By (Agent Signature) & Date
____________________________________
Title/Organization Erin Ackenheil
Vice President Sales
Senior Business
____________________________________
Agent Name (Please print)
______________________________ ___________________________________ _____________________________
Agent Writing # (Tax ID#) Agency tax ID# (if appl) Social Security #
____________________________________________________________________ ____________________________
Business Address (Street, City, State, Zip ) Email Address
______________________________ ___________________________________
Agent Phone # Agent Fax #
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
The Blue Cross names and symbols are registered marks of the Blue Cross Association.
Page 8 of 8 July 2011
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Individual California Agent Commission Schedule
For Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company Individual and Family Medical Plans/Policies
Effective January 1, 2012
This Individual Commission Schedule will become effective on January 1, 2012 for Individual and Family Policies issued by Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company with effective dates on or after January 1, 2012. This Individual Commission Schedule will not be applicable to Individual and Family Policies issued by Anthem Blue Cross or Anthem Blue Cross Life and Health Insurance Company with effective dates prior to January 1, 2012. This schedule does not affect existing or future broker compensation for Small Group Health, Dental, Vision, Life and Disability, Employee Assistance Program, Senior or Medicare Supplement Policies.
Individual Medical (First Year/Renewal)
(The commission percentages for underwriting levels greater than Underwriting Level 1 have been adjusted in order to make the paid commission for each underwriting level equal to the commission earned under Underwriting Level 1. In the event that additional underwriting levels are implemented, the underlying commission percentage will be adjusted such that the paid commission will be equivalent to the dollar amount earned under Underwriting Level 1. For plans/policies subject to an underwriting level greater than 1 + 100, the commissions are addressed in Section II D).
HIPAA Plans (PPO) HIPAA Plans (HMO)
Underwriting Underwriting Underwriting Underwriting Underwriting Underwriting
Tier
2
Life Insurance*** Dental***
*Annual member sales will be determined based on issued and paid contracts with an Original Effective Date within the calendar year. See Section I for definitions of Annual Member Sales and Original Effective Date and Section II A for additional information. Under Section II B, commissions on member sales achieved via aggregation of agent business will be capped at tier 2 unless an employer/employee relationship can be established.
**Renewal commissions for a plan/policy will be paid at the final compensation tier that Agent qualified for in the year of the OED of the plan/policy.
Under this Schedule, the compensation tier used for purposes of determining renewal commissions will not change as long as the plan/policy remains in effect. Policies may be rated at either the member level, or at the contract level. For member level rated plans/policies, renewal commissions are based on Original Premium and are payable according to the terms of the Agent Agreement. Renewal commissions for contract rated plans/policies will be based on actual premium received and are not subject to Original Premium.
The commission percentages are designed so that the amount of money earned in commission is, despite the underwriting level, no less than the amount of compensation earned under Underwriting Level 1. Renewal commissions paid for plans/policies subject to Original Premium will appear on the commission statement as being calculated at the renewal commission rate and standard premium applicable to Underwriting Level 1.
***Dental and Life plans do not count towards Annual Member Sales and are not subject to original premium. Contract rated plans/policies are not subject to Original Premium.
Compensation Under Tiered Schedule
Agent will earn compensation under a specific tier based on current year’s “Annual Member Sales.” First year and renewal commissions for Individual and Family Plans/Policies accepted by Anthem Blue Cross/Anthem Blue Cross Life and Health Insurance Company with an original effective date on or after January 1, 2012, shall be based on the following:
I. Definitions
1. “Agent” shall mean the agent that receives a commission from Anthem Blue Cross/Anthem Blue Cross Life and Health Insurance Company as a result of selling a new plan/policy.
2. “Original Effective Date” (“OED”) shall mean the first effective date of a plan/policy placed by Agent and accepted by Anthem Blue Cross/Anthem Blue Cross Life and Health Insurance Company.
3. “Member Effective Date” shall mean the date when a member first becomes effective under a plan/policy.
For purposes of renewal the Original Effective Date of the plan/policy will apply to all members under that plan/policy.
4. “Annual Member Sales” shall mean all new members on a plan/policy with an OED within a calendar year (January 1 through December 31) that are issued and paid at least one month’s premium in the calendar year. Anthem retains sole discretion to determine what constitutes a ‘new’ sale or member. For example and without limitation, Anthem may determine that switching plans, splitting plans, and/or switching subscribers does not constitute a ‘new’ sale. Additions to an existing plan/policy will not count as a new sale for purposes of annual member sales unless the addition is completed in the same calendar year as the OED. Member lapses that are not considered “cancelled never effective”, will not reduce the Annual Member Sales count.
Policy Type
Term Life Insurance
First year Renewal
25% 10%
Policy Type
Anthem Blue Cross Individual, Dental Select HMO, Dental Blue PPO, Dental PPO, Tonik
First year Renewal 10% 10%
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5. “Original Premium” shall mean the member level premium in effect on the Member Effective Date.
Contract rated plans/policies are not subject to Original Premium. Any surcharges applied to a plan/policy are not considered premium for purposes of determining commissions under this schedule or included within Original Premium.
6. “Underwriting levels” shall mean an applicant’s final underwriting level as determined by medical underwriting. Underwriting levels include Level 1 (no rate-up), Level 1 +20%, Level 1 +25%, Level 1 +50%, Level 1 +75%, Level 1+100% and any additional underwriting levels as set forth in Anthem Blue Cross/Anthem Blue Cross Life and Health Insurance Company underwriting guidelines. In the event that additional underwriting levels are implemented, the underlying commission percentage will be adjusted such that the paid commission will be equivalent to the dollar amount earned under Level 1.
7. “Surcharge” shall mean any additional sum charged on a policy/plan in addition to the rate or premium.
This shall include any surcharge applied pursuant to AB 2244 (2010) wherein a charge of 20% may be assessed to children under the age of 19 for no greater than 12 months if the child has not had coverage within the 90 day period prior to the date of application and is not a late enrollee.
II. Determination of Applicable Compensation Tier
A. Determination of Tier – For purposes of determining an Agent’s “Annual Member Sales” and tier, the following will apply:
• On January 1 of each year, Agent’s Annual Member Sales for that year will be set to compensation tier 1.
Anthem in its sole and absolute discretion may set Agent to a higher tier than tier 1 to begin the year.
Anthem’s exercise of its discretion in any particular manner will not be binding on future actions or guarantee that such discretion shall be exercised in the same manner in the future.
• Increased commission levels resulting from moving to a higher compensation tier based on increased Annual Member Sales will apply to members still active and sold with OEDs in the same calendar year.
Any changes to the initial compensation tier set in January will begin in April, and will include all Annual Member Sales of the current year.
Rate Plan Definitions (In the event that additional underwriting levels are implemented, the underlying commission percentage will be adjusted such that the paid commission will be equivalent to the dollar amount earned under Underwriting Level 1)
Underwriting Level 1 Standard Rate Plan
Underwriting Level 1 +20 Plus 20% Rate-Up for those applicants who meet that underwriting criteria Underwriting Level 1 +25 Plus 25% Rate-Up for those applicants who meet that underwriting criteria Underwriting Level 1 +50 Plus 50% Rate-Up for those applicants who meet that underwriting criteria Underwriting Level 1 +75 Plus 75% Rate-Up for those applicants who meet that underwriting criteria Underwriting Level 1 +100 Plus 100% Rate-Up for those applicants who meet that underwriting criteria Underwriting Levels greater than 1 + 100 Standard Rate Plan plus Rate-Up as specified in underwriting guidelines
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• There is a 3-month period after the end of each calendar year to allow for processing applications with requested effective dates in one year that are issued in the following year. For instance, if a plan/policy is sold in December of 2012 with a requested December effective date, and is issued in the first quarter of the following year with the requested effective date, it will count as part of the Annual Member Sales for 2012. The cut-off for adjustments to the prior year’s commission tier is March 31st of the following year.
B. Rules Regarding Aggregation of Business
• In order to qualify for a higher compensation tier based on aggregation with other licensed and appointed agents, Agent must establish to Anthem’s satisfaction a bona fide and demonstrable employment relationship with each agent for which aggregation is sought. In the event such a relationship cannot be established with each agent, Agent will not be able to aggregate sales and Agent’s commissions will be capped at compensation tier 2.
C. Premium Levels Used to Determine Commissions
• First Year Commissions shall be based on Agent’s tier and member underwriting level.
• Renewal commissions will be based on the Original Premium for member level rated plans/policies and actual premium received for contract rated plans/policies and Agent’s tier at calendar year-end of OED.
Original Premium will apply to the plan/policy regardless of if the member changes plans, zip codes, underwriting levels, or changes agent of record.
D. Commissions for Underwriting Levels Greater Than Level 1 +100
• For underwriting levels greater than Level 1 +100, the underlying commission percentage applied to the Original Premium for such plan/policy will be adjusted such that the paid commission will be equivalent to the dollar amount earned under Underwriting Level 1.
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association.
15028MUIENMUB-CA 1/12
Effective July 1, 2011
Small Group Services, P.O. Box 9074, Oxnard, California 93031-9074