2014 commission schedule

Transcription

1 2014 commission schedule Individual and Family and Individual Only Plan Medicare Supplement plan Blue Shield Medicare Advantage Prescription Drug (MA-PD) plans for individuals Blue Shield Medicare Prescription Drug Plans (PDP) for individuals Dental PPO plan available for Medicare Supplement members Individual term life insurance* Individual and family dental plan Commission schedule for groups with 1 to 50 eligible employees Excludes large group, no schedules apply to large group For all business lines inside and outside the Exchange, except SHOP and Medicare plans, commissions will be paid on base premium only which excludes applicable taxes and fees. Commissions will be paid if dues/ premiums are pre-paid, paid, or paid late. However, commission will not be paid if dues/premiums are not paid. For small group and IFP, we will not pay commissions on new policies until the policy is in effect and paid. Refer to the Termination of Benefits language for complete details. In order to receive commissions on Blue Shield products, you must be individually appointed by Blue Shield or endorsed by an agency appointed by Blue Shield. Blue Shield will participate in the Health Insurance Exchange (Exchange) for Individual and Family Plan (IFP) and small group plans beginning in 2014, and abides by all applicable laws and regulations established for the Exchange, including the payment of commissions. This 2014 Commission Schedule also applies to any contract issued to a Blue Shield member with an IFP contract in effect anytime during the period January 1, 2011 to December 31, 2013, inclusive. Blue Shield of California is an HMO and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. H0504_13_263A S2468_13-263A * Underwritten by Blue Shield of California Life & Health Insurance Company. blueshieldca.com

2 Individual and Family and Individual Only Plan This schedule applies to any contract issued to a Blue Shield member with an IFP contract in effect any time during the period January 1, 2011 to December 31, 2013, inclusive. This schedule does not change commissions on IFP contracts in effect prior to January 1, Commissions for Medicare Supplement plans are covered by separate schedules. Percentage First year 4% Renewal year 4% Commissions for all years of a contract will be calculated as a percentage of the first year s dues/premiums received and allocated by Blue Shield. The first year s dues/premiums are defined as the dues/premiums in the month of initial contract enrollment. Commissions for renewal business will remain tied to the rate tables in use when the contract first became effective, and will not increase over time as dues/premiums increase. 2

3 Medicare Supplement plan The commission schedule below applies to Medicare Supplement plan applications submitted and accepted by Blue Shield s underwriting department for effective dates of coverage March 1, 2005 or later. Commissions for Individual and Family Plan (IFP) plans are covered by separate schedules. This schedule does not change the commissions paid on business written with effective dates of coverage prior to March 1, % 2+ 10% Payable on accepted applications* * Blue Shield will pay 10% commission the first year, as well as in all renewal years, for new business that transfers from another Medicare Supplement plan. Payable commissions for the first and renewal year of a contract will be calculated as a percentage of the dues/ premiums received and allocated by Blue Shield. Commissions for renewal business will increase when dues increase at renewal. All Medicare Supplement commission payments will be made only after an application is approved, or accepted on the basis of guaranteed-issue eligibility, and the first month s dues have been collected. If the member s dues/ premiums payment is not received within 30 days of the current coverage from date indicated on the member s billing statement, the termination will be effective on the last day of the last coverage period for which payment was received by Blue Shield. Refer to Termination of Benefits language for complete details. All Medicare Supplement applications, whether eligible on the basis of guaranteed issue or underwritten, count toward your production totals for the performance bonus. 3

4 Blue Shield Medicare Advantage Prescription Drug (MA-PD) plan 2014 MA-PD commission schedule First-year commission Renewal year Certified Blue Shield producer $532 $266 Blue Shield is paying first-year renewal commission for all 2014 new sales. Commissions are paid as a renewal unless CMS provides data indicating the commission should be an initial first-year commission because beneficiary is a new enrollee to Medicare or to a Medicare Advantage Prescription Drug (MA-PD) plan for the first time. The balance will be paid once Blue Shield validates that the enrollment qualifies for a first-year commission. Your commission will be paid in a lump sum 30 days following the member s effective date. However, if the member disenrolls at any time during the first three months following their effective date, the full commission amount will be deducted from your future commissions.* Also, if a member disenrolls within the 12-month period following the effective date, your lump sum payment will be prorated and deducted from future commissions. Payment of MA-PD plan commissions is subject to CMS guidelines, which are subject to change. Certification requirement In order to qualify for applicable commissions for the sale of Blue Shield s MA-PD plans, you must certify that you have received and understand all the rules and regulations that govern the sale of an MA-PD including: Applicable Medicare Advantage and/or Part D laws Current CMS Medicare marketing guidelines Producers must complete the certification training that is required by CMS and each specific carrier. Please sign the certification section and clearly print your name on each Blue Shield MA-PD plan application to be eligible for commissions. Commission splits The Blue Shield Medicare MA-PD plans are not eligible for commission splits between producers. Should two or more producers be listed, including super producers and general agents, the commission will be paid to the primary producer. The primary producer is deemed to be the first producer listed on the application. Eligibility for bonus and reward programs Applications for Blue Shield MA-PD plans do not count toward your production totals for any bonus or reward program. * Please note, when a member enrolls for an October 1, November 1, or December 1 effective date, and subsequently changes plans effective January 1 of the following year, it is not considered a rapid disenrollment. 4

5 Blue Shield Medicare Prescription Drug Plans (PDP) for individuals 2014 PDP commission schedule First-year commission Renewal year Certified Blue Shield producer $56 $28 Blue Shield is paying first-year renewal commission for all 2014 new sales. Commissions are paid as a renewal unless CMS provides data indicating the commission should be an initial first-year commission because beneficiary is a new enrollee to Medicare or to a Medicare Prescription Drug Plan (PDP) for the first time. The balance will be paid once Blue Shield validates that the enrollment qualifies for a first-year commission. Your commission will be paid in a lump sum 30 days following the member s effective date. However, if the member disenrolls at any time during the first three months following their effective date, the full commission amount will be deducted from your future commissions.* Also, if a member disenrolls within the 12-month period following the effective date, your lump sum payment will be prorated and deducted from future commissions. Payment of PDP commissions is subject to CMS guidelines, which are subject to change. Certification requirement In order to qualify for applicable commissions for the sale of Blue Shield PDP for individuals, you must certify that you have received and understand all the rules and regulations that govern the sale of a Medicare PDP including: Applicable Medicare Advantage and/or Part D laws Current CMS Medicare marketing guidelines Producers must complete the certification training that is required by CMS and each specific carrier. Please sign the certification section and clearly print your name on each Blue Shield Medicare PDP application to be eligible for commissions. Commission splits The Blue Shield Medicare PDPs are not eligible for commission splits between producers. Should two or more producers be listed, including super producers and general agents, the commission will be paid to the primary producer. The primary producer is deemed to be the first producer listed on the application. Eligibility for bonus and reward programs Applications for Blue Shield Medicare PDPs do not count toward your production totals for any bonus or reward program. * Please note, when a member enrolls for an October 1, November 1, or December 1 effective date, and subsequently changes plans effective January 1 of the following year, it is not considered a rapid disenrollment. 5

6 Blue Shield of California Dental PPO plan for Medicare Supplement plan members Commissions for the Blue Shield of California Dental PPO plan for Medicare Supplement subscribers are based on the Medicare Supplement plan commission schedule and are effective for dates of coverage April 1, 2007 or later. 1 20% 2+ 10% * Payable on accepted applications* Blue Shield will pay 10% commission the first year, as well as in all renewal years, for new business that transfers from another Medicare Supplement plan or when dental is purchased after the first year of medical coverage. Payable commissions for the first and renewal year of a contract will be calculated as a percentage of the dues/ premiums received and allocated by Blue Shield. Commissions for renewal business will increase when dues increase at renewal. All dental commission payments will be made only after an application is approved, or accepted on the basis of guaranteed-issue eligibility, and the first month s dues have been collected. If the member s dues/premiums payment is not received within 30 days of the current coverage from date indicated on the member s billing statement, the termination will be effective on the last day of the last coverage period for which payment was received by Blue Shield. Refer to Termination of Benefits language for complete details. All Medicare Supplement applications, whether eligible on the basis of guaranteed issue or underwritten, count toward your production totals for the performance. 6

7 Individual term life insurance and Individual and family dental and vision plans This schedule does not change commissions paid on business written with effective dates of coverage prior to January 1, The commission schedules below apply to Individual and Family Plan (IFP) dental, vision, and life insurance* plan applications submitted and accepted by Blue Shield for effective dates of coverage January 1, 2011, or later. For Individual and Family Plan (IFP) Dental, Vision and Life Insurance plans Year 1 20% Year 2+ 10% Commission For Dental Pediatric plans only (effective January 1, 2014) Year 1 10% Year 2+ 10% Commission For Vision Pediatric plans only embedded with medical plans (effective January 1, 2014) Year 1 Year 2+ Commission Same commission as medical plans Same commission as medical plans * Individual term life insurance is underwritten by Blue Shield of California Life & Health Insurance Company. Commissions for all years of a contract will be calculated as a percentage of the first year s dues/premiums received and allocated by Blue Shield. The first year s dues/premiums are defined as the dues/premiums in the month of initial contract enrollment. Commissions for renewal business will remain tied to the rate tables in use when the contract first became effective, and will not increase over time as dues/premiums increase. 7

8 Blue Shield of California and Blue Shield of California Life & Health Insurance Company (Blue Shield Life) commission schedule for small business products Commission schedule for small businesses with 1 to 50 eligible employees with original effective dates of January 1, 2014 or later. Medical plans only Blue Shield of California Off Exchange Package for Small Business Year Percentage 1st year 6.5% 2nd year 6.2% 3rd year 5.9% 4th year 5.6% 5th year 5.3% 6th year and beyond 5.0% Blue Shield of California Mirror Package for Small Business Annual premium/dues Year Percentage 1st year 6.5% 2nd year 6.2% Up to $500,000 3rd year 5.9% 4th year 5.6% 5th year 5.3% 6th year and beyond 5.0% over $500,000 1st year and beyond 1% 8

9 Commission Schedule for small businesses with 1 to 50 eligible employees with original effective dates of January 1, 2014 or later. Specialty Products Product Percentage Vision plans 10% Vision Pediatric plans Same commission as medical plan (embedded) Dental plans 10% Dental Pediatric plans 10% Life plans* 10% Commission schedule for small businesses with 2 to 50 eligible employees with original effective dates of January 1, 2004 through December 31, Flat 7% for first $500,000 2 in annual dues/premium applies to: Medical products Vision Basic Life (group term life insurance) Dental PPO Flat 10% commission applies to: Dental HMO plans Vision Standard, Vision Plus, and Vision Deluxe plans Blue Shield Life commission schedule for Life Plus insurance and vision coverage Life Plus group term life insurance Life Plus insurance cases sold with administration and billing through Blue Shield Life utilize the table below (graded 10%). Annual paid premium Commission on policy premium for first through policy anniversary years First $0-$9,999 10% Additional $10,000-$19,999 4% Additional $20,000-$29,999 2% Additional $30,000-$49,999 1% Additional $50,000-$99,999.75% Additional $100,000-$149,999.5% Additional $150,000-$499, % Additional $500,000 and over Contact a Blue Shield Life sales representative Blue Shield Life pays a flat 10% for groups converting from Life Plus to Life. * Underwritten by Blue Shield of California Life & Health Insurance Company. 1 Effective January 1, 2004, renewals on contracts for groups with 2 to 50 eligible employees sold before January 1, 2004 will be paid on the applicable commission schedule in effect at the time of the original sale. 2 After a group s annual dues/premium exceeds $500,000, any additional commission paid on that group is 1.0%. The annual dues/premium is based on the group s contract year. Blue Shield of California is an independent member of the Blue Shield Association A35301-FORM-REV3 (1/14) blueshieldca.com