Hi Brokers. Got questions? We ve got answers. For the most up-to-date version of this document and all referenced materials please visit www.hioscar.com/brokers. Basics Where can I find plan information & learn more about Oscar s unique perks? Our broker resources page has lots of great information, including plan comparisons, rate sheets, SBCs, and more. Visit www.hioscar.com/brokers, click on Broker Resources, and pick a state from the drop-down list at the top. Information for 2017 plans should be available by early October 2016. Where can I find out about in-network providers & covered drugs? Explore in-network doctors & hospitals, plus find covered drugs in our easy to use search tool - www.hioscar.com/search. You can also find the list of in-network hospitals on our broker resources page (www.hioscar.com/brokers). Where are Oscar plans available in 2017? See below for a complete list of covered counties by state: New York: Bronx Kings Nassau New York Queens Texas 1 : Bexar California: Los Angeles (Region 16) Orange (Region 18) San Francisco (Region 4) Richmond Rockland Suffolk Westchester Does Oscar Offer On & Off-Exchange plans? Yes. Oscar s unique plan designs with great perks are available both on and off the state and federal marketplace sites. Does Oscar offer child-only policies? Yes. Contact your GA or Oscar Broker Support at 1-855-OSCAR-88, option 4 to get a child-only quote or email brokers@hioscar.com. Does Oscar offer group plans in addition to the individual market products? No. Oscar only sells ACA-compliant individual and family health insurance policies to the under 65 market at this time. We plan on entering the Small Group market in mid-2017. Appointments How do I get appointed with Oscar? Our appointment process runs through Sentinel Elite. All agents must be appointed through one of our general agent partners to sell Oscar. Visit our broker website (www.hioscar.com/brokers) to find a GA we work with in your area. Once you have selected one to affiliate with, contact them to get a PIN code for Sentinel Elite. Then go to the Sentinel Elite website (sentinelelite.com), register, and enter the PIN code to affiliate with that GA. You will be able to complete the entire appointment and contracting process online. 1 For 2017, Oscar offers a Bronze plan off-exchange only in Collin, Dallas and Tarrant counties. It is not commission eligible.
Appointments What are the requirements to get appointed with Oscar and paid commissions? Oscar has several requirements: Agents must be licensed and have the appropriate lines of authority for each state in which they sell Oscar policies. We check licensure using the agent s NPN number via NIPR. Oscar conducts a background check and reviews any regulatory actions that have been taken against applying agents. We reserve the right to deny the application of any agent who does not meet Oscar s standards of professional conduct. All agents must have Errors & Omissions insurance in the amount of $1 million per incident and $1 million in aggregate. If the E&O certificate is provided by an agency and the individual agent is not named specifically, the agent must provide contact information for an individual at the agency who can confirm that they are covered. Oscar reserves the right to audit this documentation throughout the year and terminate appointment if the coverage is not valid. All agents selling on-exchange policies must have completed the FFM or state-based exchange certification programs for that year. In accordance with CMS regulations, any policies written prior to certification/re-certification in a given year will not be paid commissions and the submitting agent will not receive Agent of Record credit. New York State has unique license types and requirements governing which types of producer licenses can be appointed. Beginning in 2017, Oscar will only pay commissions to appointed agents with Life / Accident & Health licenses not Life Broker, P&C Agent, or P&C Broker licenses. If you have another type of NY license you must also get a Life / Accident & Health license in order to receive commissions from Oscar. In order to be considered the Agent of Record (AOR) for a policy and receive commissions for it, an agent must complete the appointment process within 15 days (in NY and CA) or 30 days (TX) of submitting their first policy to Oscar. will not be paid on any policies written by producers who are not appointed within this timeframe. GA Affiliations Can I work with more than one GA? Oscar requires agents to select one GA to write through for individual business. All commissions for new policies must be paid through that single GA. Please note that this is a change from last year. In the past, Oscar allowed agents who sell in multiple states to work through a different GA in each state. This is no longer the case. How can I switch GAs? Oscar allows agents to switch GAs once per year during a designated time period. Outside that window no changes are allowed. If an agent switches GAs all new business placed with Oscar will be paid through the new GA. In-force policies will remain with the GA the agent was affiliated with when the policy was first sold. Agents who wish to switch GAs should reach out to appointments@hioscar.com. Please note that GA switches take 14 days to take effect and must be requested by October 15th. How can I enroll clients in Oscar plans? Broker custom link (for Off Exchange plans only): We recommend using our custom link builder (www.hioscar.com/brokers/create-referral-link/) to generate a unique link you can send to clients. Your clients can then enroll in an Off Exchange plan and create a member account in a few simple steps. We ll give you credit for the enrollment when the client signs up with Oscar.
Online enrollment forms (for Off Exchange plans only): Submit Off Exchange applications directly via our online enrollment form available on our state-based broker resource pages. Paper applications (for Off Exchange plans only): Paper applications are available on our broker resources page. Completed paper applications can be sent to our GA partners for processing. Oscar does not have the capability to directly process paper applications. Please check with your GA regarding whether or not they will accept paper applications. If they don t, just re-enter the information from the paper app you use into our online enrollment form. Marketplaces (for On Exchange plans only): Oscar plans are available on the state & federally-run marketplaces. Oscar plans are also available on a number of commonly used quoting tools. Don t see us on your quoting tool of choice but are sure we sell individual plans in the area? Send us an email at brokers@hioscar.com. How does the broker custom link work? We designed the broker custom link to allow agents to scale their business by minimizing the data entry you have to do yourself. Here are the steps: 1. Use this page (www.hioscar.com/brokers/create-referral-link/) to create a custom link one for each state you are appointed to sell Oscar. 2. Send the link generated directly to your clients or post it on Facebook, Twitter, or other social media. 3. After a client clicks on the broker custom link, any enrollment completed within 14 days will be attributed to the broker who created the link, even if they call Oscar directly to complete the enrollment. It is important to note that the broker custom link is designed to support off-exchange enrollments. If a client using the custom link is subsidy-eligible, they will be redirected back to the broker who created the link to be enrolled on-exchange and receive the subsidies to which they are entitled. How & when do I get paid? Commission payments are processed by our GA partners. differ by region, so be sure to check with your GA to get the latest figures. are paid to our GA partners by the middle of the month following the coverage month. Brokers can typically expect to be paid no later than the end of the month following the coverage month, though exact timing will vary by GA partner. For example, commissions for effectuated January membership will be paid to our GA partners by mid-february. Commission payments from the GAs to brokers should typically be made by the end of February. For Special Enrollment Period enrollments that start mid-month, the agent will be paid for the full month. Where can I find the status of a client s submitted application? Brokers can check on the status of a submitted application in two easy ways: 1. With the GA you re appointed through. GAs regularly receive enrollment production reports that track application status. 2. By contracting Broker Support at 1-855-OSCAR-88, option 4. Please make sure to have member s DOB, last 4 digits of SSN and Agent/Broker of Record ready when you call. How can I get paid through my agency? Our appointment program, Sentinel Elite, provides an opportunity to assign commissions to another individual or agency. Please note that this agency must be appointed as well in order for the assignment to be effective. Once your personal appointment has been completed and the agency is appointed we will pay commissions directly to the agency.
How do I appoint my agency? To appoint an agency, a principal must get appointed through Sentinel Elite. In the program, they will be asked if they wish to appoint their agency as well. If they select yes they will be prompted to enter their agency information for appointment. What happens to my book of business if I switch agencies? It depends on whether you assigned commissions to your agency. If you completed the Assignment of form, then your in-force book of business will remain with the agency you assigned them to. If you wrote the policies with your own personal license number and did not assign commissions, then they will stay with you regardless of which agency or GA you work through. What happens to my book of business if I switch GAs? When an agent switches GAs during the designated switching period, all new policies written during Open Enrollment are attributed to their new GA. However, please note that Plan Year 2016 SEP policies written before the end of 2016 will continue to be attributed to the old GA they worked with through 2016. Their existing book of business (including all gapless renewals) will stay with the GA the agent was affiliated with at the time of initial sale. Does Oscar have a broker portal that I can log into? Not yet. We re constantly building new tools and resources so stay tuned. We do send regular enrollment reports to our GA partners. The reports include information on clients, plan selection, premium payment status, and commission status. Information can also be obtained via 1-855-OSCAR-88, option 4. Client Service How can Oscar members make their premium payment? Oscar members have several options to make monthly premium payments: 1. We encourage all members to setup recurring ACH payments with their bank account. Members need to login to their accounts to do this. Turning recurring payments on/off is as simple as pressing a button. 2. Members can make one-time payments online using their debit card. Oscar does not accept credit cards at this time. 3. Members can call Member Services at 1-855-OSCAR-55 to pay via phone - make sure they have their bank account information handy. 4. Members can also mail in checks or money orders to Oscar. Contact Member Services 1-855-OSCAR-55 to find the specific address and instructions by state. My client is an existing Oscar member, how can we change her member files to reflect me as the new Agent of Record? NY On-Exchange Any On Exchange Agent of Record (AOR) Change must come to Oscar from the New York State of Health (NYSOH). The broker must be named by the client on the NYSOH for Oscar to be able to recognize them. Oscar does not have the ability to alter information received from the NYSOH. On-exchange in TX and CA; Off-exchange in all states Oscar has created a standard AOR Letter to help streamline the process of AOR changes. This is available on our broker resources website (www.hioscar.com/brokers). Please have your client complete and sign our Agent of Record Change Letter and submit by email to brokers@hioscar.com.
Client Service For enrollments completed during Open Enrollment (OE) The deadline to submit AOR Change Letters is the last day of OE4 (1/31/2017) The next opportunity to submit AOR Change Letters will be the start of OE4 (scheduled to begin November 1, 2016) For enrollments completed during SEP The deadline to submit AOR Change Letters is the first of the month following the policy s effective date Exception: middle of the month effective dates have 30 days from the effectuation date I think I was accidentally left off a member s enrollment file, how can I be added as the Agent of Record? Please reach out to Oscar at brokers@hioscar.com. Once we verify the request, you will be required to follow the same process as for changing a AOR, described above. What should I do if an emergency interrupts Oscar s regular business operations? In the event of an emergency that impacts Oscar s normal processes, Oscar will send an email outlining any changes to normal operating procedures relevant to the sale and service of Oscar products. This email will be sent to all appointed agents who are affected; in addition, a copy will be sent to all GA partners with a request that they distribute to their brokers/agents as well, ensuring redundancy in communication channels. Additional Assistance Who can I talk to for more help? Below are the best contacts for efficient support. If you need help with... Appointments - Contact your General Agent or appointments@hioscar.com. - Contact your General Agent. Verifying Member Enrollment, Premium Payment or ID Number - Contact Broker Support at 1-855-OSCAR-88, option 4. Please have member s DOB, last 4 digits of SSN and AOR ready when you call. Member Claims - Contact Member Services at 1-855-OSCAR-55. You must complete a HIPAA Authorization form to ask about specific claims. Plan Changes - Contact Broker Support at 1-855-OSCAR-88, option 4. This includes plan type, dependent add / removal, and demographic information. Sales/Product Questions - Contact Broker Support at 1-855-OSCAR-88, option 4. All Other Inquiries - Contact Broker Support at 1-855-OSCAR-88, option 4 or email brokers@hioscar.com.