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California Health Benefits Exchange August 25 Update

Some updates to my previous HBEX blog post August HBEX Update from August 13th. The HBEX Board meeting on August 23rd has some agent/broker actions as follows:

*Agent Compensation for individual & family coverage plans (IFP) will be paid to agents directly by the health insurance carrier at an equal level (parity) for plans sold both inside and outside of the health benefits exchange.

*Agent Compensation for small group coverage plans (SHOP) will be paid directly to agents by the SHOP exchange for SHOP plans and directly to agents by the carrier for plans sold outside of the SHOP exchange.

*Member premiums for individual & family coverage plans will be paid to the insurance carrier and not to the exchange.

*Employer premiums for small group coverage plans will be paid to the SHOP exchange directly and not to the carrier(s).

*Agents and Brokers must certify with the exchanges in order to sell health plans for the exchange. Agents and Brokers who do not certify will not be allowed to facilitate enrollment into the exchanges (emphasis in on the individual exchange).

*Agents and Brokers must assist prospective clients if they are eligible for Medi-Cal (California Medicaid) and/or the Healthy Families Program. Agents and Brokers will not be compensated for assisting with Medi-Cal or Healthy Families enrollments (Navigators will get $58 for these enrollments). The exchange considers this a "cost of doing business" and a community service.

*Web-based agents' sites will be carefully scrutinized to ensure that they don't develop competing exchange web sites or quoting engines that use algorithms designed to drive business to any specific carrier or plan displays designed to promote a certain carrier or carriers over others.

*Agents and Brokers in the individual exchange must present plans from all carriers in a metal tier in a fair, equal and balanced way.

*General Agents/Agencies will be excluded from the Individual & Family Exchange. They will be allowed in the SHOP Exchange.

That's the big stuff from August.


As always, for specific information concerning health insurance coverage, please visit my web site at the link above.


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