Author Archives: Reeve Conover

Why your broker won’t help you get coverage…

From insurance Business America, 2/11/16:


The bad news for health insurance agents continues.

Earlier this week, three of the largest insurance companies in the country announced they would not be paying broker commissions for consumers that sign up for plans after the open enrollment season deadline.

Anthem, Aetna and Cigna announced the ban on broker commissions independently, hoping the actions would dissuade people from signing up for their individual marketplace plans outside of the designated period.

Additionally, Cigna and Humana announced they will no longer pay commissions on the more expensive “gold” plans sold through the Affordable Care Act marketplaces in an effort to encourage enrollment in cheaper, higher-deductible plans at the “silver” or “bronze” level.

The actions come amid criticism from insurers on “special enrollment periods” that allow consumers to shop for insurance outside of the designated window each year. Health insurers have said that consumers are using the provisions granting a special enrollment period – such as job loss or a move – to sign up for insurance when they are sick and plan to use healthcare services.

Because they cannot bar consumers from signing up, however, they are pushing back by dissuading agents – who have been instrumental in enrolling customers to their plans – from taking the time to do so.

Agents have suffered heavy commission losses from the “Top 5” health insurer already this year, with UnitedHealth Group first scaling back and then altogether eliminating compensation for brokers.

Just weeks after UnitedHealth’s announcement, Manhattan-based startup Oscar sent a letter to agents saying it will no longer be paying brokers $14 per contract per month for individual subscribers or $26 for enrolled families as planned. Instead, all Oscar policies will generate only $6 per contract per month regardless of people in the plan.

These decisions have led agents to readjust their business models. Many have elected to no longer assist clients who select Oscar or UnitedHealth plans, while others are focusing more heavily on other markets.

Obamacare Pummels Blue Cross Blue Shield Of NC–What Can We Learn From This?

Forbes posted an article on January 30, 2016 with this title.  Very scary stuff-

According to this morning’s News and Observer, “The dramatic deterioration in Blue Cross’ ACA business is causing increasing alarm among agents and public health officials.”  In response to its bleak experience with the Obamacare exchange, the company has decided to eliminate sales commissions for agents, terminate advertising of Obamacare policies, and stop accepting applications on-line through a web link that provides insurance price quotes–all moves calculated to limited Obamacare enrollment.”

The losses incurred by Obamacare policies has caused the company to have an overall loss of $50.6 million dollars.  They have not lost money in more than a decade.  Considering that they are the largest carrier in North Carolina, and with United Healthcares’ announcement that they are likely leaving Obamacare as well, this does not bode well for individuals looking to get coverage next year.

Nor does it bode well for the United States’ ability to pay for this law, which has always been in question, and for the future of the law itself.

Read the full article here.

CIGNA banned from Medicare Sales

Cigna was temporarily banned from marketing its Medicare products to new customers, after the U.S. found deficiencies in how the health insurer ran its plans, citing widespread violations that the government said threatened patients’ health.  This means that existing customers can keep their policies but no new customers can be brought on board.

I appears this relates more to the Medicare Advantage plans than Prescription Plans.

It will remain to be seen if this impacts the pending merger with Anthem Health.

IRA Reminder

You have until April 18 to make your IRA contribution this year

Are you being forced to use mail order?

We have been hearing some issues pop up on this so we wanted to send it back out again.  Members for NY Oxford groups (small and large) are not required to use Mail Order, they are being gently nudged to do so.   If they want to opt out they can either call the Oxford number on their card or log into the oxford website.  Here is the information from Oxford again:


We are extending the Mail Service Member SelectSM program to our Oxford fully insured commercial group members in New York, effective October 1, 2015. The program will be implemented with these members beginning on their group’s renewal date, on or after October 1, 2015. Mail Service Member Select is intended to help members better manage the medication they take on a regular basis through use of the OptumRx® Mail Service Pharmacy. Oxford New York self-funded clients are not affected at this time, although they may elect the program at renewal. Additionally, Mail Service Member Select is not available in New Jersey or Connecticut. 



  • Employers: In addition to the postcard mailing approximately 45-days prior to the affected customer’s renewal date with us, and Account Management email outreach, this information will be posted to the Messages section of the Employer portal. The employer flier will be posted to the Tools & Resources section of the Employer portal.
  • Members: Approximately 30-days prior to the affected group’s renewal date with us, we will inform members who are taking a maintenance medication about the Mail Service Member Select Program.



  • Broker eBulletin
  • Employer Postcard
  • Employer Flier

The program requires members to make a choice – switch to mail service or stay at retail pharmacy

∙       OptumRx will promote the value of Mail Service (Convenience, Safety, Potential Savings and Adherence)

∙       This is NOT mandatory mail and NO financial penalties for staying at retail


Members allowed to fill prescription twice at retail pharmacy while they decide

∙       Initial notification of program and value of mail service sent 30 days prior to effective date for existing customers

∙       Multiple communications with members instructing them to contact OptumRx

∙       At any time, members can move to mail or disenroll from program by either calling customer service or via the web


If member has not notified OptumRx by third fill of a prescription, the pharmacist will instruct member to contact OptumRx before the prescription can be filled

∙       Once member contacts OptumRx and chooses mail service or retail, the third fill prescription can be completed real-time

∙       If member switches to mail, OptumRx will provide a one-time 30 day fill to allow enough time until first OptumRx fill arrives in mail”

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck