OSCAR Annual Recertification Requirement

Good news!

As you know, the program we use to process Oscar’s appointments has created issues for you and some some of our agents. We have been working closely with our vendor over the past month to resolve these problems, but a significant number of our returning agents have not completed the program to date.

In light of these issues, we have decided to waive the requirement that all returning agents complete a recertification program. For agents who were appointed with Oscar last year, the Sentinel Elite program will now be optional. In place of a Writing Number assigned by Oscar these agents may continue to use their NPN when they submit business to Oscar for the duration of this Open Enrollment.

We hope this change will make your jobs easier and allow you to focus your efforts on the much smaller number of new agents who need to go through the appointment process.

Please note that all contractual and regulatory requirements outlined in Oscar’s Producer Agreement remain in place for these agents. Most importantly:

All agents must have a valid license and active appointment with Oscar
All agents writing business on Healthcare.gov must have completed Federally Facilitated Marketplace (FFM) certification for 2017 before submitting any enrollments
All agents must maintain current Errors & Omissions insurance in the amount of $1 million in aggregate / $1 million per incident
It remains the responsibility of the agent to ensure they remain licensed and appointed before selling any Oscar policies this Open Enrollment. Oscar cannot pay commissions on any policies written while an agent is out of compliance with these requirements.

Note that agents who are new to Oscar must still complete the Sentinel Elite program to get appointed with Oscar. This is the only way for them to sign our Producer Agreement and get appointed. We will be reaching out directly and through you to agents who have started but not completed the Sentinel Elite program to help them through the process.

We will be sending a notice to all affected agents tomorrow afternoon informing them of this change.

CareConnect Broker Update

Earn Extra Money With Our New Member Wellness Initiative*

As a CareConnect broker, you are vital to our mission of offering quality care at affordable prices. We are asking for your partnership to encourage your clients to see their physician before the end of this year. You can even be rewarded with $25 per adult member that visits their physician by 12/31/2016!

Here’s how it works:

  • You will receive an excel spreadsheet of active adult members from your sales representative, for whom you are the broker of record, that we’d like you to reach out to.
  • Reach out to your clients to encourage them to utilize their wellness benefits and record the following information within the spreadsheet for each member:
  • Contact Date
  • Contact Type
    • Spoke with subscriber
    • Spoke with member Left message Not reached More than one outreach effort may be needed. Return your completed file to your Sales Representative by 2/1/2017
  •  You will earn $25 for each member who visits their PCP between your date of contact and December 31, 2016 – up to a maximum of $10,000
  • Payment will be processed by May 1, 2017.


The following Commission Schedule shall apply to New York policies in effect beginning January 1, 2017 and shall remain in effect until terminated or replaced by the Company in writing and  within the Company’s sole discretion. The Commission Schedule for each respective market in effect at the time the commission is paid shall govern for the respective market. The Commission Schedule sets forth the amount of commission payments to be made to eligible Subproducers; it does not modify, guarantee, or otherwise amend any aspect of the contractual agreement between the Company and a Subproducer (“Appointed Producer Agreement”). In the event of a conflict between this Commission Schedule and the Appointed Producer Agreement, the Appointed Producer Agreement shall control.

This Commission Schedule is informational in nature and does not confer any rights on a General Agency, Subproducer, or any other party. It does not govern payments of Overrides to General  Agencies, if applicable.  For purposes of this Commission Schedule, “Initial Term” shall include the months of the first calendar year that the applicable coverage is in effect, up to and including  December 31 of the first calendar year. “Renewal Term” shall refer to any months after the “Initial Term” for which the applicable coverage is in effect.

To the extent that a Subproducer earns a commission as set forth in the applicable Appointed Producer Agreement, the commission amount shall be as follows:

New York Per Member Per Month (PMPM):

$8 Per Member Per Month (capped at 4 members per contract)

Example New York Per Member Per Month Calculation:

Subproducer places coverage for an eligible New York three (3) member-family

(subscriber, spouse, and child) effective January 1, 2017 and meets all applicable

contractual obligations to earn commission for such coverage. The coverage

continues through December 31, 2017, and the Subproducer at all times remains

eligible to receive commission payments for such coverage. The Subproducer will

earn $8 dollars per month for the 12 months of 2017 for a total of $288 (3

members * 12 month * $8) in 2017.

The Company’s General Agencies are responsible for distribution of all commissions and required documentation to Subproducers as set forth in the applicable General Agency agreement.

Empire Blue Cross Producer Toolbox video is all about renewals

September 9, 2016

Our Producer Toolbox is a powerful tool, packed with what you need to sell, service and renew your clients. And by now, you should know that we developed a series of short Producer Toolbox video tutorials to help you prepare for the upcoming Open Enrollment season and the year ahead. Each video covers a user example that’s based on a real-life scenario. We  include with it a companion How To Guide in a format you can download and print. Our latest video is all about renewals for Individual and Small Group business.

As a reminder, we’ll post a new video tutorial each week, along with its How To Guide, in your Producer Toolbox. You’ll find these under Sales & Training > Producer Toolbox Tips and Training. Check out what we have for you this week

  1. Individual and Small Group renewal video
  2. Individual renewal How To Guide
  3. Small Group renewal How To Guide

Missed a week?  Don’t worry. After videos have been posted, you can watch them at any time in your Producer Toolbox under Sales & Training > Producer Toolbox Tips and Training.

United HealthCare Encourage Clients to Complete Group Size Survey

September 7, 2016
Accuracy is extremely important because it affects Medical Loss Ratio (MLR), Essential Health Benefit requirements, Employer Mandate and how an employer group is rated (adjusted community rating).

Each state has its own method of determining an employer group’s size. It may be a definition based upon – eligible, average total number of employees (ATNE) or full time equivalent employees (FTE).  MLR is always based upon ATNE count. Small Business Health Options Program is always based upon FTE count; however, rating may be based upon either eligible, ATNE or FTE depending on the state.

Why is the Employee Count Survey Important?
Based on the rules under the Affordable Care Act, for rating purposes insurers are required to use the preceding calendar year employer size for any quotes for the current year. This is true for quotes for new as well as renewing customers.  For example, rates quoted in 2016 MUST use the size of the employer from 2015 NOT the size of the employer in 2016.

Please encourage your clients to complete this important survey when it is mailed. And remember, for rating, to use the preceding calendar year employer size as required by the state and federal law.

For more information, please contact your UnitedHealthcare representative.

United HealthCare Prospecting Program Scheduled for Mid-September

September 9, 2016

Prospective businesses may receive one of the following informational materials:

The campaign includes a prospect “Call-to-Action” including:

  • Contacting their broker
  • Visiting a website
  • Calling a toll-free number
  • Mailing a business reply card

Samples of the campaign and fulfillment materials are located above. For more information, please contact your UnitedHealthcare representative.

United Health Care Service Provider Compensation Changes Announced for Fully Insured 51-100 Groups

September 8, 2016
As previously announced, UnitedHealthcare will no longer include commissions in premium for groups in the “large group” size segment in select states. In these states, as a convenience, we offer the service of collecting the service fee from the customer bill and paying it to the service provider.

In Wisconsin, we are moving to a non-commissionable basis for groups in the 51-100 employer market for fully insured medical business. (Self-funded, stand-alone ancillary and stop loss coverage are not affected by the transition.) This change will be implemented for Wisconsin situs groups in the 51-100 employer market for new and renewing business effective Jan. 1, 2017. Compensation for all new cases in Wisconsin with effective dates on or after Jan. 1, 2017, will be through a service fee. Existing cases in Utah and Pennsylvania will convert to a service fee on their first renewal date on or after Jan. 1, 2017.

This change impacts all 51-100 employer groups sitused in these markets. (Please note the service fee rules apply based on the group’s location, not the service provider’s location.) These changes are being made as part of broader effort to expand transparency and align with the current service fee compensation model in the 101+ employer market for these states.

The service fee model is currently in place in Iowa, Missouri, Utah and Pennsylvania for 51+ groups and 101+ groups in 23 additional states. More states will adopt the service fee method for groups with 51-100 employees throughout 2017. We will continue to communicate updates as additional markets are launched.

To learn more about the broker/service provider compensation changes, please contact your UnitedHealthcare representative and review the 2016 UnitedHealthcare Producer Compensation Producer FAQ.