How to Complete Agent Paperwork for
Accurate Payment of Your
Covered California – SHOP Commissions
• Two Scenarios
• Scenario #1
• Agent certification with payment to company (Agency)
• Scenario #2
• Agent certification with payment to individual (Agent)
Questions?
Covered California Agent Service Center: 877-453-9198 [email protected]
Scenario #1
• Agent certification with commission payments to
company (Agency)
• Paperwork includes both the Agent and the Agency
Scenario 1:
Contract with Agent
and SHOP Commission
Payments to Agency
Contractor’s Name
should read “Agent’s
Name for the benefit
of Company Name”
Contractor’s Name
should read Agent’s
name and be signed
by the agent.
Joe Agent for the benefit of Insurance Benefits Company
Joe Agent
Joe Agent
Joe Agent, Sales Manager
123 Any Street City, CA 12345
Scenario 1:
Contract with Agent
and SHOP Commission
Payments to Agency
Contractor’s Name
should read “Agent’s
Name for the benefit
of Company Name”
Joe Agent for the benefit of Insurance Benefits Company
Scenario 1:
Contract with Agent
and SHOP Commission
Payments to Agency
PAYEE DATA RECORD
Joe Agent for the benefit of Insurance
Benefits Company
Payee Data Record
information on this
form (sections 2-4)
should be that of the
Agency, not the Agent
Scenario #2
• Agent certification with commission payments to
individual Agent
• Paperwork includes only the Agent
Important
If the Agent operates under a DBA, include the DBA when
entering the Agent name. Example: if the agent is John
Smith and he does business as Smith Insurance Agency,
then enter the name as:
John Smith DBA Smith Insurance Agency
Scenario 2:
Contract with Agent and
SHOP Commission
Payments to Agent
STANDARD AGREEMENT
Contractor’s Name
should read “Agent’s
Name”
Contractor’s Name
should read Agent’s
name and be signed
by the agent.
Joe Agent
Joe Agent
Joe Agent
Joe Agent, Sales Manager
123 Any Street City, CA 12345
Scenario 2:
Contract with Agent
and SHOP Commission
Payments to Agent
EXHIBIT A
Contractor’s Name
should read “Agent’s
Name”
Joe Agent
Scenario 2:
Contract with Agent
and SHOP Commission
Payments to Agent
PAYEE DATA RECORD
Joe Agent for the benefit of Insurance
Benefits Company
Payee Data Record
information on this
form (sections 2-4)
should be that of the
individual Agent, not
the Agency