The Patient Protection and Affordable Care Act (PPACA) public exchange in California might give exchange agents a chance to grade carrier support for them. 

The staff of the Covered California exchange went into a board meeting scheduled for today with a draft of an individual market health plan contract that includes detailed agent support provisions.

See also: California exchange chief proposes agent comp floor

If the board adopts the contract as written, it will apply to insurers that sell qualified health plan (QHP) coverage, or coverage that makes the insureds eligible for PPACA exchange plan subsidies, through Covered California in 2017, 2018 and 2019.

The draft contract includes an “incentive compensation program” provision that would require an issuer to pay the same commissions throughout the year. An issuer could not pay one commission during the regular open enrollment period and a lower commission, or no commission, to agents who help consumers who apply for coverage at other times of the year.

An issuer would also have to pay the same commissions for sales of different “metal levels” of the same product. An issuer that paid a 2 percent commission on sales of the bronze version of XYZ Health Plan, which covered 60 percent of the actuarial value of California’s standard “essential health benefits” package, would also have to pay 2 percent commission on sales of the platinum version of the XYZ Health Plan, which would pay 90 percent of the actuarial value of the EHB package. 

If a new exchange customer chose an agent, the exchange would tell the QHP issuer about the agent through a new-enrollment file or a weekly reconciliation file. The QHP issuer would have five days to get the agent selection information into its system. To clear up any agent-selection data problems, the QHP issuer would have to send the exchange an “exceptions report,” showing any requested agent file changes that were not actually made, by 5 p.m. on the last business day of the month.

A similar provision would apply to consumers’ requests for agent changes.

The exchange would ask agents to participate in an annual carrier agent support scorecard and publish the carrier scorecard results on the Covered California agent website. 

See also:

PPACA World 2017: How it’s supposed to work

UnitedHealth to avoid 2016 public exchange plan sales

 

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