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Agents Issues

California health insurance agents are expected to be an important outreach and enrollment channel for the Covered California health insurance marketplace. Covered California must design policies to address several agent issues including Medi-Cal enrollment, training and certification, commission parity inside and out of the Exchange, and unbiased access to consumer information.

Agent Role in Medi-Cal Enrollments

Eligibility for a potential subsidy in the Covered California can only be determined by a process that also first determines if an individual is eligible for Medi-Cal. Because of this, agents will need to understand the full range of eligibility rules to assist individuals to enroll in these non-exchange plans. Beyond assisting anyone on the basis of eligibility, the Exchange would require that Agents assist Medi-Cal eligible individuals in completing their enrollment in those programs. Agents will provide the same full scope of counsel and advice as would a Navigator, but would not receive compensation for this service. Treating agents as “Direct Benefit Assisters,” means certifying agents that have completed training with the Exchange.

Defining Scope of Agent Training and Certification

All Agents must meet California Department of Insurance licensure standards that include training requirements. Those standards will need to be updated to reflect new market rules that will apply to Covered California and non-Exchange plans - such as essential health benefits, guaranteed issue and actuarial value. Covered California will also need to develop curriculum and training that are specific to licensed agents that reflect the full range of training the Exchange considers important, including specific training on eligibility for subsidies and Covered Clifornia coverage. Mechanisms will need to be established to verify Exchange certification and licensure, ensure continuing education, and implement any other agent guidelines set forth by the Exchange. Whether this would be done by the Exchange or health plans needs to be investigated.

Commission Parity Inside and Outside the Exchange

Covered California plans to base agent compensation for the sale of Exchange products on market commission rates. But to ensure that agents are not incentivized to sell outside of the Exchange, it is suggested that there be a contractual requirement on plans in Covered California to pay equal commissions for the sale of non-Exchange products. Creating parity in commission rates between sales of Exchange and non-Exchange plans both reduces incentive for agents to steer consumers toward or away from the Exchange. While Covered California is clear that parity should exist for commissions related to QHPs, whether the parity should relate to non-QHP products offered by plans outside of the Exchange requires additional study.

Assuring Consumers’ Access to Unbiased Information

It is critical to Covered California that all individuals have the full range of information presented to them in an unbiased way. Consequently, the agent policies must include an obligation that Agents present all health plan and product choices to potential enrollees in a fair and balanced way, regardless of the level of compensation an Agent receives from different health plan issuers. Agent compensation for incentive programs and some vested arrangements may be out of line with this requirement, and the Covered California will need to monitor compensation arrangements to ensure there is no bias introduced in how different health plan options are presented to enrollees.

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