NAIFA Blog

By Diane Boyle, NAIFA

In my nearly 20 years with NAIFA, our members who serve health insurance clients have a running joke about their relationship with the carriers: If the carriers could figure out how to provide year-round, quality service to clients without involving agents, then agents would be gone tomorrow.

The truth is, agents play a critical role in servicing clients with local, personalized and cost-effective ways that deliver value. And the carriers know that.
 
A new survey of NAIFA members confirms this. According to the survey of more than 800 members – which I presented today during a meeting of the National Association of Insurance Commissioners – agents say they receive an average of 223 requests each year from clients who are having difficulty resolving health insurance claims.

For each claim, an overwhelming majority of requests require the agent to place at least two calls to the insurance company (70 percent) and two calls to the client (82 percent). In addition, 43 percent of the agents surveyed say they call the health care provider at least twice per claim. That’s an average of four to six calls agents have to make per claim issue. Imagine if these year-round consumer queries were left to the state insurance departments. Pass the aspirin.

In the midst of this massive healthcare overhaul, many are asking how agents will fare in the reformed system. The real question is how consumers will fare after they are enrolled in a plan. Who will help them navigate this complex system of healthcare?

Right now, NAIFA members are compensated for the services they provide, and if a client is unhappy with their service, they can go elsewhere. Competition drives and enhances the quality of service for consumers. What will be the role of the agent in the Exchange, when their business structure (and compensation levels) are likely to change dramatically before 2014?

Like the clients they serve, NAIFA members are diverse - some are large health and employee benefits operations, others are small business owners. Some focus only on health insurance, others offer other product lines. Some provide insurance primarily through employers while others serve primarily individuals.

Within these diverse levels of service, I believe NAIFA members will react differently to a reduction in their compensation. Some will change their businesses and place greater emphasis on service and compliance for their group clients. Others will focus on other product lines. But the unintended consequence is almost a given: Few, if any agents, will be able to dedicate the amount of time now provided to serve small businesses and individuals. The consumer misses out.

Looking forward to 2014, agents certainly can play an important role in assisting the uninsured evaluate coverage options inside and outside the Exchange. One only has to look at the under enrollment in current public programs to recognize that professional assistance is needed to enhance enrollment. However, more important is the service that will be needed such as claims assistance that agents typically provide throughout the year. Enrolling in a plan is just the beginning. Servicing that plan is the heart of what NAIFA members do.

NAIFA will continue our efforts to ensure consumers have access to professional and fairly compensated agents throughout the life of their policy.

(See National Underwriter story on where NAIC stands on agents' compensation.)