Agent Role on Federal Facilitated Exchanges

by Melanie Jackson Ensminger - May 22nd, 2013

The Center for Consumer Information and Insurance Oversight (CCIIO) recently released guidance on the role of Agents and Brokers on Federal Facilitated Exchanges-Health Insurance Marketplace. Essentially, CCIIO has divided the guidance into three sections: the Agent Registration, the Carrier-Agent Pathway, and the Marketplace Pathway. (

The process for Agent Registration will be quite different from that which Agents are accustomed to today. In order to assist individuals on the Exchange, Agents must be able to confirm their identity, complete Marketplace-specific training, complete and successfully pass an exam, and agree to all federal and state regulations. Once the registration has been completed and the Agent is approved, he/she will receive a Marketplace userid.

The Carrier-Agent Pathway is similar to that system which is in place today. Once the Agent can supply proof that he/she is licensed and has completed the Agent Registration as highlighted above, the Carrier (Issuer) may appoint the Agent to sell their product.

And finally, the Marketplace Pathway is an electronic system that helps Agents enroll qualified individuals into individual Marketplace options after helping the individual determine subsidy eligibility. The process sounds easy enough; however, as stated time and time again: “The devil is in the details!”

What does this mean to you?

Understanding the rules and regulations as they pertain to selling on the exchange is extremely important. As an Agent, it will be incumbent upon you to understand your role, comprehend the rule, and advise your clients correctly.

Staying Focused

by Tom Swayne - March 20th, 2013

Each day brings  new clarifications from the  Office of Health and Human Services (HHS).  The more we read , the more confused many of us become.

As the January 1, 2014 deadline approaches and we begin to hear more about the Federal Exchange, subsidies, tax credits, metal plans, play or pay, measurement periods, stability periods , and “affordable premiums”,  it is going to be even more difficult to understand how Agents and Brokers should advise their clients.  It is easy to become consumed and confused with all this “stuff,” but what we need to focus on is the “here and now.”

For the most part we don’t have a clear understanding of what most of the new rules and regulations mean and how they will truly impact the industry overall.  Until the carriers file their rates and plan designs, AND until the Federal Government issues final regulations on subsidies and enrollment in the exchanges, most of the concerns are  based only on speculation.   Many business owners are confused about what they need to be doing, if anything at all.  Should they keep their health plan grandfathered? Should they keep their group coverage?  Should they drop their group  plans and let their employees go to the exchange to purchase coverage?  If the group is subject to fines, the answer could change..  The main reason they don’t know what to do now is they are not sure of the various moving parts and how the moving parts all come together.

At this time, employers need to focus on determining whether they are a large employer, employing over 50 FTE’s, or a small employer.  If they employ less than 50, essentially there is really nothing to do at this point.  If they employ over 50 FTE’s, then they need to determine if they have any part time employees averaging over 30 hours/week during a selected measurement period.   Additional guidance can be found on the Department of Labor website Technical Release  No. 2012-02.  If an employer is unsure as to whether or not they have over 50 full-time eligible employees, they need to seek council now.  Common ownership (Controlled Group Rules) may apply if an owner has an ownership interest in other businesses.  Penalties for not offering an affordable qualified health plan only apply to those businesses employing over 50 FTE’s- (30 hour/ week or more)

We will learn much more in the coming months.  Assuming the current timelines are met, we will be hearing a great deal more as to the rules.  Carriers will be filing plan designs and rates during the month of April so we anticipate more clarification on the operation of the exchanges in the 2nd quarter.  The message now is to stay focused on the rules and regulations that have an immediate impact and seek guidance when appropriate.

Proudly Supporting MUSC’s Children’s Hospital this Holiday Season!

by Kitty Jackson - December 11th, 2012

holiday card 2012For almost 20 years, the David Gilston Insurance Agency has supported MUSC Children’s Hospital and their Holiday Card Project. This year we thank Riley Norris, age 10, of Mt. Pleasant, who is the artist of our card this year. Riley is a heart patient of MUSC Children’s Hospital.

Each year the MUSC Children’s Hospital Fund teams up with young patients and their siblings, local businesses and individuals to raise money for the MUSC Children’s Hospital in a very unique way called the “Kids Helping Kids” Holiday Card Project.  This is done with the help of inspired patients and young friends of the Children’s Hospital who paint wonderful holiday themed works of art that, thanks to our sponsors, will be proudly displayed on the front of holiday greeting cards.  Last year this exciting project raised $55,000 for research and the programs at the MUSC Children’s Hospital!  Since its inception, the “Kids Helping Kids” Holiday Card Project has raised more than $850,000 for the MUSC Children’s Hospital.

We hope that you too will capture the magic of the holiday season by devoting your time or money to a cause close to your heart.

Do You Know… Pam Shober?

by Kitty Jackson - October 22nd, 2012
I am married with two daughters: a freshman in high school and a freshman at Clemson. We also have two huskies.

I studied Biology at the College of Charleston. I also have received my HIA, Health Care Anti-Fraud Associate (AHIP) and Associate, Customer Service (LOMA)

How long have you worked for the Gilston Agency:
22 years!

Current Position:
Account Service Representative

Favorite childhood memory:
Traveling across country with my family in a camper!

When I was younger I wanted to be:
A veterinarian

First job:
McDonald’s cashier

I am an avid reader and I enjoy playing the saxophone.

What is your favorite color?

Accomplishment I am most proud of:
My two children!

If I won the lottery the first thing I would purchase is:
Pay off college for my daughters and then have some fun!

Top 5 job responsibilities:

  1. Assist group administrators, members and agents with benefit inquiries and claims processing resolution.
  2. Complete reconciliation of carrier invoices against payroll deductions.
  3. Processes group enrollment additions, terminations, and changes in a timely fashion.
  4. Ensuring HRA claim requests are submitted in a timely fashion and reimbursed correctly for the member.
  5. Effectively communicates with plan administrators, as well as members, providers, insurance carriers, and agents to resolve billing, enrollment or claims problems.

BlueCross BlueShield Under 65 Rate Change

by Kitty Jackson - September 20th, 2012

For the first time in three years, BlueCross BlueShield will be raising the premiums on their individual under 65 policies. The rate changes will be in effect beginning November 1, 2012.

According to BlueCross, the increase is due to members using more medical services this year than in previous years and they expect the trend to continue. Because of this, they have to adjust their rates to keep up with the continuing increasing cost of health care. Members are beginning to receive their notification letters beginning this week. Members with drug cards will also receive an increase in drug rates.

If you have been running individual proposals in Accel-A-Rate with an effective date of November 1 or later, the rates could have changed. When you open a saved proposal and make changes or submit a proposal rated prior to the rate update, Accel-A-Rate will recalculate and display the new rate. New rate books are available from the BlueCross BlueShield Storefront.

Click here to view the bulletin from BlueCross BlueShield. Click here to view the letter that will go to Grandfathered Plans and click here for the non-Grandfathered letter.

The Gilston Agency Turns 50!

by Kitty Jackson - September 4th, 2012

50thAnnvLogo_FINAL emailToday is a very special day at the Gilston Agency as we celebrate 50 years in the business! Established in 1962, the David M. Gilston Insurance Agency has supported insurance brokers and agents across the state of South Carolina through our Columbia and Charleston locations. We congratulate David Gilston, Chairman of the Board, and Tom Swayne, President, on this wonderful achievement!

After attending the University of South Carolina in the late 1950s, Gilston began his insurance career with Combined Insurance Co., working with successful insurance businessman and philanthropist W. Clement Stone. At the start of his career, Gilston attended a management training course where Stone handed out books to 18 students along with a single message: “Read this book, follow it and you’ll make as much money as you’ll want.”

The book was “Think & Grow Rich” by Napoleon Hill. Published in 1937, this book has become a classic, sitting on the bookshelves of countless businesspeople. Gilston was 25 years old when he first read “Think & Grow Rich” and he’s been a believer in its principles for 50 years. It’s how he built his own business, which is one of the state’s largest health insurance marketing and support organizations.

As he started his own business in the 1970s, Gilston put Hill’s philosophy into action, writing out his goals, creating a plan of action and creating a mastermind alliance and surrounding himself with people who would help the company grow. One of those people was Tom Swayne, who started as an insurance salesman and has worked his way up to president of the company.

Swayne is a 1975 University of South Carolina graduate with a Bachelor of Science Degree in Insurance and Economic Security. He began his insurance career with Equity Life as Vice President of Claims. In 1978, Swayne joined the David M. Gilston Insurance Agency, Inc., in the capacity of Sales Manager. He possesses his LA&H license and is a South Carolina Department of Insurance sanctioned Certified Instructor for continuing education and teaches courses throughout the state promoting professionalism of the insurance community in South Carolina.

Many of Gilston’s employees have been with the company for more than a decade. Some of them subscribe to his philosophies and others simply pick up on the inspirational vibe that flows through the business. It is this inspirational vibe that has kept the Gilston Agency going strong for 50 years.

“I get a tremendous amount of enjoyment in seeing people I’ve helped do well,” Gilston says.

Congratulations to David Gilston and Tom Swayne!

Do You Know… Kitty Jackson?

by Kimberly Smith - August 15th, 2012

favorite 3Family:
My parents, Peggy and Earl live in Atlanta in my childhood home with our two dogs. My horse, Sadie, lives out on Johns Island.

I graduated from the College of Charleston in 2011 with a degree in Communication with a concentration in Media Studies and Public Relations.

How long have you worked for the Gilston Agency:
I began my internship in the marketing department in March 2011, became a staff member in June 2011 and became full time in January 2012.

Current Position:
Marketing and Administrative Assistant

Favorite childhood memory:

Winning second place at the Junior Olympics for horseback riding in the hunter/jumper division.

Five words that best describe me:
Outgoing, determined, blunt, loyal, funny

Favorite book:
Black Beauty

Accomplishment I am most proud of:
Making honor roll my last 4 semesters at CofC!

If I won the lottery the first thing I would purchase is:
A pair of Christian Louboutin heels

If I could trade places with anyone for a day, who and why:
Giuliana Rancic because she is my professional idol as she has her hands in all things entertainment and fashion!

Top 5 job responsibilities:

  1. Admin for company Facebook and LinkedIn accounts
  2. Author of reform blog, agent blog and weekly e-newsletter
  3. Update company website as needed
  4. Create all marketing and advertising material for both the Gilston Agency and in-house agents
  5. Organize agency events

Life After SCOTUS

by Tom Swayne - July 10th, 2012

trainingI hope you had a safe July 4th holiday and are enjoying your summer thus far.  It is hard to believe that the end of the year is fast approaching!

By now you are aware of the Supreme Court decision on the Affordable Care Act and, like many of us, were relatively surprised by the outcome.  However, despite the final ruling, at least we now know the rules and can re-engage in mapping out future strategies.  Although many unknowns still remain, our strategies must incorporate the rules as they have been presented in conjunction with our knowledge of the insurance industry. As many of you have heard me say, the outcome of the Supreme Court decision will do little to change the direction of our industry.  Technology and the cost of healthcare will be the driving factors behind change.

We must all now begin to initiate strategies that will help guide us in the direction in which we need to be moving.  I know this may sound like a stretch when we don’t even know what the Federal Government will do with the exchanges.  Additionally, the carriers will need to make decisions with regard to their business strategies in order for many of us to develop comprehensive plans for expanding our business. The greatest concern that many Agents will face at this time is procrastination.  Continuing to operate under a “Wait and See” mindset is no longer an option.  It is incumbent on all of us to begin seeking out the necessary training opportunities we will need to help guide clients through the maze of choices they will soon face as it relates to their health insurance.

As an Agent, you must scrutinize the way you approach your clients today and ask yourself, “What additional training will I need to acquire in order to counsel my clients?”  For example, did you know that information such as an employee’s household income will be relevant when speaking to employers about providing benefits either in or out of the exchange?  It will be important to begin profiling your accounts as to potential business growth opportunities.  By all means, now is the time to stay in touch with your clients so they have the confidence in your ability to counsel them as the changes begin to take place.  Remember, as it stands today, the exchange will begin enrolling members October 1st of next year, a mere 14 months away.

As always, we at the Gilston Agency are developing training programs to assist you in your learning development.  If you are interested in continuing to be a part of our success, please reach out to us and let us know.  We are always interested in hearing from you and addressing any concerns you may have.  We expect to host continuous training sessions throughout the coming months as we identify specific needs as they relate to the changing environment.

The elections are on the horizon and with them will come many discussions on the ACA and the potential changes that will affect our industry.  But, as I previously stated, technology and the cost of healthcare will be the catalysts that bring change to this industry.  Some of you will remain a player in this industry while others may decide to retire from the business all together.  Either way, the Gilston Agency stands ready to continue to play a vital role.

Do You Know… Julie Poncar?

by Kitty Jackson - July 2nd, 2012
favorite 3Family:
I have been married to my husband, Greg, for 27.5 years.
I graduated from the College of Charleston with a Bachelor’s of Science in Business Administration. I have also received my Registered Health Underwriter (RHU) and Registered Employee Benefits Consultant (REBC) designations from The American College.
How long have you worked for the Gilston Agency:
I celebrated 10 years in February!
Current Position:
Agency Sales Representative
Favorite childhood memory:
Spending my summers at Lake Sinclair in Georgia.
When I was younger I wanted to be:
The President
First car:
A 1968 purple British Ford
Scuba diving and traveling
Favorite book:
Zion chronicles by Thoene
Accomplishment I am most proud of:
Being married for over 27 years!
Top 5 job responsibilities:
  1. Represent & promote the services & staff of the Gilston Agency to others.
  2. Educate myself on the changes in our industry so I can educate others.
  3. Help Carriers by providing feedback to them so they can provide the best products and services using the most efficient procedures.
  4. Help Agents/Brokers navigate through the Federal & State laws and the carrier rules so they can help their clients.
  5. Help Employers find the best carriers and benefits for their employees.
  6. Help Employees understand their benefits through educational meetings and materials.

Do You Know… Kimberly Smith?

by Kitty Jackson - May 25th, 2012
linked in
I have been married to my high school sweetheart, Tillman, for 9 years but we have been together since we were 16. We have two wild boys, Tripp, 5 and Bennett, 3.
I received my Bachelor’s Degree from University of Georgia with a major in Risk Management and Insurance. I also have my HIA and RHU designations. I was a certified Continuing Education instructor for 6 years.
How long have you worked for the Gilston Agency:
It will be 8 years in August!                       
Current Position:
Netchex Payroll Sales Representative
First job:
I was a cheerleader instructor at cheer camp for USC.
Five words that best describe me:
Energetic, personable, funny, hardworking, motivator
A celebrity I would love to meet:
Sean Connery
What is your favorite color?
Favorite book:
The Catcher in the Rye
Accomplishment I am most proud of:
Being a UGA scholarship recipient!
Top 5 job responsibilities:
  1. Identify businesses that could benefit from the Netchex payroll system and meet with business owners to learn about their current payroll processes
  2. Demonstrate Netchex to businesses and explain how we can simplify their processes
  3. Generate proposals and enroll businesses onto the Netchex platform
  4. Train employers on how to process payroll in the Netchex system and utilize optional features like time and attendance, self service, benefits and COBRA.
  5. Assist employers with the first two payroll inputs and schedule follow up appointments