When it comes to health insurance, the application and subsequent policy documents establishes the contractual requirements of the responsible parties, the insurance carrier and the policy owner. The insurance agent (or broker), stands between both parties. The agent is contracted to represent the insurance carrier while also working on behalf of the policy owner. The agent explains the benefits of the policy and helps the policy owner understand various coverage options and their premium costs. The agent represents the insurance carrier by assisting the applicant with the application process and ensuring that the application is submitted accurately.
Health insurance is considered a financial service product. Over an extended period of time, the health insurance policy can involve large sums of money, and ongoing financial transactions must be completed by both the insurance carrier and the policy owner to complete the financial obligations.
Because of the complexity of health insurance, state regulatory authorities had to be created in order to monitor and regulate activities related to all forms of insurance. In 1851 New Hampshire appointed the first insurance commissioner, thus creating the current state regulatory framework. Twenty years later the National Association of Insurance Commissioners (NAIC) was established to coordinate activities of individual state regulators and to share resources. The NAIC is used to pool resources, discuss common concern issues, and standardize oversight of the insurance industry; however, each state decides how the insurance industry will function individually within that state.
Insurance regulation was established with the purpose of protecting American consumers. Congress adopted the McCarran-Ferguson Act in 1945 and so affirmed state responsibility to regulate insurance. This act is responsible for protecting consumers, ensuring that insurance carriers meet their policies’ obligations and that agents operate ethically and knowledgeably. To sell insurance agents must be licensed in a designated home state and must comply with the laws of that state. State authority regulation is organized around several responsibilities, such as company and agent licensing, product and financial regulation, market conduct, and consumer services. These authorities oversee agent activities as they complete the insurance transaction.
The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010 and is ushering in a new period of increased regulation of the insurance industry. Although it concentrates on reforming the health insurance market, passage of PPACA actually increased the emphasis on continuing education. Continuing education programs are a source for information pertaining to PPACA regulations and how they will be implemented. Increased regulation means that agents must remain well versed in how this new legislation and components of the legislation will affect clients.
To ensure agents are meeting high professional standards and maintaining knowledge on current insurance products and industry trends, continuing education programs were put in place. Each state requires continuing education credits and monitors fulfillment when the agent renews his or her license. Specific requirements vary by state, but typically 30 hours of continuing education are required in every two-year renewal cycle. Half of the total hours must be completed in a classroom setting. Agents can choose from a list of approved subjects which courses to take, but it is mandatory that two hours be completed regarding ethics/consumer protection.
STATESIDE CAN HELP!
Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.
Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs.
Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods.
By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.