Agent Role

The agent must be licensed and appointed by the insurer providing the contract. The agent must receive the usual commission, which varies case by case. This situation can lead to an agent conflict of interest in public procurement or negotiation. An agent has a conflict of interest if they receive any remuneration or item of value from any potential participating carriers in any form, or if they are appointed with a carrier. Actual, potential, or perceived conflicts apply in these scenarios. The agent may effectuate contracts and provide essential agent services, including: delivering contracts, handling enrollments and terminations, managing qualifying events, addressing coverage questions, conducting provider outreach, offering claims support, assisting with billing support, analyzing loss history, making market observations (nonbinding and noncompliant), promoting wellness, and enhancing health literacy, all while ensuring government unit compliance.

Another option for the delivery of contracts and effectuation involves the captive agent (employee) of the carrier, ASO, consortium, trusts, and pools. To ensure government unit compliance and mitigate any potential agent conflict of interest, agent services must be competitively bid every 3-5 years. 

• Nonnegotiable

• Submit to audits annually

• Comply with public records requests (when applicable)

• Follow Sunshine law requirements

The agent must have a detailed contract with the government unit, which should include:

• Defined scope of services

• Annual audits for compliance

• Specific responsibilities outlined

• Dependent eligibility verification obligations

• Audit requirements established by the client