The Jefferson Health Plan welcomes the opportunity to work with brokers who understand the value self-insurance can provide to clients. The Jefferson Health Plan is a complex organization with its member employers having a variety of needs. Brokers, in many cases, know the needs of their clients better than the consortium.
The consortium is,therefore, always looking for partners who understand the value of self-insurance and can relate those benefits to their clients. Although many members of the consortium are represented by brokers, representation by a broker is not a membership requirement of the consortium.
Brokers act as consultants to the member groups of The Jefferson Health Plan. The broker's role is to help the members in managing their plans to provide the best value for the member organizations. The broker's role is not to bid out the plan, as the benefits of self-insurance are realized over the long term. Potential member organizations or brokers looking for short-term solutions to the problems of their clients should not expect to find answers with The Jefferson Health Plan.
The Jefferson Health Plan does not directly compensate brokers for the activities on behalf of a member group. Each member group designating a broker representative will be free to set the terms of compensation for the broker/consultant as the situation dictates. The consortium will, however, facilitate the payment of such broker for the member organization.
BECOMING A BROKER FOR THE JEFFERSON HEALTH PLAN
Welcome to The Jefferson Health Plan website where we are committed to helping brokers and agents succeed. To that end, The Jefferson Health Plan will work with you in a number of ways to help you better serve your customers and strengthen your business. We welcome feedback on our program offerings and will do our utmost to earn your loyalty.
The Jefferson Health Plan is proud if its hard-won reputation and the success that we have enjoyed. We count on you, as a broker or agent representing a member of the consortium, to understand our programs so you can help educate your potential clients on the benefits of consortium membership. As our representative, we expect you to conduct yourself with the same commitment to honesty and integrity that we have at The Jefferson Health Plan. We expect you to:
• Comply with the law
• Treat others with the same respect you deserve
• Be reliable, dependable, and trustworthy
• Keep your promises
• Communicate with honesty, truthfulness, and, above all, skill
First and foremost, The Jefferson Health Plan would like brokers who represent the consortium to prospective member groups to have a solid understanding of the consortium's objectives. Knowledge of what the consortium can and cannot do and how it distinguishes itself from other available alternatives is important for both the consortium and its broker partners.
The first step in becoming a broker for the consortium, therefore, is to study this website and then contact us to learn more about how the consortium works. After an initial discussion, you can decide if a meeting to discuss in greater detail the benefits of the consortium is right for your clients.
All external producers (e.g., agents and agencies) intending to conduct business on behalf of the consortium must be authorized to represent its products and services. Authorization includes among other things, entering into a legal agreement with The Jefferson Health Plan. Please submit an agent/agency agreement, appointment forms, and license information as required by applicable federal and state laws and The Jefferson Health Plan's policies to be appointed.
The consortium also employs a national marketing director who can also meet with interested brokers on the value proposition available to prospective members through a JHP membership.
BROKER POLICIES AND PROCEDURES
The Jefferson Health Plan will develop quotes for groups based on the information submitted on behalf of a potential member organization. The Jefferson Health Plan will provide the requested quote using the network and third party administrator requested in the submission. If no network or third party administrator is specified, The Jefferson Health Plan will make a determination.
While The Jefferson Health Plan will always defer to the specification of a third party administrator and network, in some circumstances The Jefferson Health Plan may issue a second bid contemplating the use of an alternative network and third party administrator. When two bids are issued on behalf of a potential member organization, you will be notified that the second bid is an alternative proposal.
If multiple agents or brokers are attempting to solicit bids from The Jefferson Health Plan on behalf of a potential member group, the consortium will issue competing bids. If the requests for bids from the competing agents are similar, the bids will generally be alike, save for any variation in agent compensation. If after the consortium has already issued a bid on a prospective group and another request for a bid is submitted for the same group from another party, the consortium will issue a second or third bid, notifying the recipients of the earlier bids that subsequent bids were issued.
The consortium operates several pools of small public employers that may be made available to interested groups. Each of those pools has its own restrictions, and membership may be limited.
Membership in The Jefferson Health Plan is open to public employers considered to be political subdivisions of their respective state. The Jefferson Health Plan is not open to state-supported organizations or private non-profit groups, nor to non-public organizations.
The average size of member groups is 150 employees. Very large groups are probably not ideal candidates for membership, as they may already be credible for rating purposes without membership in the pool, but the consortium will happily work with groups of any size above 50 employees. Groups of fewer than 50 employees may want to consider membership in one of the many pools operated by the consortium.
In developing bids for prospective member groups, ideally the consortium would like to receive at least two years of claims experience by month for each line of coverage being considered in connection with the prospective member's enrollment in the consortium. Along with claims experience by line of coverage, the consortium will also need employee headcounts by month by line of coverage for at least twenty-four months. Large claim information is also critical in providing bids for prospective member groups along with plan designs in effect at the time of membership and any plan changes that have occurred during the prior twenty-four months. Also useful would be a rate history for prospective members as well as the network and claims administrator being used by the organization seeking a quote from The Jefferson Health Plan.
In some cases, it is acknowledged that detailed historical claim information is not always available. In such cases, The Jefferson Health Plan can use its manual rating process to establish rates; however, all individual member groups of the consortium will be rated upon their own experience. Therefore, the initial rates established for manually rated groups may not be as precise.
You must be authorized to represent The Jefferson Health Plan and your client. Authorization includes certain obligations and receipt of appointment letters. You will be required to submit an agency agreement, an appointment form or letter, and license information as required under applicable federal and state laws in order to be authorized to represent a member of the consortium.
Please carefully read and follow all instructions when applying for authorization. Completed forms should be submitted by mail, fax, or email (PDF) to the contact information on the form. You may be advised that additional forms are required. You will be notified by email of the disposition of your request.
Forms and Information
· A letter from The Jefferson Health Plan member or prospective member organization of their
consent to your appointment as their representative (broker of record agreement).
· A compensation agreement between you and the member or prospective member organization
signed by a duly authorized representative of the member or perspective member group.
· A Direct Deposit Authorization form must accompany your representation. Direct deposit is
· A copy of your current life, accident, and health license for Ohio.
You will need to complete and sign an Agent Agreement to represent a member of The Jefferson Health Plan. If you alter in any way that agreement, your application will be denied.
· Please provide the full name of the agent and/or contracting agency.
· Print the TIN of the agency for which payment is to be received. Fees paid will be reported on a
1099 statement using the number reported on this form.
· Provide the direct deposit information.
· Sign the agreement.
· Broker of record agreement.
If a business name is used, an officer of the entity must sign on behalf of the business. The group you are representing in the consortium must sign the broker of record agreement along with an officer of your company and/or you.
Instructions for Direct Deposit
All payments to authorized agents of The Jefferson Health Plan members will be made by direct deposit. The Direct Deposit Authorization form should be completed and faxed to The Jefferson Health Plan for handling. When you complete the form:
· Save the form for your files. Print and sign the form.
· Forward the form to The Jefferson Health Plan via PDF or fax.
The Jefferson Health Plan is a non-profit organization dedicated to providing cost effective benefit solutions for its member organizations. It is operated on what is commonly referred to as an allocated balance model, where each member organization maintains its own reserves. Because of this allocated balance model, the consortium does not have funds to pay brokers who represent individual member organizations within the consortium.
Member organizations are, however, free to use the services of broker agents. Any compensation directed to broker agents on behalf of member groups is charged directly to the member organization. Compensation under such arrangements is at the discretion of the broker agent and the member organization. The consortium facilitates the compensation to the broker agent on behalf of the member organization.
Compensation is only paid to agents or brokers who have an agent of record appointment letter from the member organization. Along with an agent of record appointment from a member organization, they must have also completed and submitted to The Jefferson Health Plan the Broker-Agent Application and provided the required direct deposit information.