Fee Paid to Agents Enrolling Consumers in Federal High-Risk Pool

by Kimberly Smith - June 1st, 2011.
Filed under: Health Insurance Reform. Tagged as: , , , , .

coinsGreat news for the agent community!  The U.S. Department of Health and Human Services (HHS) announced it will work with licensed health insurance agents to make it easier for Americans to enroll in the federally administered Pre-Existing Condition Insurance Plan (PCIP).  NAHU met with PCIP officials to obtain more details about the new changes to the program.  Their target is to begin compensating licensed agents and brokers by October 1, 2011, and they will pay a flat fee of $100 per enrolled applicant with the PCIP program.  In addition to compensating agents, HHS also announced they are reducing premiums and easing eligibility requirements for the high-risk pool beginning July 1, 2011.  You can access additional information about these changes in our reform blog

Below is a great excerpt from Alan Katz’s blog that will encourage you to look at the overall significance of HHS’s decision:

Progress usually comes in small steps, not giant leaps. The significance of HHS recognizing the value brokers bring to America’s health care system—and their willingness to pay for that value—should not be underestimated. For example, the House of Representatives will soon conduct a hearing on HR 1206, the legislation to remove broker compensation from the medical loss ratio calculations required by the Patient Protection and Affordable Care Act. Proponents of this law will be able to point to the recruitment efforts of HHS in support of the federal Pre-Existing Condition Insurance Plan to reinforce the need to keep brokers in their role as consumer counselors and advocates in the new health insurance world being created by the PPACA.

NAHU and other agent organizations worked hard to achieve this recognition. No doubt, however, some brokers will protest that the HHS program pays brokers only a one-time fee. This complaint is misplaced. Enrollment in the PCIP is fundamentally different than working with consumers shopping for coverage in the commercial market. The PCIP is, after all, a government health plan, more similar to Medicaid than to plans available on the open market. Further, enrollees in the high risk plan, by definition, cannot obtain traditional coverage. What’s significant is not the details of the compensation (although it is worth pointing out that HHS is setting the fee higher than the average paid by states), but the existence of compensation for enrolling Americans into a federal health plan.  When it comes to precedents, this is one that can aptly be described as “significant.”

Do you agree with Alan?  What are your thoughts?  I encourage you to comment on the blog or send us an email.

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