You work hard for your clients every day. That s why we re working hard for you.

Transcription

1 2015 BROKER GUIDE You work hard for your clients every day. That s why we re working hard for you. Excellus BlueCross BlueShield dedicated to making your job easier. A nonprofit independent licensee of the Blue Cross Blue Shield Association

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3 We couldn t do it without you the brokers who represent us and promote our products. You should know that we value our relationship, we appreciate your efforts on our behalf, and we re committed to continuing to provide the support you need. This brochure backs up those words with real examples of how we ll do more to make your job easier and make Excellus BlueCross BlueShield easier to work with, including: A commission for Individual, Small and Large Group contracts and new Medicare Employer Group contracts, in addition to the Medicare Direct Pay Referral Bonus. Our enhanced online Blue on Demand SM comparison tool that allows you to find and compare plans more easily than ever before. More web tools to help you manage your business monthly commission reports, electronic Broker of Record submission option, online group enrollment & account maintenance, forms & applications, and much more. A steady stream of communications including newsletters, tutorials and industry updates to help you stay informed about the latest news and product updates. Special pricing on life insurance products and Employee Assistance Programs. Improvements to our processes, including streamlined processing with simpler underwriting guidelines and less paperwork. Also, don t forget to ask us about the Blue Honors reward program. We hope this brochure will give you a sense of our commitment to you as a valued partner. We look forward to helping you grow your business. Best regards, Jim Reed Sr. Vice President of Marketing and Sales 3

4 Finding the right plan for your clients is easy with the online Blue on Demand SM tool Access detailed 2015 plan benefits and view side-by-side comparisons. As part of our commitment to making your job easier, we provide the Blue on Demand Plan Comparison Tool an online resource that allows you to compare a complete set of medical and dental plan options in just a few clicks. NEW! Blue on Demand now includes packages for small groups (2 to 50 eligible employees) and mid-sized groups (51 to 300 eligible employees), individuals & families, and sole proprietors (direct pay). Features include: View the full list of 2015 medical packages; side-by-side comparison of up to three plans Search packages by plan ID or Mid Segment Packaging (MSP) code Shop and compare by product type, metal levels, and other key variables Access Summary of Benefits & Coverage (SBC) for all Plan IDs and MSPs Package-level mapping and side-by-side comparison to plans including pediatric dental coverage per Health Care Reform Pre-populated rate sheets with Plan IDs and enrollment codes Selectable rider options Find and print detailed benefit summaries and rates Obtain forms and other resources to request a rate quote & implement a group Simply fill in the search fields with either the type of plan or price range you re looking for, and a number of plan options will instantly appear for an easy, side-by-side comparison. Plus, it s updated frequently, so you ll always be aware of our latest product offerings. To use Blue on Demand, visit ExcellusBCBS.com/Broker 4 Contact your Account Consultant or visit ExcellusBCBS.com/Broker

5 More web tools Our broker Web site also offers the following features and tools to help you manage your business. Online Enrollment & Account Maintenance Enroll a new subscriber, add/remove family members, change coverage, order ID cards, or reinstate a canceled policy Get applications, forms and instructions Get answers to membership and billing questions & Reporting View our commission payment schedule Learn about our account reporting tools for small and large groups Eligibility & Underwriting View group eligibility guidelines and what s needed to enroll a new group Training & Resources Sign up to attend a broker information session Register as Broker of Record and e-submit Learn about our new broker training Engage Members Download brochures, posters, online tours and more When information comes to you, it s easier to do business With your busy schedule, it can be hard to stay up-to-date with the latest products, regulatory changes and industry news. That s why Excellus BlueCross BlueShield makes it easier to stay informed with ongoing communications and tools, including: Broker eblasts monthly Online product tutorials Product brochures, posters, toolkits and flyers Interactive sales tools like Blue on Demand SM Dedicated Web site, including group Training and Information Sessions to help enrollment tools grow your business Information consulting better partnerships through better information Our Information Consulting team is dedicated to providing easily accessible group reporting that supports an understanding of health plan experience, and helps target actionable improvement opportunities. Most reports are available online and can be scheduled monthly, quarterly, or annually based on group needs. Report eligibility varies with group size and funding, but can include the following: contract experience rated groups, and 50+ contract community rated groups utilization based (non financial) reports including topics such as emergency room utilization, prevalence of chronic conditions, and generic fill rates 100+ contract experience rated groups designated Information Consultant, utilization and financial reports, claims vs. premium reporting, high cost claimant reports, online data cube for custom reporting on demand Claims based billing groups all of the above, plus weekly billing detail, high claim early alerts, and detailed financial reports Additional online tools are available specifically for brokers, including a multigroup dashboard and multigroup data cube to support analysis, and a Monthly Rate Summary Report for community rated groups. Contact your Account Consultant or visit ExcellusBCBS.com/Broker 5

6 2015 schedule Base Medical : Small Group (Includes HMO Business) Product Description Off NY State of Health Exchange: SimplyBlue Plus PPO, Healthy New York 4% On NY State of Health Exchange: SimplyBlue Plus PPO 4% $150K annual cap (base commission) applies to existing business (no cap on newly exclusive business) Base Medical : Large Group (excludes HMO business) Cumulative YTD Premium First $500, % $500,001 - $1,000, % $1,000,001 - $1,500, % $1,500,001 - $2,000, % $2,000,001 - $5,000, % $5,000, % $150K annual cap (base commission) applies to existing business (no cap on newly exclusive business) Base Medical : Individual Market Product Description Off/On NY State of Health Exchange: ExchangeBlue EPO, ExchangeBassett EPO $25 Per Contract Per Month (PCPM) Base Dental : Community and Experience Rated Cumulative YTD Premium First $20,000 12% $20,001 - $30,000 10% $30,001 - $40,000 8% $40,001 - $50,000 6% $50,001 - $100,000 5% Greater than $100,000 2% New dental business and existing dental business scale Growth of +1 contract on existing business is required before eligible for commissions Bonus program Medical Override : New Business New Medical Contracts New Medical Group Minimum Applicable Payout contracts 2 new groups $15, contracts 2 new groups $30, contracts 3 new groups $50,000 1,000-1,499 contracts 4 new groups $100,000 1,500 or more contracts 5 new groups $150,000 Broker must attain both new medical contract and new medical group minimum targets to qualify Qualifying new contracts are from prospect medical clients only; growth on existing does not count toward goal Quarterly payouts based on year-to-date performance and paid on Large Group (non-hmo) business only RMSCO business will be included in the calculation 6 Contact your Account Consultant or visit ExcellusBCBS.com/Broker

7 Medical Override : Retention of Business Percentage of Medical Contracts Retained Applicable Payout Maximum Payout 95.0% 0.50% of in-force premium $50,000 per agency 98.0% 0.75% of in-force premium $75,000 per agency Calculation to include new medical business Annual payout based on year-end retention performance and paid on Large Group (non HMO) business only RMSCO business will be included in the calculation Dental Override : New Business New Dental Contracts New Dental Group Minimum Applicable Payout contracts 2 new groups $2, contracts 3 new groups $5, contracts 4 new groups $10, contracts 5 new groups $15, or more contracts 6 new groups $30,000 Broker must attain both new dental contract and new dental group minimum targets to qualify Qualifying new contracts are from prospect dental clients only; growth on existing does not count toward goal Quarterly payouts based on year-to-date performance RMSCO business will be included in the calculation Dental Override Schedule: Retention of Business Percentage of Dental Contracts Retained Applicable Payout Maximum Payout 95.0% 3% of in-force premium $20,000 per agency 98.0% 5% of in-force premium $40,000 per agency Calculation to include new dental business Annual payout based on year-end retention performance Medicare Group Product Description Medicare Advantage (HMO/PPO) $12.50 per contract per month (PCPM) Applies to contracts for new Medicare groups or new Medicare Advantage offerings that are effective January 1, 2015 and later* s do not include Medicare Supplement/Medigap or Prescription Drug Plans Small Group or Large Group plans are paid the same PCPM commission New contracts are defined as new Medicare Group business coming from a competitor, coming from Medicare age-ins (newly established MA plan), coming from Medicare Supplement plans (newly established MA plan), or coming from commercial carve-out plans (newly established MA plan) Prior certification and product training is required. Contact MedicareGroup@excellus.com for more information. Medicare Direct Pay Referral Bonus Product Description Referral Payment Medicare Advantage (HMO/PPO) $100 Prescription Drug Plan $25 Referral will be paid on new enrollment Referral payment will be a one time payment Referral must be enrolled within 5 months from date of scope of appointment form to receive payment Scope of appointment form must be completed and submitted to designated Sales Rep Medicare group business is excluded *New Medicare Group business is commissionable for employer groups that have not offered Excellus Health Plan, Inc. Medicare products for six months prior to the effective date of coverage. Contact your Account Consultant or visit ExcellusBCBS.com/Broker 7

8 General program terms Monthly commission payments are paid based on the prior month s premium receipts and are targeted for issue by the 15th business day. Dental and experience rated medical commissions are paid on an accumulated premium formula. Each monthly premium payment is added to the effective year-to-date cumulative received premium and the appropriate commission schedule applied. Override program payments will be issued in the quarter following the close of the measurement period. Broker of Record (BOR) on group accounts is eligible to receive commission according to the terms of the applicable Schedule A on the BOR effective date. A valid BOR letter must be presented on the account s letterhead and signed by an officer of the account. BOR s will be considered effective on the first of the month following receipt of the valid BOR. Qualifying Agent/Brokers must have signed Agent/Broker and Business Associate agreements on file with Excellus BCBS including a current NYSID appointment to be eligible to represent Excellus BCBS products and receive commission payments. Agent/Broker must maintain all standards and provisions of the Agent/Broker Agreement. Discrepancies in commission statements and other Agent/Broker reports must be raised promptly. Excellus BCBS will review commission questions and consider adjustments no longer than 90 days retroactively from the current month s commission statement. Producers must be appointed by Excellus BlueCross BlueShield. s, bonuses and the value of prizes will be reported to all groups of 100 or more contracts for their preparation of ERISA 5500 form whether or not they are required to submit a form. Only the amount applicable to that group will be reported to them. Health Plan may change the rate of commission applicable to specific contract forms upon 30 days written notice and may impose rates of commission on new contract forms by written notice to Agent/Broker. Note: Excellus BlueCross BlueShield reserves the right to alter or void the compensation program at any time in response to issues and conditions that affect the corporation, business, marketplace or economy. Entitlement to commissions and bonuses is subject to terms and conditions contained in the Agent/Broker Agreement. Excellus BlueCross BlueShield reserves the right to make final determination of eligibility for case (group/contract) credit, premium credit and commission/bonus payments. If you have any questions about our program or product offerings, please contact your Account Consultant or visit ExcellusBCBS.com/Broker. B-3153 / M