Agent/Broker
Orientation Guide
October 1, 2014
Proprietary & Confidential
Table of Contents
Welcome Letter: Rick Yearry, CEAO …………………………………………………………………………………………… 4
Introduction …………………………………………………………………………………………………………………………… …………….5
Mission
Leadership
MHC Corporate Structure
Financial
Important Contacts
Agent Appointment Process ………………………………………………………………………………………………………………8
Our Producer Agreement
E&O Requirement
Idaho State License/NPN#
YHI State Training
Commissions ……………………………………………………………………………………………………………………………………………9
Overview
Expenses
Product Sales Recordkeeping
Payment
Premium Payment Collection ……………………………………………………………………………………………………………10
Online Insight/Agent Portal ………………………………………………………………………………………………………………10
Overview
Access to Site
Utilizing the Site
Customer Service ………………..……………………………………………………………………………………………………………….11
Consumer Call Center
Claims Service Center
Altius – Third Party Administration Services ……………………………………………………………………………12
Overview
Excellent Customer Service
Health Plan Networks ……………………………………………………………………………………………………………………..12
Connected Care – High Performance Network (HPN)
Access Care – Preferred Provider Organization (PPO)
Marketing MHC Health Plans ……………………………………………………………………………………… ……………..13
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Welcome Producers!
Dear Valued Insurance Producer,
Mountain Health CO-OP is actively working to make health insurance affordable to the 20% of Idaho’s
statewide population that is currently without coverage. The Mountain Health CO-OP is excited you
have elected to join us as we collectively assist individuals and groups through the Your Health Idaho.
In this unprecedented time of reform in the sales and distribution of health insurance, we are confident
our attractively priced product line and outstanding customer support will create much needed
competition in the Idaho marketplace. We pleased you have chosen us as part of your product line
portfolio. On behalf of our entire team my promise to you, as a licensed producer for the Mountain
Health CO-OP, will be consistent and outstanding customer service.
I trust you will find this Agent Orientation Guide to be both informative and easy to comprehend. We
are looking forward to working with you and wish you the best of luck as you enter this new era in
health care.
Thanks again and happy selling!
With regard and anticipation,
Rick Yeary
Chief External Affairs Officer
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Introduction
Mission
Affordable health insurance for Idaho —by the people, for the people.
Formed in response to the Affordable Care Act, Montana Health CO-OP is a member-controlled
organization dedicated to making health insurance available first in Montana in 2014, and with an
expansion into Idaho for 2015. Our coverage is available for all Idahoans, including the low-income
segment of our population. We embrace an innovative health insurance model that keeps healthcare
local, affordable and available.
High-quality health insurance for individuals and families.
Mountain Health CO-OP offers quality, affordable health insurance plans for individuals and families in
Idaho. As a member-controlled nonprofit, we use any profit we earn to lower costs or provide additional
benefits for members. And we spend as little as possible on marketing and overhead so we can keep our
prices low.
Lower insurance costs for small-business owners.
We help employers eliminate the expense of a group plan—all while keeping their employees healthy
and happy. We will help you learn how the Affordable Care Act will affect you and your employees.
Reliable reimbursement for providers.
At Mountain Health CO-OP, we’re changing the face of healthcare in the state. Together with our
provider network, we’re making quality healthcare available to low-income and uninsured Idahoans. We
also make sure our providers receive the reimbursement they deserve for services they provide.
Leadership
Jerry Dworak, Chief Executive Officer
Jerry Dworak brings over 25 years of health insurance experience to Mountain Health CO-OP. Prior to
joining MHC, Jerry spent over 25 years in a variety of senior management positions with Blue Cross Blue
Shield of Nebraska and most recently as Senior Vice President and Chief Marketing Officer of Blue Cross
of Idaho.
A native of Omaha, Nebraska, Jerry is a graduate of the University of Nebraska with a BA in Business
Administration. He is a Chartered Life Underwriter and received his Certified Employee Benefit
Specialist designation from the Wharton School of Finance at the University of Pennsylvania.
As CEO, Mr. Dworak will be responsible for the overall operations of the Mountain Health CO-OP.
Larry Turney, Chief Internal Affairs Officer
Larry Turney was hired by the Mountain Health CO-OP to facilitate the development of the federal loan
application and business plan. Larry was originally hired as an independent consultant; however he is
now the Chief Operations Officer and was the first employee of the Mountain Health CO-OP. Larry
Turney came to Mountain Health CO-OP from his most recent position as the MontanaProgram
Manager for the Regional Extension Center (REC). Larry was responsible for setting up the program and
staff for assisting physicians and critical access hospitals in selecting, implementing and meaningfully
using Electronic Health Record Technology and other health information technologies. Larry was the
first employee hired by the Director of the REC after receiving the federal grant and in the 15 months
employed there, he grew the staff to over 20 employees, which he was responsible for leading. The
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Montana REC is recognized as one of the top RECs in the country and is highly respected by the Office
of National Coordinators and DPHHS.
Before joining the REC Larry spent over 19 years with Blue Cross Blue Shield of Montana in various
leadership positions. His most recent position as the Director of Strategic Planning and Projects, he was
responsible for assisting the Board of Directors and Executive Team in developing the organizations
strategic plan and then working with the rest of the organization in executing, managing, and
monitoring the strategic and operational plans. He was also responsible for the staff that managed all
corporate projects. Larry is a certified Project Management Professional (PMP), which is a worldwide
recognized certification from the Project Management Institute (PMI). Larry is also a certified
professional in Health Information Technology (CPHIT) and Electronic Health Records (CPEHR).
As CIAO, Mr. Turney will be responsible for all internal operations within the Mountain Health CO-OP
such as finance, claims processing, quality assurance, and information technology.
Rick Yearry, Chief External Affairs Officer
Mr. Yearry has over 30 years of experience in healthcare administration. His experience began with Blue
Cross Blue Shield of Montana (BCBSMT) where he was Director of Computer Operations and Technical
Support. While at BCBS MT, Mr. Yearry also managed the $10 million annual IT budget. After nine
years of working internally at BCBS MT, Mr. Yearry designed and built a new subsidiary for BCBS MT
called Healthy WEB. This organization contracted with all of the Montana hospitals and 80% of
Montana clinics as a payer clearinghouse and technical support service.
In 2003, Mr. Yearry resigned from BCBS MT to become the founder and CEO of U.S. Medtrans an
internet based medical transcription company with staff in the US, India, and Ghana, Africa. After
several years, Mr. Yearry sold his interest in US Medtrans and founded two small international internet
based companies, e-Medical Coders and e-World Resources, operating in the US, Norway, and Ghana.
In 2007, Mr. Yearry joined the Montana Department of Health and Human Services. There he managed
the disease management contracts and developed analytics to track the performance of several Medicaid
programs.
In 2008, Mr. Yearry was recruited by Mountain Pacific Quality Health Foundation as the Executive
Director of the Idaho Wyoming Regional Extension Center (REC). In this position, Mr. Yearry was
responsible for a staff of 32 including sales and marketing, technical support, nurses and education staff.
The REC was very successful in contracting with hospitals in Montana and Wyoming as well as over a
thousand primary care providers to assist them in selecting, implementing and utilizing electronic health
records.
As Chief External Affairs Officer (CEAO), Mr. Yearry will oversee the provider contracting, sales and
government relations.
MHC Corporate Structure
Mountain Health CO-OP was formed out of the Affordable Care Act (ACA). When Congress passed the
ACA in 2010 they realized that some state markets in the US were dominated by one or two insurance
companies and that simply instituting an on-line marketplace would not necessarily stimulate
competition within these states. They also understood that due to the cost of initial claims and the high
cost of setting up the infrastructure to support a new insurance company, the average individual
entrepreneur could not afford to establish a new insurance company in these markets.
ThereforeCongress allocated funding within the ACA in the form of small business loans to groups
interested in establishing new insurance companies in these dominated markets.
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These loans were not a grant or free funding, but will have to be repaid to the federal government. The
loans were predicated on specific criteria such as, overall need in the marketplace, the submission of an
official application, the organization had to be structured as a non-profit, had to appoint an impartial
board of directors, and finally the organization had to place a down payment as evidence of financial
stability and credibility.
Mountain Health CO-OP is a consumer oriented and operated organization and functions as a true nonprofit. The current Board of Directors consists of an impressive array of business and political leaders, but
is temporary in nature. Within the next year, the Mountain Health CO-OP policyholders will elect a
new board that is representative of our members. Mountain Health CO-OP will truly be an insurance
company operating for and managed by Idahoans. The CEO, CIAO and CEAO will report directly to the
newly elected board making the Mountain Health CO-OP a truly unique insurance company when
compared with currently established insurers.
Important Contacts
Agent Customer Service - (855) 447-2900 Option 2
Agent support for claims, health plan applications, premium payments.
Pedro Rojas, Outreach Specialist – [email protected] 208-917-1604
Public outreach education, broker support, sales support
Karen Murphy, Senior Outreach Specialist – [email protected] - (406) 447-9510 Ext: 5776
Public outreach education, training programs, and marketing development.
Jeaneen Campbell, Chief Financial Officer – [email protected] - (406) 447-9510 Ext: 5770
Commission distribution to agents/brokers.
Agent Appointment Process
Overview
The Mountain Health CO-OP views agents and brokers as a vital link to the new Federally Facilitated
Marketplace. Each agent/broker relationship provides the Mountain Health CO-OP with the
opportunity to showcase our new approach to the delivery of health insurance services.
We expect most agents in Idaho to embrace this new frontier and we will work with all
qualified/certified agents across the state. We are confident that the agents that are appointed with
Mountain Health CO-OP will experience a higher level of personalized service that will make agents
proud to sell and manage the Mountain Health CO-OP products on and off the Federally Facilitated
Marketplace (FFM).
Our Producer Agreement
Each individual agent is required to have a signed appointment agreement on file with the Mountain
Health CO-OP. This agreement serves two purposes. First, it serves as the agent’s or broker’s application
for appointment with the Mountain Health CO-OP. Once we receive this signed commitment from an
agent or broker we will consider them for appointment as a producer for the Mountain Health CO-OP.
Second, the agreement serves as our long term commitment to the agent or broker. Once an agent or
broker has submitted the appropriate paperwork, passed all Federal and State licensing requirements to
become a producer on the FFM, we will countersign the agreement and send the agent or broker a copy
for their files. This fully executed agreement becomes evidence that the agent or broker is a fully
appointed producer for the Mountain Health CO-OP.
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Agents and brokers that have additional agents working for their agencies that are selling Mountain
Health CO-OP products can submit one producer agreement to cover multiple agents that work for one
agency. Agencies or brokers that wish to do this may simply submit along with their producer
agreement, the Mountain Health CO-OP’s supplementary Attachment A. Attachment A lists additional
agents and their license numbers allowing the Mountain Health CO-OP to associate those agents listed
with the producer agreement for that agency or broker. (This topic is covered more under Commissions.)
E&O Insurance
All Agents and brokers must submit a copy of their Errors and Omissions Insurance coverage prior to
appointment with the Mountain Health CO-OP. Mountain Health CO-OP recommends coverage of at
least $1,000,000 per occurrence with aggregate coverage of $5,000,000.
Idaho State License/NPN#
All agents and brokers must be licensed in the State of Idaho, and be in good standing with the Idaho
State Insurance Commission. All agents and brokers must submit a copy of their Idaho State Insurance
License their NPN to the Mountain Health CO-OP prior to appointment.
Agencies or brokers that employ multiple agents that are appointed to the Mountain Health CO-OP,
should provide both their agency license# as well as the individual Idaho Disability/Health Licenses for
all producers.
YHI State Training
All brokers and agents that plan to work within the Your Health Idaho must take the YHI training as
mandated by Your Health Idaho. Mountain Health CO-OP requires certification from the agent that the
agent took and passed this training.
Commissions
Overview
Mountain Health CO-OP will pay the Producer compensation in the form of commission payments as set
forth in the Schedule of Commissions contained in the producer agreement. (Example A below.) All
commissions must be approved by the Mountain Health CO-OP based on the fact that the Producer is in
compliance with all the terms and conditions of the producer agreement and is not terminated as defined
within the producer agreement, continues to be designated by the policyholder named in the Product or
policy as the Broker or Agent or Producer of record with respect to such policyholder, and the
policyholder continues to be enrolled with the Mountain Health CO-OP.
Example A
Product
Remuneration for life of the policy
associated with specific agent
Each individual policy on or off the FFM up to a max of 5
individuals per policy (max of 3 children).
(each person, family member or not represents a policy)
$10 per person per month based on paid
premium, max of $50 per policy per month
Small Group Product on or off YHI
5% annually, paid monthly based on paid
premium
Expenses
The Mountain Health CO-OP has no obligation to any agent or broker for any expenses that may be
incurred in connection with the sale or services performed by the agent or broker.
Product Sales Recordkeeping
According to CMS the FFM should have a field that will record an agent’s or broker’s name and
marketplace certification number to track commissions for policies sold through the FFM. Regular
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reports on policies sold will be sent to Mountain Health CO-OP via Altius, the Mountain Health COOP’s claims administrator who will process the application and send the customer their policy.
We highly recommend that all agents or brokers track their product sales during the first few months of
open enrollment to make sure that the sales tracking system is accurate. Any agent or broker finding that
his or her sales are not being recorded properly should contact the Mountain Health CO-OP.
Payment
Commission payments shall be paid monthly based on collected and reconciled premium for the previous
month of sales. If an agent or broker finds a discrepancy between his/her sales and his/her commission
payout for any given period the agent or broker must contact the Mountain Health CO-OP in writing
within forty-five (45) days, but no longer than fourteen (14) months from the time of the discrepancy. It
is recommended that you submit an ACH form to receive your commission payments by direct deposit
into your bank account. This will speed the payment of your commissions.
Premium Payment Collection
The Mountain Health CO-OP is well aware that agents and brokers will be receiving cash and/or checks
for the payment of both initial premiums as well as on-going premiums. Therefore the Mountain Health
CO-OP offering 2 options for managing these funds. 1) Agents may deposit cash into their own account
and send a check to the Mountain Health CO-OP to apply to a members account. Any checks received
may be mailed directly to the Mountain Health CO-OP home office. 2) Agents and brokers may set up a
bank account that the Mountain Health CO-OP can electronically withdraw funds from once we receive
notification from the agent/broker identifying the deposit of funds are available for withdrawal. We will
supply you with an ACH form to set up the automatic withdrawal.
We are confident that setting up this type of arrangement will help to eliminate the need for you to keep
large sums of cash at your facility and provide a convenient way for you to deliver these funds to the
Mountain Health CO-OP. For either option, agent/broker must provide a signed receipt of cash to their
client and include a copy of that receipt with any notification to Mountain Health CO-OP for applying
funds. We will supply a form you may use to issue the cash receipt. If you do not use our form,
Mountain Health CO-OP needs all the required data submitted on the form you choose to use.
Send checks, receipts or completed form needed to set up our ACH pull of funds to the following
address:
Attn: Jeaneen Campbell, Controller
Mountain Health CO-OP
P.O. Box 5358
Helena, MT 59604
You may also e-mail receipts or completed forms to [email protected].
Online Insight/Agent Portal
Overview
Whether you call yourself an agent, broker or producer, in order to be successful, you are going to have to
be more productive. The Mountain Health CO-OP is leveraging technology tools to create more time in
your day and allow you to service more clients.
The Mountain Health CO-OP has partnered with Online Insight. Online Insight's agent storefront will
be deployed as an Individual and Group storefront. Agent and broker tools are completely configured to
the line of business they are serving. Whether it's generating a proposal, utilizing rating tiers or helping a
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customer complete their online application, the Mountain Health CO-OP’s agent storefront will allow
you to access a comprehensive, brand integrated, suite of agent and inside sales tools.
Access to the Site
All agents and brokers that are appointed to the Mountain Health CO-OP will be provided access to our
customized Online Insight agent/broker portal. Each agent or broker will be given a username and
password that will be unique to them.
Utilizing the Site
Online Insight is extremely user friendly and simple to learn. We are confident that all agents and
brokers will be able to grasp the site quickly and begin using the customer interaction tools that are
available as part of the site.
During the initial start-up of the Mountain Health CO-OP this site will be used primarily for off the
exchange products and communications with agents and brokers. Eventually the site will be linked
directly to the FFM and will allow for the transfer of individual applicant data such as, Modified
Adjusted Gross Income, number in household, etc. to the FFM to complete the sale.
However, at this point the site can only be utilized to estimate premiums and potential federal subsidies
for customers without logging directly onto the exchange. Please keep in mind that Online Insight will
not link to the FFM until later in 2013. We apologize for this inconvenience and hope to have this
rectified soon.
As of October 1, 2013, the agent or broker will have to log directly onto the FFM to gain access to
premium prices, federal subsidies, available health plans, and to enrol the individual.
Customer Service
Consumer Call Center
The Mountain Health CO-OP will have a customer service call center that will be available to agents,
brokers, navigators, and consumers five days per week nine hours per day from 7:00AM to 8:00PM MST.
The call center will have an option that will allow agents to connect directly with an Agent Specialist
that will be fully educated on our products and trained to specifically handle agent questions regarding
claims processing, enrolment, subsidies, Online Insight, and the FFM website. We are confident that this
system will help the agent avoid multiple phone tree prompts and long wait times.
An agent or broker can contact an agent specialist at (855) 447-2900 Option 2.
Claims Service Center
In addition to our Consumer Call Center the Mountain Health CO-OP policy holders will have a Claims
Service Center that will be available to help policy holding members of the Mountain Health CO-OP
with preauthorization, payments, explanation of coverage, problems with billing or any other type of
questions relating to their health plan. This call center is supported by Altius the Mountain Health COOP’s third party claims administrator and is dedicated to servicing consumers that are already members
of the CO-OP. This Claims Service Center will also serve as a resource for questions from medical
providers in Idaho.
We want our customer service to separate us from other insurers that agents and brokers may currently
be working with, by providing excellent service to resolve both consumer and agent or broker issues
quickly and efficiently.
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Third Party Administration Services Provided by Altius
Overview
Early in 2012 the Mountain Health CO-OP embarked on a rigorous bid process to find the right firm to
provide claims management services for the CO-OP. After months of evaluation the Mountain Health
CO-OP chose Altius Health Plans as their partner for claims processing.
Altius is one of the most respected health claims administration organizations in the U.S. Altius’ claims
processing experience should be an extremely valuable asset for the Mountain Health CO-OP. By
outsourcing this portion of the business the Mountain Health CO-OP does not have to spend the time or
money developing an entire claims administration system. Instead, the consumers of Idaho will enjoy
great service and timely claims processing right from the start.
This does not mean that the Mountain Health CO-OP won’t be interacting with their members on a daily
basis, but will be an integrated partnership that should be extremely user friendly and still Idaho based
with Idaho values.
Excellent Customer Service is their main goal at Altius Health Plans
They want to make sure all of their customers have a mountaintop experience. To make sure they do,
they evaluate how well they are doing on a continuous basis. Altius strives to reach and exceed
the following customer service goals:
Account Management - Customer Service - Claims Systems - Operations
• Calls returned within 24 hours
• Flexible and able to meet client specific needs
• Excellent company and product knowledge
• Answered calls within 30 seconds on average
• 5% or less abandonment rate
• Professional issue resolutions
• 99% financial accuracy
• 97.5% procedural accuracy
• 90% of claims processed within 30 days
• 99% of ID cards issued within 10 business days
• 99% of member’s enrollment completed within 5 business days
Altius Health Plans strives to exceed your expectations. Altius values every individual and they
show it in the way they serve their members every day. To learn more, visit
www.altiushealthplans.com
Health Plan Networks
LINK – High Performance Network (HPN)
LINK is a network of healthcare-delivery institutions contractually joined to provide services for
Mountain Health CO-OP members. This new and innovative way of partnering with clinical
organizations is designed to stimulate efficiency, productivity, and a high level of quality care. The
Mountain Health CO-OP has partnered with multiple providers throughout Idaho to give each consumer
the opportunity to participate in this exciting new healthcare-delivery system.
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LINK is the backbone of the Mountain Health CO-OP’s flagship products and we are confident that the
health plans associated with the provider network will deliver the most value to Idaho citizens.
Access Care – Preferred Provider Organization (PPO)
Our Access Care plan is a plan that saves policyholders money by offering a wide network of doctors,
hospitals and other providers with whom we’ve negotiated special pricing for our members. Choosing a
provider outside of our network will generally cost a policyholder more. This network is made up or over
5000 provider locations from hospitals to private physicians throughout the state. These providers have
agreed to provide clinical services to Mountain Health CO-OP policy holders. Access Care will provide
you with more options and greater flexibility in helping you find a plan that fits your client’s needs and
budget.
Marketing MHC Health Plans
Mountain Health CO-OP is enthusiastically promoting the opportunities afforded by the Patient
Protection and Affordable Care Act (PPACA). Established as a member-owned nonprofit health
insurance CO-OP, Mountain Health CO-OP is working to ensure that healthcare is available to all Idaho
residents, regardless of income.
The Mountain Health CO-OP has been awarded a Certificate of Authority from the Commissioner of
Securities and Insurance and is prepared to offer health coverage to all Idaho residents, including the 20%
who are currently uninsured. Embracing the consumer-oriented / consumer-operated (CO-OP) business
model, the Mountain Health CO-OP will focus on both quality and cost, establishing itself as an exciting
alternative to traditional health insurance organizations.
The Mountain Health CO-OP recognizes the importance of properly engaging the public through an
effective sales and marketing plan, generating enthusiasm regarding this new health insurance model.
Consequently, the Mountain Health CO-OP has crafted the following sales and marketing plan to guide
its efforts to attract target populations and to generate subsequent product sales.
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