance!

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[CALTCAgent]

Hello AJAX,

In the contract if you replace any UHC policyholders after you leave, whether or not they gave you that lead, you forfeit any other renewal business you have with them. Is this correct? You stated. Incorrect.

You stated "Your contract should state that you keep the renewals for as long as the client is on the books (their plan). It's like that for all companies, with the new changes MIPPA made through Medicare commission regulation. Remember you are an Independant agent as an ICA, you keep the renewal commissions, you are "fully vested." EEven if down the road you decide to no longer write business for UHC as an ICA."

In the ICA UHC contract, under 4.4 "termination with cause", it states "if an agent systematically contacts, communicates or meets with any member for the purpose of replacing a product offered by the company with an MA plan, PDP, or other product offered by an MA Organization, PDP sponsor, or other entity which is not affiliated with the company (UHC).

4.7 a. In the event this agreement is automatically terminated under section 4.4 the company shall cease paying compansation to agent and no further payment shall be due. This termination of payment shall be independent of any rights company may have as a result of this breach of agreement.

To me this is clear, you replace any business and you are terminated with cause, you breached the agreement and you are not vested for your renewal commissions. If you are terminated without cause it goes on to say you are vested for renewals.

Do you have a different take on the ICA contract?

Do you agree that the UHC ICA contract is not vested for renwals on ALL your business if you replace ANY MA, PDP business?

I am not a lawyer, but to me this says you are in breach of agreement, they could even sue you on top of stripping away your renewal commissions.

Am I correct, are renewals gone if you replace business?

They don't mention med supp business, is that OK to replace and not risk losing renewal commissions?

Thanks in advance!

 

[timsip]

Hello AJAX,

In the contract if you replace any UHC policyholders after you leave, whether or not they gave you that lead, you forfeit any other renewal business you have with them. Is this correct? You stated. Incorrect.

You stated "Your contract should state that you keep the renewals for as long as the client is on the books (their plan). It's like that for all companies, with the new changes MIPPA made through Medicare commission regulation. Remember you are an Independant agent as an ICA, you keep the renewal commissions, you are "fully vested." EEven if down the road you decide to no longer write business for UHC as an ICA."

In the ICA UHC contract, under 4.4 "termination with cause", it states "if an agent systematically contacts, communicates or meets with any member for the purpose of replacing a product offered by the company with an MA plan, PDP, or other product offered by an MA Organization, PDP sponsor, or other entity which is not affiliated with the company (UHC).

4.7 a. In the event this agreement is automatically terminated under section 4.4 the company shall cease paying compansation to agent and no further payment shall be due. This termination of payment shall be independent of any rights company may have as a result of this breach of agreement.

To me this is clear, you replace any business and you are terminated with cause, you breached the agreement and you are not vested for your renewal commissions. If you are terminated without cause it goes on to say you are vested for renewals.

Do you have a different take on the ICA contract?

Do you agree that the UHC ICA contract is not vested for renwals on ALL your business if you replace ANY MA, PDP business?

I am not a lawyer, but to me this says you are in breach of agreement, they could even sue you on top of stripping away your renewal commissions.

Am I correct, are renewals gone if you replace business?

They don't mention med supp business, is that OK to replace and not risk losing renewal commissions?

Thanks in advance!

My take on this is that if you get contracted with another MA company and you replace a product with one of you clients to another company, you lose. I don't know if it is possible to contract with two MA companies, but I don't see why not. If you replace a UHC MA plan with another UHC plan, you are good.

I also don't see how the company would know if you switch the client from a UHC MA plan to a Med Supp with another company, maybe someone can speak to that.

 

[AJAX]

My take on this is that if you get contracted with another MA company and you replace a product with one of you clients to another company, you lose. I don't know if it is possible to contract with two MA companies, but I don't see why not. If you replace a UHC MA plan with another UHC plan, you are good.

I also don't see how the company would know if you switch the client from a UHC MA plan to a Med Supp with another company, maybe someone can speak to that.

I agree with timsip's understanding of the contract.

CALTCAGENT, I don't think they will sue you, but I am not certain. Can they win in court if you act in the best interest of the client, by replacing a plan? I doubt a judge and jury would find you guilty or penalize you for acting in the best interest of the client. But, I am not a lawyer, so, I'm not qualified to answer that.

Even though you may not be adjudicated (like that word). It will follow you, one of the questions asked for appointments or applications for insurance jobs is have you been terminated with cause. So, replacing business can be like walking on eggshells.

But, concerning what I wrote. I wasn't thorough enough on my answer about renewals. Replacing an MA/PDP plan is cause for termination, and you are right, it states that payments will stop and any further payments will cease. I haven't found anything about Med Supp replacement as cause for termination.

But, my main point is know the Medicare plans in your market. That will give you a better understanding if it is worth being an Independant Career Agent (ICA) or a broker.

From what I know, the benefit of being independent is being able to offer the best product in your market. For seniors I believe that is either a PPO plan or a Med Supp (if they can truly afford it). As an Independent agent I wouldn't sell an HMO to a senior, even if the co-pays are less, the gatekeeper and medically neccessary authorizations are too restrictive.

It's more common for people to need medical attention as they get older. As an Independant agent, the last thing I want to hear is I'm hurting, but the MD/Insurance company wont authorize a diagnostic test or refferal to see a specialist.

That's why I mentioned for you to research on Medicare.gov to see the plans that are offered in your market. What is the best PPO plan in your market? You can also search your state's Insurance department to get rates on different Med Supps. What are the top 3 Med Supps in the areas you work? Also, try to find what the average rate increase has been for these med supps, because some give good rates but later give high premium rate increases.

I believe if you analyze the competition, you will know what companies you want to represent. Or, ask some other Insurance agents in your area, they should have a feel of your market.

 

[timsip]

CALTCAgent, from what I have found, and after asking my sales manager, the interpretation that I posted earlier seems to be true.

I would advise against selling any med supp to a lead given by UHC, at least for the first year. I don't think there is any way that they could tell if you did sell a different company without calling your client, but the professionalism dictates giving them the premium for giving you the lead.

On that note, I tried to sell MAPD to each lead I was given thinking that was the intent of the program, but this year I will not be so focused on MAPD, but as the entire book of business. My sales manager is ok with that, even though I know he is rated on the sales of MAPD and he would prefer that I sell that.

 

[CALTCAgent]

Hello Timsip,

Thanks for your info!

I however agree with my understanding of the contract.

Why:

1. My information is in writing in black and white.

2. Your "Sales Manager" statement is not as valuable as what is in writing. I am very familiar with the less than straightforward statements of "Sales Managers".

3. You state not to sell a med supp to a lead given when in the contract they don't care if you sell their med supp or MA plans. They do have a provision against replacement now or in future on any UHC business written while under the ICA contract, even if you are no longer under the contract.

Anybody have the same or different take on the UHC ICA contract?

How would they know if you replace any MA and/or med supp business in the future?

Do they get a report from CMS with agent info?

I'm sure they could/would investigate if they started losing a lot of business a particular agent wrote?

Thanks in advance!

 

[timsip]

Hello Timsip,


3. You state not to sell a med supp to a lead given when in the contract they don't care if you sell their med supp or MA plans. They do have a provision against replacement now or in future on any UHC business written while under the ICA contract, even if you are no longer under the contract.

I think we have a misunderstanding. I didn't say not to sell them a med supp, I was saying not to sell them a MAPD from a competing company. I don't know of any way UHC could even find out aside from calling the client who sold them a med supp from another company, but since CMS tracks data to include agent info from MA sales, I don't know if UHC would have access to if you replace UHC products or not. That would be the only way they could find out if at all possible.

As far as selling to the lead the first year, you should be able to sell anything you want, but from a professionalism point of view, I sell the products of the company that provided me the lead. Second year, I will replace with another company (if it is replaced with a Med Supp, I am only contracted with UHC for MA) if it is better for the client. It is how I balance the relationship I have with the insurance company that gives me leads and the relationship with my clients.

 

[AgentPitstop]

I am a Marketer - so first off my oppinion is Bias - But as an agent I think first and foremost about my renewal and my ability to grow my book - So under a capitive program you forfeit a lot of your Freedoms and 7 years to vest is outrageous.....I am aware of the "overpromisses" dont get caught up in that mess.....#1 Leads are not free and anyone spouting free leads is Blowing Smoke up your _ _ _ . The agreement in Black in white is everything - A relationship between agent and Marketer or Ins. Co. should be a revolving door - its give and take all the way......Look for open release policy - full street contracts and if possible some co-op for your production.....Agent or sales support is important as well as how do they pay commision (Assignment or Direct).....Hope this helps.