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What Role Does Your California Health Insurance Agent Or Broker Play?

Oct 5, 2007
First, what is the difference between a broker and an agent?

These terms are often interchanged in conversation. Officially, an Agent is an individual or company that acts on behalf of the carriers to market, sell, and service insurance. The Agent has a contract with the carrier in order to transact this business. A broker is person who also contracts with carriers but officially acts on behalf of the client. In practical terms, they are not that different when dealing with California health insurance.

For example, Goodacre Insurance Services is a California agent but our goal is to find the right plan for a individual or company across the major carriers. If Blue Cross has the right option and better pricing for a given person or company, then that's where we will go. We are independent agents which is important because we do not have interest in pushing one particular company or plan. We do have knowledge from dealing with the carriers every day in terms of which companies are easier to deal with, more stable, or better priced. There are dozens of plans on the market so this can really be important. 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. We know the lay of the land and I would personally not want to purchase health insurance just based on a rate quote.

Some companies (though not the majors) use "captured agents". This is a person who sells only one carrier's insurance plans. 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 carrier. The benefit of the agent relationship is that they navigate the carriers to expedite processing, help with service issues once enrolled, and act a third party. Again, a carrier's main interest to keep you enrolled as policy subscriber but your interest may actually lie with another carrier or plan. An independent broker can help bridge the two at no additional cost to you. Also, the carriers are big companies. Some of the reps are very knowledgeable and others are...let's face it...newer. By dealing with California health insurance daily, we are a wealth of information and guidance that you may not get by going directly.

What to expect from your broker/agent and especially Goodacre Insurance Services?

Goodacre Insurance Services provides service across three main areas.

California health plan selection.

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. Goodacre Insurance Services has been dealing solely with California health insurance for over a decade now. I can guarantee that with a few targeted questions, the plan selections can be narrowed down significantly. We want you to be informed. On a daily basis, we hear from our clients that they wish they would have called earlier rather than try to navigate the volumes of information provided the plans. Let us help. We do not sell. We 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 in California. We 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. Based on your situation, we can give you a benchmark of what to expect for a normal processing.

Health Insurance Service and Membership.

Once the plan is in effect, we are your point of contact for membership issues, claims, and future changes. We go in at the end of each month and make sure that faxed changes, additions, and requests have been processed correctly. The carriers 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 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 us 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, carrier 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. Some agents do both health and P&C but it is increasingly difficult to this well and keep up with the ever-changing industries. This is why we choose to concentrate on health insurance solely. We know the carriers, the plans, and changes in the market. This makes us invaluable to you.

As we say on the phone here at Goodacre Insurance Services..."How can I help you out".
About the Author
Dennis Jarvis is a licensed California broker with extensive knowledge of the Individual and Small Group health market in California. California health insurance.
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