Role of California Health Insurance Agent and How They Can Benefit You?

Officially, an Agent is an individual or company that acts on behalf of the insurance company to market, sell and service insurance. The Agent has a contract with the insurance companies in order to represent a specific insurance company. A broker is person who also contracts with insurance company but officially acts on behalf of you the client. All agent and agencies are compensated by the insurance companies and therefore are at no cost to you. The difference between agent and agency is that agent is individual contracted with insurance companies and agency usually has many agent working under umbrella of the agency. In most cases agents working under agency are employees.

Agents role is to find best possible and the most affordable option for your money. In most cases there is no incentive on the agent’s part of which company you decide to go with. How agents get paid by the insurance company is strictly regulated by the insurance commissioner. When looking for agency or agent make sure that they are brokers who represent as many health insurance companies as possible. There are dozens of plans on the market, therefore finding agent who can get you the best possible plan for your money will save you thousands long term. Just looking a rate quote and benefit summary is only half of the story when choosing health insurance. Some plans exclude certain benefits or apply caps to other types of coverage. Agents know the lay of the land and you would personally not want to purchase health insurance just based on a rate quote.

Some insurance companies have captive agent representing them. Captive agents can only represent one insurance company. They are essentially employees for that company. I would avoid such companies as they may not have the best interest of the client at heart. If a company cannot quote multiple carriers, beware. The major carriers in California are Blue Cross of California, Blue Shield of California, Health Net, Pacificare, and Kaiser. Beyond these five, we do not feel very secure about the others.

How are agents or brokers paid? Agents are paid a commission by the carriers for policies issued and in force. The commission tends to be about the same from carrier to carrier. This commission does not affect the rate. The insurance rate you will get through an agent/broker is the same as you would get going directly through the insurance company. The benefit of the agent relationship is that they navigate the insurance company to expedite processing, help with service issues once enrolled, and act a third party. Insurance company’s main interest to keep you enrolled as policy subscriber but your interest may actually lie with another insurance company or plan. An independent broker can help bridge the two at no additional cost to you.

What to expect from your broker/agent?

This really is the most difficult part and it is the reason that people put off getting health insurance. There are many plans and the language is pretty technical. Most people glaze over when they see the brochures or instant quote results. Let's face it....health insurance is not a common purchase. Typically, people have not needed to shop health insurance in years...if ever. With a few targeted questions, the plan selections can be narrowed down significantly. With great agent you wish you would have called they earlier rather than try to navigate the volumes of information provided the plans. Most Insurance agent do not sell. They listen, advise, and then it's up to you what you wish to do.

California application and enrollment.

The health application is one more reason that people procrastinate. There are sections in there are mandated by law but which are thoroughly confusing such as the HIPAA qualification. Small Group can be equally difficult in terms of qualification for Small Group health coverage. Insurance agents are happy to walk you through the application once a plan has been decided on. This is also the time to ask about the process, payment options, cancellation options, time table for enrolling in coverage.

Health Insurance Service and Membership.

Once the plan is in effect, agent is your point of contact for membership issues, claims, and future changes. Agents go in at the end of each month and make sure that faxed changes, additions, and requests have been processed correctly. The insurance companies are pretty good but 1 out of 100 requests do not show in the system. You do not want to be that one with such a critical issues as your health insurance. We can also advise for ways to reduce costs when the rate increase occur based on your changing health insurance needs.

Keep in mind that you can always contact the carrier directly if you choose but why would you? Let Insurance agent do the work for you since there is no additional cost to you.

Agents and brokers are required to have a license and continuing education by the California Department of Insurance. You can always research an agent's history, insurance company contracts, and other information through them. There are different types of licenses. The two most common are Life/Health which is used to transact California health insurance and Property and Casualty is used to transact insurance such as auto or home insurance.