As previously noted, many carriers have decided to stop paying commissions on new health insurance business written between Open Enrollment Periods. This has prompted agents to look at other income models, including fee-based.
Back in April, I wrote about my own search for an answer, and a webinar I attended explaining the ins and outs of such an arrangement. One key point that was made more than once was that one couldn't "offer to refund any part of [the fee] based on the completion of a sale or any commissions." That is, there can be no off-setting for plans that do generate a commission.
Which made sense in the context of rebating, and that was fine.
But last week, I received new guidance from another source. In their newsletter, Ohio Insurance Agents, also mentioned the issue, and offered its own take on commissions and fees:
"To help with this troubling trend, OIA wants agents to be aware that Ohio law does permit agents to charge fees for services in several instances. For personal lines policies, such as sickness or accident insurance, agents may charge a fee if the policy is sold on a no-commission basis" [emphasis added]
You can see the dilemma: one reliable source says an agent can (must) collect both a fee and a commission, while another equally trustworthy source says one may only charge a fee if there is no commission.
There's really no middle ground here.
I've reached out to the folks at Cornerstone to see what they have to say about this, and will keep readers posted as the situation develops.
Just now via email:
"UnitedHealthcare and Optum, the health benefits and services companies of UnitedHealth Group, are taking immediate action to support people affected by the recent mass shooting at a nightclub in Orlando. The company is opening Optum's Help Line, providing affected residents access to specially trained mental health specialists.
Optum's toll-free help line number, 866-342-6892, will be open 24 hours a day, seven days a week, for as long as necessary. The service is free of charge and open to anyone."
Also available online here.
Kudos, UHC.
Not much has changed since last week, as the DOI is still noodling through how to proceed. One issue which had flown under the radar has to do with the ObamaTax:
As we've previously noted, placing the $500,000 claim cap on IH policies renders them ACA non-compliant, which means that folks will lose their subsidy if they stay. But it also means that they'd be subject to the ObamaTax if they stay on longer than 90 days. And they have but 60 days to make a switch.
Talk about rocks and hard places.
Still, I have at least one client that's already met her out-of-pocket for the year, and would have to start over again mid-year if she switches. She's going to have to decide how that will play out for her financially.
Oy.
As The ObamaTax continues to auger in, the Rocket Surgeons in DC© have the perfect solution: Less choice!
"The government's move would limit short-term health coverage for an individual to less than three months each year and bar renewal."
There is so much wrong with this that it's difficult to know where to begin (not that that's going to stop me, of course).
First, Short Term plans (STM's) are never "renewable." The term has a specific meaning, and it doesn't apply to STM's. They are often re-writable (that is, one can buy another plan after the current one expires), but this is very different.
And no, I'm not splitting hairs:
Short Term plans don't cover pre-existing conditions (one of the reasons they're inexpensive, plus non-O'Care compliant). If they were "renewable," then anything I was treated for under one plan would be covered when I re-upped. But this is not the case, nor has it ever been. Rather, when the initial coverage period is up, one buys a new plan, and anything that was covered under the previous one is now pre-ex, and excluded.
Second, how in the world would the gummint enforce the "3 month rule?" It's not like there's some secret Washington database of STM clients. The most they could do is prohibit carriers from issuing plans that last more than 3 months. Okay, rocket surgeons, but what's to stop me from then going to another carrier for another 3 month stint, and on and on? Nothing, that's what: as noted above, there's zero reason not to, since there's no inherent value in sticking with the same carrier (no continuity of coverage).
Perhaps the Powers That Be should instead look at the reason this has become a problem: ObamaPlans have become unaffordable, and we have as many - perhaps more - uninsured as we did before this train wreck.
But that's just me.
Via co-blogger Patrick, some interesting news on the InHealth front, clarifying some things we already knew:
"Today, the Ohio Department of Insurance announced the approval of a 60 day Special Enrollment Period (SEP) for InHealth enrollees due to its recent financial problems which resulted in Lt. Governor/ODI Director MaryTaylor being appointed liquidator of InHealth."
Since the DOI took over the troubled carrier on May 26, the SEP will run from that date to July 26. There were two other items in the announcement that I found interesting:
First, as we suspected, it look like it will be up to individual carriers as to whether or not folks will have to satisfy a new deductible if they switch:
"[Y]our deductibles and out of pocket maximum may reset and your benefits and provider network may change"
"May" reset. My money's on "will."
The other item is one I hadn't really considered, but answers questions raised in the comments to the last post we did on this:
"If you choose not to obtain other coverage, your current deductibles may stay in place but your overall coverage will be subject to a $500,000 maximum. As a result, this option may cause you to be subject to the individual mandate penalty. You should contact the IRS or a tax professional to discuss further."
Since the ObamaTax lifted the cap on a person's claims, and the state's Guaranty Fund puts one back on, it renders the IH plan non-compliant, and therefore subject to the penalty tax fee.
And there's this:
"In addition, any subsidy that you may have been receiving will not apply to continued coverage."
Which is probably self-evident, but probably best to point it out.
The folks at CMS (Centers for Medicare & Medicaid Services) emailed to let us know that they have an updated list of the 6 Special Enrollment Period triggers. These are all pretty routine, but I thought this was interesting.
Moving to a new location to live has always been a legitimate trigger, and apparently enough folks used that as a way to game the system that the Rocket Surgeons in DC© have finally figured it out:
"Note: Starting July 2016, you must prove you had qualifying health coverage for one or more days in the 60 days before your move, unless you’re moving from a foreign country or United States territory. Also, moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period."
Who says bureauweenies have no sense of humor?
