AOR & RETENTION
A lapse in coverage is defined as a gap of this many months with no active policy.
What is one or more months?
First payments for MA/PDP are typically paid within this many business days of application approval.
What is 14 Business days
True or False
Rapid Disenrollment rules does not apply to AARP Medicare Supplement Policies?
True
This type of commission is paid to an agent’s upline for each sale.
What are Overrides?
In order to receive the commissions agent must be properly credentialed. In order to be properly credentialed an agent must be contracted, certified, appointed, and this additional requirement in the state of sale.
What is Licensed?
What are two things every AOR appeal must include?
-Written Statement of why the agent should be the AOR
-Supporting documentation, such as the Scope of Appt and/or full application.
On or after August 1, 2025, these types of payments are held until year‑end unless the agent enrolls in direct deposit.
What are paper checks?
True or False
Rapid disenrollment chargebacks do not include the true-up payments.
FALSE
Voluntary terminations in months 1-3 result in a full chargeback, including the true-up portion of payment, if applicable.
A member who is “New to Medicare” will always receive this type of payment from the agent’s perspective.
What is the full Initial Year Rate?
When escalating an SR all member information must be completed in this section of the SR, including a full MBI.
What is the Process Specific Information section?
If the AOR cannot be confirmed via GPS/COMPAS or through the physical applications in View/PCH, the agent must submit this through PHD Chat on Jarvis.
What is an AOR Appeal?
TRUE OR FALSE
THE COMMISSION STATEMENT SCHEDULE IN JARVIS INDICATES WHEN MA/PDP AND MED SUPP RENEWALS WILL PAY OUT AND IS AVAILABLE FOR ALL AGENTS TO SEE?
These three scenarios are exceptions to Rapid Disenrollment chargebacks: auto-facilitated/passive, Q4 enrollments, and this type.
What is member death.
Could also be:
Special Needs Plan (SNP) transition exceptions - MA plan to a DSNP/CSNP/ISNP plan, or CSNP to DSNP/ISNP, DSNP to CSNP/ISNP or ISNP to CSNP/DSNP (Exception chart in Comms Guide)
Agent‑level commissions are paid within 14 business days of approval except for policies with this kind of effective date.
What is a 1/1 Effective Date?
TRUE or FALSE
PHD can discuss all payment details with solicitor agents.
What is False!
As of 1/1/2024, this agent group no longer qualifies for AOR retention, even when no gap in coverage exists.
Who are Servicing Agents
(Also acceptable: Who are eAlliance agents/agencies as of 9/1/2023)
Med Supp first payments for new enrollments are normally paid using this structure unless the agent selects monthly payments.
What is a 9-month advance
EE is disenrolled between months 4 and the end of the current calendar year of the enrollment is considered a ________ ?
Prorated Chargeback
When a hierarchy level is unfilled, this happens to that level’s override amount.
What is it rolls up to the next filled position?
Ex: If an agent’s hierarchy is an MGA and then an NMA, the MGA will receive the override amount for both the GA and the MGA, and the NMA will receive the override amount for both the FMO and NMA.
What are the 3 ways UHC issues commission payments to agents?
Direct Deposit
Paper Checks
Assignment of Commissions
If no AOR is listed, or the WID is incorrect in the enrollment system, but it can be verified by viewing the physical application in either VIEW or PCH What would you do with your SR?
Escalate to Commissions tier 2 or Med Supp Commissions tier 2
The ________ __ ________ on commission payments is the current and prior calendar year.
Statute of Limitations
*NOTE--The statute of limitations applies to payments and appeals. It does not pertain to PHD’s ability to research inquiries. PHD can still research and advise on commission payments outside of the statute of limitation timeframe.*
TRUE OR FALSE
If a member switches from one AARP Med Supp to another AARP Med Supp the agent will continue to receive commissions as normal.
What is False!
No commissions will be paid for any plan change from an existing UHIC AARP Medicare Supplement Plan to another UHIC AARP Medicare Supplement Plan.
Where are the 2 places Commission Rates can be found?
-The Commissions Rates Guide in KC
-The Contract Amendments in Sharepoint -- PHD Docs>Contracting>Agreements and Amendments> Select year in question.
A ___ _________occurs when a member voluntarily disenrolls from a plan or changes plans within the first 3 months of coverage.
What is Rapid Disenrollment