Why California Brokers Should Pay Attention to Oscar

Posted: September 23, 2016

by John Hansen

If you are a health insurance broker in California, you need to know about this new up and coming health insurance company. Currently, Oscar is only available in Orange County and part of Los Angeles County, but in 2017 they will be expanding to include San Francisco, San Mateo and Santa Clara counties. We expect them to keep expanding their reach in the golden state, especially in big cities and more populated areas.

If your agency is in any of these counties, get ready to sell Oscar in 2017. They offer highly competitive pricing, easy-to-understand plans, and great customer service. Their one big drawback is that they pay low broker commissions.

In 2016, they were priced too high to be competitive for on-exchange coverage, but in 2017 their Covered California plans will be priced affordably. With increased brand recognition and lower prices, we expect Oscar to compete well for market share during the 2017 Open Enrollment Period.

Pricing

Oscar Health Care is beating out Anthem Blue Cross and Blue Shield on EPO pricing. With Anthem raising its premiums 16.5% and Blue Shield of California raising its prices 19.9% in 2017, this will give Oscar a huge opportunity to take business away from the Blues.

In some markets, Oscar will offer the least expensive plan available, and in all California markets where they sell, they will offer the least expensive non-HMO plan in 2017.

If you’re clients don’t want HMO and they don’t mind not having out-of-network coverage, Oscar will likely provide the most affordable EPO plan available.

Plan Design

Oscar offers Market Plans on and off the exchange, so consumers can get government assistance and Cost Sharing Reduction when enrolled through this carrier. They also offer Simple Plans which are super easy to understand.

If your client qualifies for an up-front tax credit, then they would want a Market Plan. Otherwise, you would want to compare and contrast the Market Plans with the Simple Plans to help them find the right coverage.

For major medical coverage, we highly recommend the Secure Plan (for people who do not qualify for a subsidy). For richer coverage, we’d recommend the Simple Gold, the Market Gold or the Market Platinum. If your client takes non-preferred brand drugs or specialty drugs, only the Market Gold and the Market Platinum cover these.

For middle-of-the-road coverage, both the Simple Silver and the Market Silver are good. The benefits vary, so it is recommended to zoom in on the details and compare these two Silver Plans.

User-Friendly Tools and Great Customer Service

The Oscar Health Insurance company was founded by young, wealthy, tech-savvy professionals who wanted to simplify health care for America. And they’ve done it!

They offer live customer service 7 days a week. You can talk to a doctor by phone 24 hours a day, 7 days a week, 365 days a year.

Login to your account and simply click “Doctor on Call”. You’ll get a phone call from an MD in less than an hour, usually in less than 15 minutes.

The Oscar website and mobile app are incredibly intuitive and easy-to-use. Find doctors and pricing. Order prescription drugs. Members can make informed decisions quickly and easily with their online tools.

Also, the mobile app tracks how many steps a member takes per day. If the steps exceed 10,000 in a day, then $1 is deducted from the insurance premiums…up to a discount of $100 per year.

Low Commissions

At $100 per application and $50 renewals, Kaiser Permanente pays the worst commissions in the industry. And, Oscar is not much better.

Currently, Oscar pays $15 per member per month the first year, and $10 per member per month after that. That’s $180 the first year and $120 for each year after that.

You must be licensed with the Department of Insurance and appointed with Oscar through a General Agency in order to earn a commission fee. You will receive PMPM commission fees on the subscriber, spouse, and up to 3 child dependents.

CEO Mario Schlosser has expressed anti-broker sentiments. It seems that they are only paying brokers in California anything because they feel that they have to in order to get their product out to the people.

The product is great. The commissions are not.

Customer Satisfaction = Long Term Retention

Commissions are low, but customer satisfaction is very high for Oscar members. Currently, the health plan enjoys a 97% satisfaction rate. People are really happy with these plans, and they are unlikely to switch plans any time soon.

Consumers like the price, the coverage, the networks and the simplicity of accessing health care through Oscar. If you enroll a customer through this health plan, your commissions will be low, but you may end up with a very happy customer who is not only happy with Oscar, but also with his/her health insurance broker.

Perhaps you can make up for the low commissions by cross-selling. Offer your client life insurance, dental, auto, homeowners, etc. Consumers who are happy with their health plan are more likely to trust their agent with other insurance decisions.

Get Appointed with Oscar

You can get appointed by Oscar through one of their local General Agency partners such as Health Care Access and Health Family Insurance. Download the broker resources including all the plans, networks and benefit information you need to present Oscar to your clients.

Also, you can get a custom link. Use this link to allow your clients to get quotes and enroll on Oscar plans. If they use your custom broker link, then you will get credit for the sale.

Clients enroll themselves online via the secure enrollment platform. You get credit (and commission!) just as if you submitted the application.

Currently, this link is only useful for off-exchange sales.

Local GA partners handle all broker commission payments and administer broker appointments. Follow these three steps to become an Oscar broker:

1. Get signed up with your GA
2. Apply to be appointed by Oscar (your GA will send you a link to apply online)
3. Start selling!

Broker commission payments are distributed monthly.

Enrollment through Oscar

Choose one of the following four options to help your clients apply for Oscar health plans:

• Submit off exchange application via our online enrollment form.

• Submit paper application to the GA for processing.

• Enroll client on exchange via the marketplace website (Covered California).

• Enroll with Oscar directly through the Broker’s Personalized Enrollment Link, which gives you credit for the enrollment.

Onboarding a New Oscar Member

When someone enrolls, Oscar receives member, benefit, and agency information. They will bill the member for the first payment, so the binder check is NOT required with the application. They will send ID cards, process claims and bill the members.

The Role of the General Agency

Oscar will provide a PMPM marketing/admin fee for services rendered as mentioned above. The General Agency disburses commission payments to their brokers. Also, the GA is available to help with processing enrollments and answering broker questions.