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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


2014 Commission News

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Question: I saw where Blue Shield announced agent commissions at 4% on individual business. Any news on other carriers?

Answer: Yes. Shield announced 4% first year and renewal for ACA-compliant individual business effective 1/1/14. Anthem also disclosed their commission: $18 per member per month first year and $12 pmpm renewal. Looks like Kaiser will be staying at a $100 flat fee. Anybody heard from Health Net?

21 Comments

Karen G wrote … “For each client we will get two commission checks(if CC pays a portion) ONE from insurance Co & ONE from CC… Am I correct?”

I don’t believe that that’s quite correct. I, too, received my commission check for all of $9.30 (one client’s commission was a whopping $0.66). I called HealthNet to inquire.

We will be paid on the gross commissions — minus the 2% deduction for HelathNet’s cost of doing business (I don’t know why I have to pay that) — but HealthNet is waiting for CoveredCA to pay them the premium tax credits.

I don’t know if that money goes to CoveredCA from the IRS or to the insurance company from the IRS. We’ll just have to wait and see.

At least HealthNet’s commission check came ahead of any other company.

Deborah wrote (among other things) “i will not sell h/net ppo plans unless the client go for the Platinum…beside their rates are higher.”

First, you can be accused of discrimination and adverse selection for doing what you suggest above, and that will lead to the loss of your license. Your public responsibility as a licensed agent is to put the client’s interests ahead of your own. If they want the HealthNet bronze plan, for which you get a 2% commission, compared to the silver, gold, or platinum plans and their 5% commissions, so be it. You cannot force the consumer to buy what is best for you.

I would offer to be the first person to testify against you at your license revocation hearing.

On the other hand, there could be legitimate reasons to lead someone away from HealthNet to Blue Shield or Anthem, but, again, those reasons must be in the best interests of the client, not you as the agent, such as the physician they see is only in a certain network.

It might just be better, if you cannot live up to your ethical responsibilities, to only write coverage off the Exchange. If you don’t want to represent HealthNet, that’s your choice and your clients don’t have to do business with you if they want HealthNet and you don’t.

Until a few days ago, I was not previously appointed by Anthem — by my choice. But because a few CoveredCA clients have chosen Anthem plans, I needed to be appointed if I wanted the commissions.

It’s ALWAYS about the clients and their needs.

i would send in a complaint to www.insurance.ca.gov. about the commissions , especially H/net going to 2% on all ppo s call them to complain 800-967-9331 i will not sell h/net ppo plans unless the client go for the Platinum… beside their rates are higher . The out of network benefit is not worth it. Blue shield i better.

no you will not be paid for medical, don t bother.

Just received a commission check from HN, The premium is $40.89 and Comm Premium is 39.88 and the commission is $1.99! (Wow. )

Does that mean the other portion of the premium paid by Covered CA for this client to the insurance Co will also give me commissions?

IF YES, do the Commissions come from Covered CA?

My belief: For each client we will get two commission checks(if CC pays a portion) ONE from insurance Co & ONE from CC… Am I correct?

Bwaahahhaaaaa.

CALL CoveredCA? Are you serious?

Let me clue you in on how that goes.

“Thank you for calling Covered CA, we are way to busy to answer your call, goodbye”

Repeat in Spanish

Disconnect

Christy …

A person can use the “Forgot my PIN number” function to reset their password and/or PIN. They will be required to answer three of the five security questions they initially completed. If a person cannot do this successfully, or if they have made repeated incorrect attempts to log in, the only choice is to call CoveredCA and have a CSR unlock their account and reset their password.

I was wondering if any one knows the proceedure to assigned your self as a client agent? If they do not remember what their password and stuff is but they want an agent what is the procedure

I hve not been able to confirm that Medi-Cal enrollments will be paid.

I spent 90 minutes on hold yesterday with CoveredCA only to be told “no” by the representative, and when I asked what she based her information on, she could not say. When I asked about the October 24 report that indicated that payments would be made, she said, “Well, things are changing all the time.”

I wrote an email to “info@hbex.ca.gov” over 24 hours ago, and have not received either an acknowledgment or a response. Will update if I receive one.

Does anybody know the actual facts on commission for individual fully paid or partial subsidized / Medical

It looks like we all will need to get a second job to suuplement our income. More work with less pay. I never thought I’d be one of those guys saying “remember the good ole days”. 20% to 12% to 4% all within two years. What happens after all the fine citizens of our country are enrolled? Will they need us at all anymore? Doubtful…

I’ve tried staying positive throughout all this but at this point I’m glad I know how to wait tables! : )

anybody know about the commission s on Molina and• Chinese Community Health Plan and how to get appointed with them. are they going to offer agents anything?

Per Member Per Month means what it says. Husband is Member 1, Wife is Member 2, Child is Member 3, etc. Family of four = $72 per month. Premium could be $900, $1200, it’s not a percentage.

At least in the SHOP exchange, the commission is a percentage of annual (pre-credit = gross) premium per business account. The percentage declines as the annual premium volume per business account increases. Starts at 6.5% of gross and declines from there. 5% renewal as long as the business stays on the books as agent-of-record.

What about Blue Cross’ $18 ppm, is that per actual member or per family/application?

Health Net’s most current individual commission schedule (effective 1-1-2012) shows 8% first year, 5% renewal on its PPO plans. As always, things are subject to change.

Chalk up all this poor compensation to the 80% MLR imposed by the ACA on insurance companies, PLUS their “pay to play” tariff on top of all that. Congressional insanity, and no truly affordable premiums because the insurers have steadily been increasing premiums since 2010 to try to get ahead of the premium wave that crashes and establishes the benchmarks on 1-1-2014.

Kaiser pays $100 per application not per member.

Agent commissions are the same on exchange and off exchange.c

I think what he meant was $100 flat per application regardless of # of members…is this correct Phil?

Also are these rates for ON and OFF the exchange? or just ON the exchange?

When you say $18 per month per member (Anthem), and $100 flat Kaiser, does that mean that enrolling a family of 4 would equate to $72/month with Anthem and $400 flat Kaiser?

anybody know about the commission s on Molina and• Chinese Community Health Plan

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