BEST SERVE YOUR CLIENTS - RISING TO THE CHALLENGE TO 2020 BROKER GUIDE - Excellus BlueCross ...
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RISING TO THE CHALLENGE TO
BEST SERVE YOUR CLIENTS 2020 BROKER GUIDE
A nonprofit independent licensee of the Blue Cross Blue Shield Association
You want your clients to feel confident
about their health plan selection. As you navigate the
complexity of health insurance products, you can be assured
knowing we’re here to help meet the challenges they face
each step of way.
We want our brokers to have that same sense of confidence.
The programs and tools outlined in this guide demonstrate our commitment to
helping you better serve your clients and grow your business.
These are just some of the many ways we’re here to help you along the way:
• A commission for Individuals, Small and Large Group medical and dental contracts,
Rx Program for Claims Based Business, in addition to Medicare employer contracts
and Medicare Direct Pay Referral Bonus.
•
NEW!
•
NEW!
•
• More web tools to help you manage your business – monthly commission
reports, electronic Broker of Record submission option, online group enrollment &
account maintenance, online bill pay, forms & applications, and much more.
•
• Special pricing on life insurance products and Employee Assistance Programs.
•
Thank you for your continued support.
Best regards,
Jim Reed
Sr. Vice President of Marketing and Sales,
CNY Regional President
Finding the right plan for your clients is easy
with the online Blue on Demand tool SM
Access detailed
2020 plan
benefits and
view side-by-side
comparisons.
What’s NEW for 2020
NEW! • All Small Business quotes include Ancillary Products, including Dental, Lifetime Benefit Solutions Reimbursement
Accounts, and Vision. (image showing)
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 view and compare medical and dental plan options in just a few clicks.
Blue on Demand includes packages for small businesses, experience rated businesses, and direct pay members,
including individuals & families and sole proprietors. Features include:
• Administrative and COBRA services provided by our partner, Lifetime Benefit Solutions
• View and compare all medical plans or shop by Preferred Packages for small businesses
• Shop by product design Signature Preferred plans for experience rated businesses
NEW! • Enhanced features on the Data Export Tool
• Less clicks required to Print your Package selections
NEW!
For Small Business
• Shop and compare by product type, metal levels, and other key variables
• Access Summary of Benefits & Coverage (SBC) for all Plan IDs and Mid-Segment Packages (MSPs)
• Package-level mapping and side-by-side comparisons
• Pre-populated rate sheets with Plan IDs and enrollment codes
• Print detailed benefit summaries and rates
• Obtain forms and other resources to request a rate quote & implement a group
• Easily search by either the type of plan or price range you’re looking for, and a number of plan options will
instantly appear for a simple, side-by-side comparison
To use Blue on Demand, visit Broker.ExcellusBCBS.com
Contact your Account Consultant or visit Broker.ExcellusBCBS.com 3
MORE web tools
Our broker website also offers the following features and tools to help you manage your business.
Online Enrollment & Account Maintenance Eligibility & Underwriting
• Enroll a new subscriber, add/remove family members, • View group eligibility guidelines and what’s
change coverage, view member roster, order ID cards, needed to enroll a new group
or reinstate a canceled policy • View Annual Group Information Forms for your
• Get applications, forms and instructions groups (must have broker access)
• Get answers to membership and billing questions
Training & Resources
Online Bill Pay • Sign up to attend a broker information session
• View invoices & payment activity • Register as Broker of Record and e-submit
• Get email notification of new invoices • Learn about our new broker training
• Create customized reports
Engage Members
• Pay invoices online with checking or savings accounts
• Download brochures, posters, online tours and more
Commission & Reporting
• View our commission payment schedule
• Learn about our account reporting tools for small and
large group
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
4 Contact your Account Consultant or visit Broker.ExcellusBCBS.com
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:
• 50+ contract groups - utilization-based (non-financial) reports including topics such as emergency room utilization,
prevalence of chronic conditions, telemedicine utilization, and generic fill rates
• 100+ contract experience rated groups – designated Information Consultant, utilization and financial reports,
enrollment census reporting, out of pocket costs 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
• 50+ contract dental groups - financial and enrollment reports, claims vs premium reports, utilization reports
including services by dental class and member utilization
• Claims based billing dental groups - all of the above and monthly claim detail to support billing
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. For additional
information contact us at general.ic@lifethc.com.
2020 Commission schedule
Base Medical Commission: Small Group (Includes HMO Business)
Product Description Commission
Off NY State of Health Exchange: SimplyBlue Plus
4%
PPO, Healthy New York
On NY State of Health Exchange: SimplyBlue Plus PPO 4%
Base Medical Commission: Large Group (excludes HMO business)
Cumulative YTD Premium Commission
First $500,000 4.5%
$500,001 - $1,000,000 4.0%
$1,000,001 - $1,500,000 3.5%
$1,500,001 - $2,000,000 2.5%
$2,000,001 - $5,000,000 1.5%
$5,000,001 + 1.0%
Base Medical Commission: Individual Market
Product Description Commission
Off/On NY State of Health Exchange: ExchangeBlue
$25 Per Contract Per Month (PCPM)
EPO, ExchangeBassett EPO
Contact your Account Consultant or visit Broker.ExcellusBCBS.com 5
2020 Commission schedule (continued)
Base Dental Commission: New and Existing Community and Experience Rated Business
Cumulative YTD Premium Commission
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%
Bonus program
Medical Override Commission: New Business
New Medical Contracts New Medical Group Minimum Applicable Payout
100 - 249 contracts 2 new groups $15,000
250 - 499 contracts 2 new groups $30,000
500 - 999 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
•
• Quarterly payouts based on year-to-date performance and paid on Large Group (non-HMO) business only
• LBS business will be included in the calculation
Medical Override Commission: 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
• LBS business will be included in the calculation
Dental Override Commission: New Business
New Dental Contracts New Dental Group Minimum Applicable Payout
100 - 199 contracts 1 new group $2,000
200 - 299 contracts 1 new group $5,000
300 - 399 contracts 1 new group $10,000
400 - 499 contracts 1 new group $15,000
500 or more contracts 1 new group $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
• LBS business will be included in the calculation
Dental Override Commission 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
6 Contact your Account Consultant or visit Broker.ExcellusBCBS.com
Claims Based Business Pharmacy Broker Commission Program
Commission Structure
Pharmacy Effective Date Commission (Per Script Per Member)
Prior to January 1, 2017 $ 0.60
Between January 1, 2017 and December 31, 2017 $ 0.85
Between January 1, 2018 and December 31, 2020 $ 1.00
Percent of Pharmacy Contracts Retained Applicable Payout
95.0% $ 0.10
• Book of business retention measurement will be calculated on a calendar year basis for each year following
the initial qualification year for the commission payment. Brokers agencies would need to requalify for this
additional payment annually
NEW! Pharmacy Concierge Broker Commission Program
Commission Structure
Product Description Commission (Per Member Per Month)
Rx Concierge Level 1: Physician Detailing $ 0.25
Rx Concierge Level 2: Specialty Care Rx Management $ 0.25
Rx Concierge Level 3: Physician Detailing & Specialty $ 0.50
Care Rx Management
• Broker agencies appointed with the Excellus Health Plan, Inc will be eligible for a per member per month
commission for any self-funded and minimum premium groups who purchase the program
• Schedule effective January 1, 2020
• Pending DFS approval for minimum premium groups only
Medicare Group Commission
Product Description Commission
Medicare Supplemental 5% paid premium
Simply Prescription $5 per contract per month (PCPM)
• Applies to contracts for new and existing Medicare Supplemental and Simply Prescription plans
• To be eligible brokers must be appointed, state licensed, and trained on our products
Product Description Commission
NEW! Medicare Advantage $12.50 per contract per month (PCPM)
• Applies to contracts for new and existing Medicare Advantage Group contracts
• Small Group or Large Group plans are paid the same PCPM commission
• Prior certification and product training is required. Contact BrokerContractsExcellus@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
Contact your Account Consultant or visit Broker.ExcellusBCBS.com 7General 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.
A $150,000 commission cap applies to existing medical business. Existing medical business classification
applies to groups that were unbrokered with the health plan at the time of the sale, and added a broker
at a later date.
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. For more information contact us at
BrokerContractsExcellus@excellus.com
Producers must be appointed by Excellus BlueCross BlueShield.
Commissions, 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 Broker.ExcellusBCBS.com.
B-3153 / 13856-19S
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