AGENT ROLE

• The agent must be licensed and appointed by the insurer providing the contract
• The agent must receive the usual commission 
• Usual commission varies case by case
• This creates the agent conflict of interest in public procurement or negotiation
• Agent has a conflict of interest if any remuneration or item of value is received from any potential participating carriers in any form 
• Agent has a conflict of interest if appointed with a carrier
• Actual, potential or perceived conflicts apply
• Agent may effectuate contracts

                    • Deliver contracts

                    • Enrollments/Terminations

                    • Qualifying events

                    • Coverage questions

                    • Provider outreach

                    • Claims support

                    • Billing support

                    • Loss history analysis

                    • Market observations (nonbinding and noncompliant)

                    • Wellness

                    • Health literacy

• Other option for delivery of contract and effectuation is the captive agent (employee) of carrier, ASO, consortium, trusts and pools 
• Agent services must be competitively bid every 3-5 years

                    • Nonnegotiable

                    • Submit to audits annually

                    • Comply with public records request (when applicable)

                    • Follow Sunshine law requirements

• Agent must have detailed contract with Govt Unit

                    • Scope of services defined

                    • Audited annual for compliance

                    • Address responsibilities specifically

                    • Dependent eligibility verification obligations

                    • Audit requirement established by the client