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The Aftermath of ACA Enrollment

Whew! The initial Obamacare enrollment is behind us, and we were able to assist our clients with coming into compliance with the new laws. Now what? ACA enrollment war stories?

  • Did anybody else receive a call to help with coverage for the first of the year, “so I won’t be arrested for not signing up?” 
  • Did anybody else receive an irate insured call because a 55-year-old male’s premium doubled for significantly less usable coverage based upon his needs, even though his utilization in prior years has been 25 to 50 percent of paid premiums at most? At least now he is covered when he’s pregnant, right?
  • What percentage of those enrolled seemed happy or thankful for the new requirements and plans versus those that were not? If you search the Web, you can find tons of stories, true or not, supporting both sides. It appears that many of those stories are just agents throwing in their two cents whether they agree or not, rather than supporting the required changes in the best interest of their clients for compliance.

Agents need to stop complaining to the general public about lost data or missing commissions and change their focus to those that needed the coverage and finally have it. We work to make sure the enrollees are educated about what they’re getting, and we compare it to what they had previously, if relevant. If insureds understand what is available, and how to use the coverage properly, it could result in healthier families dodging the surprises that cause grief and/or financial devastation. That was the stated goal of PPACA in the first place, and its potential needs to be continually communicated.

So, when you help an insured, the comparison looks like this:


NEW PLAN (In Network)

Wellness and preventative visit

$0 copay

$0 copay

Sick visit to your doctor’s office

$30 copay

Deductible & Coinsurance

Urgent care visit

$30 copay

Deductible & Coinsurance

Chemical Dependency Treatment

Deductible & Coinsurance ($20,000 maximum benefit cap)

Deductible & Coinsurance       (no maximum benefit cap)

Be aware that many insureds may not understand they will now be required to pay more for their sick visits to the doctor and even more if they go to an urgent care facility under the new plan. Teach them. Help them understand their options. Present inexpensive supplemental plans to fill the gaps they didn’t have before and may not know they have now. Provide services to make benefits easier for the insured and the employer.

More specifically, put a positive spin on situations that you know may be far from positive. The insureds are relying on us for peace of mind amongst other things, and they will definitely not have a positive experience if you present healthcare reform in a negative manner.

Insurance agents have assisted employers to complete annual enrollments and write plans that cost a bit more for their employees, and may even require a slightly  higher contribution  on their part, to avoid Obamacare penalties. What about any ongoing requirements to keep them penalty-free now? Do the employers know about their ongoing risks or exposures? Are you able to assist with their ongoing compliance needs? Or, are you receiving compensation for providing lip-service and directing the employer someplace else? Or worse, have you simply provided the rules and regulatory information only to let the company owner figure the rest out on their own?

Keeping the employer up to date on rules, regulations, and deadlines can be a daunting task, but it’s just the tip of the iceberg as far as what is truly needed. Provide help with compliance, discrimination testing, ongoing enrollments, eligibility verifications, customer support services, and tools the employers need. Don’t charge clients excessive fees that could cover at least one programmer’s annual salary. There are ways to customize these types of services and tools for each client without using up any of their savings or “available” funds due to cutting costs in some other area … that way of doing business is no different than theft. Can you be sure you and your business partners are not guilty of ‘stealing’ from your clients inadvertently? 

Administration of the employer’s benefit plans (FSA, HSA/HRA, Sec.125, 401k or 403b, COBRA, payroll, enrollment, billing, carrier remittance and reconciliations, and HR Compliance) are what your clients need, in addition to the health plans and core or supplemental benefits. They are relying on you to provide it for them— not with a company or set of companies that meets your requirements, not with those containing extra fees or overrides for representatives selling the services, nor with those exhibiting costs high above the others due to a name you recognize in something that isn’t your specialty or exceeds your understanding. The employer is relying on you to find out what they need when they don’t know what to ask themselves (which companies offer the services for them when they don’t know the services even exist, and what the different companies cover under specific fees). You are unofficially charged with putting each and every one of your employers’ needs out to bid even if the employers don’t have official bid processes or requirements.

Bringing in a big-name company, but not providing connectivity of the essential benefits requirements is not in your clients’ best interests … and will ultimately lead to a loss of clients for you.

We provide access to multiple different vendors at no cost to our clients because it makes sense. We are able to get bulk discounts for certain services that tie in with our ultimate goal of doing what is right for each and every person we come in contact with, not just those we come under contract with. If we can receive a benefit that helps a client and costs us $2.50 per employee per month, the $2.50 is what we pass through to the client, not $5 per employee per month so we have a new revenue stream.

As a broker/agent, you receive commissions not only for assisting with these enrollments and making sure the Obamacare regulations are presented and in compliance up front, but for walking through the process with the employer throughout the year to earn every dime you receive. Help clients with the calculations to make sure they are meeting all eligibility requirements for each quarter, and to make sure they aren’t going to be inadvertently hit with fees for something you “told them about” but didn’t actually offer to help with. 

For example, do you make sure that you have a copy of their employee handbook each year and offer to have your compliance or legal department review it as part of the revenue you are earning from the client, rather than for an additional fee? In good faith, offer to provide new employee handbooks reviewed for full compliance each year by your attorneys at the actual cost to your firm rather than employing the “what the market will bear” mentality. Provide online access for every individual in a single, simplified location so you can be assured that each person has what they need for themselves, and what the employer needs employees to receive for compliance. 

Multiple sites confuse most insureds. Sure, insureds can go to the health insurance company website to login and access their ID number if they forgot their card, but will they be able to remember their specific login information for that site when it is typically something different from the varying other carrier sites they have to go to for other sets of information? 

After the enrollment, and making sure your employer clients are taken care of with regards to initial Obamacare regulations, are you making sure they truly have everything they need with you as their main go-to person? Or, are you providing them with printed information decorated with your logos and taking the owner or HR person to lunch and golf to stay friendly, while leaving them exposed, struggling, and even drowning in the details?

When you help employers with what they need, and exceed their expectations, you truly become their trusted go-to person for much more than just benefits. As the PPACA continues to roll out and change the landscape of our industry for years to come, you have the ability to arm yourself with the necessary tools and services to gain trust, help people and grow your business in the process. Work to be the first contact your clients make with an inquiry, not the last contact they make as they change their agent of record.

About Lisa Williams

Lisa Williams
Lisa Williams is an insurance and education specialist, a mother and wife, and a business owner. Based in Flower Mound, Texas, she is determined to unveil the secrets of how benefits work through educating and empowering individuals everywhere to make informed decisions about health care and insurance benefit plans. Lisa's credentials include a General Life and Health Insurance license and LHIC license (Life Health Insurance Counselor), both through the Texas Department of Insurance. She most recently completed all CMS training and testing to assist with the federally-facilitated marketplaces for individuals and businesses. In 2013, Lisa's growing agency was not only awarded an A+ rating by the Better Business Bureau, but she was also personally awarded the honor of being a National Association of Professional Women's VIP Woman of the Year.

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