Citing widespread abuse by consumers of the Special Enrollment Period (SEP), most of the health plans in Virginia have decided not to support insurance agents who have traditionally helped individual consumers through the myriad of questions and forms for individual coverage. The SEP is the majority of the time of year when someone with a life changing event is in dire need of individual coverage due to things such as – loss of minimum coverage including loss of COBRA, birth, adoption, marriage, divorce – can get health insurance outside of the regular open enrollment period.
“Health insurance agents are the most qualified individuals to help consumers navigate the system and have the patience and professional experience to insure that individuals get the insurance coverage that they need,” noted Bob Bradshaw, President & CEO of the Independent Insurance Agents of Virginia. “The health plans don’t seem to get this and are no longer going to pay agents for helping individuals looking for insurance during the Special Enrollment Period.”
Insurance agents can often spend hours with a consumer coordinating their needs with the myriad of plans available through the exchange and the health plans and making sure that the coverage the consumer needs is indeed available. Consumers appear to be caught in the middle. Few are knowledgeable enough to know which companies are providing individual health insurance and have the time and/or ability to compare plans and available networks for adequate coverage. They are quick to learn however which companies have invested in customer service, or not.
“It’s not unusual for us to spend hours on the phone between the consumer and the health insurance plan who typically is not responsive to service questions consumers have,” noted Monty Dise, Vice Chairman of the Independent Insurance Agents of Virginia and principal at Asset Protection Group in Virginia. “I am truly concerned for consumers who now will have to work directly with the health plans as well as the various exchanges without an agent’s professional guidance they are accustom to. Sadly, now if we’re not paid for the lifetime of a SEP policyholder – generally through commissions directly from the health plans – we can’t suggest a plan to the consumer as it could be considered ‘steering’ and this places agents in a legal dilemma as well.
Agents are now referring consumers to the Virginia Bureau of Insurance. “I truly feel sorry for the consumers who desperately need health insurance but agents can’t work for free and they can’t put themselves at legal risk,” stated Bob Bradshaw.
NOTE: Individuals looking for individual health insurance should contact:
Virginia Bureau of Insurance
LIFE & HEALTH DIVISION CONSUMER SERVICES SECTION
(Toll-Free) 1-877-310-6560(In Richmond) (804) 371-9691
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