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Home arrow CEO's Corner
CEO's Corner How to Advise

How to Advise Your Individual Plan Customers Now

 

With the new government health care program continuing to have “fits and starts,” the time has come to be proactive in serving your clients in the individual plan marketplace and be compensated for your work. Looking for some suggestions? Here’s what we recommend at EBRM: 


1. It is neither cost effective nor possible to use the Exchange website for your individual customers. It was the intent of the government as well as the carriers to process subsidy-eligible customers through the Healthcare.gov website. It doesn’t work. So most of your customers have already been frustrated by trying to navigate through the government website. Many agents have attempted to use paper or phone to secure subsidy information for their clients, which is exhausting and unproductive, at best.


EBRM recommends: You do neither of these at this time.


2. So, what’s your best option? As we anticipate that the BCBSIL shopping cart will function properly before the government website does, you should now send your subsidy-eligible customers to your BCBSIL Express Link, your agency’s easy-to-use, personalized, online application process provided by BCBSIL. Your clients can use this link to get their actual subsidy and complete their BCBSIL application process.


EBRM recommends: You send your subsidy-eligible customers to your BCBSIL Express Link as soon as possible.


3. Remember those ICHIP-eligible clients, or the customers who had previously been declined? Individual health insurance is now guaranteed issue with no underwriting, so the medical circumstances of the client are no longer a variable. Your focus should be to write your non-subsidy eligible customers regardless of health, with the added benefit of choosing between a short form paper application or going online through your Express Link.


 

EBRM recommends: NOW is the time to write Guaranteed Issue major medical plans!


4. Even though the open enrollment period for individual coverage concludes March 31, 2014, once open enrollment ends, there are many opportunities for your clients to apply for individual coverage. As always, if a person loses his/her job, or reaches a limiting age, they qualify for individual coverage. Other examples include:

 

  • Your client gains a dependent or becomes a dependent through marriage, birth, adoption or placement for adoption or foster care.
  • Your client becomes newly eligible for premium tax credits or cost-sharing assistance.
  • Your client is eligible to enroll but didn’t because of a mistake, misrepresentation or inaction of an officer, employee or agent of the Marketplace.
  • Your client demonstrates to the Marketplace that he has other extenuating circumstances that qualify him for special enrollment.
  • Your client makes a permanent move and has access to new health plans.
  • Your client loses minimum essential coverage, including through divorce.

EBRM recommends: You continue growing your individual health insurance book of business by servicing your client’s needs throughout the year.


For further information or comments, please email me at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .


# # #

Jeff Kubik, an attorney with an MBA from the University of Chicago, brings more than 30 years of experience to his company, Employee Benefit Risk Management (EBRM). EBRM has first-hand knowledge of what it takes to process claims and manage risk in the individual medical and small-group markets.

Working exclusively with brokers, EBRM currently meets the needs of more than 4,000 agents with policies totaling more than $300 million in premium covering over 50,000 primary insureds.

 

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