New Transparency Rules for Brokers and Employers in Health Insurance

Imagine this: you're comparing health insurance plans for your employees, juggling brochures and premium quotes. Your broker confidently recommends Plan A, highlighting its comprehensive coverage.

But later, you discover that the broker receives a significantly higher commission for selling Plan A, even though Plan B offers similar benefits at a lower cost. This scenario, unfortunately, plays out all too often. Until recently, employers had limited insight into the financial motivations behind their brokers' recommendations. But now, new disclosure requirements are bringing much-needed transparency to the world of group health insurance.

As an employer, providing quality health insurance benefits is one of the most important ways to attract and retain talent. However, navigating the complexities of group health insurance can be daunting.

Until recently, many of us have relied on agents and brokers to guide us through the process, often without fully understanding the financial incentives that drive their recommendations.

Now, thanks to new disclosure requirements introduced under the Consolidated Appropriations Act, 2021 (CAA), specifically the provisions under the “Transparency in Coverage” rule, employers like us are finally getting a clearer picture of these relationships. These changes are a welcome step toward greater transparency and fairness, but they also come with responsibilities for employers.

New Rules, New Opportunities

The new disclosure requirements ensure that agents and brokers working with group health plans reveal any compensation they receive related to their services. For employers, this means that when you work with a broker, you will be given detailed information about how they are paid.

Here is what must be disclosed:

• Compensation Details: Brokers must outline any direct payments they receive, such as commissions from insurance carriers, as well as indirect compensation like bonuses tied to the volume of business or client retention.

• Timing: These disclosures must be provided before you sign any contracts for group health insurance services.
• Transparency in Writing: All disclosures must be in writing, giving you a clear, tangible record of the broker's financial arrangements.
• Ongoing Obligations: If any changes occur in the compensation structure during the plan year, the broker must update the disclosure, ensuring employers are kept informed.
  
  

Employer Focus: Why It Matters

• Making Informed Decisions: As an employer, your primary goal is to select a health plan that provides value to your employees while staying within your budget. The new rules empower you to evaluate whether your broker’s recommendations are truly aligned with your needs—or if they’re influenced by financial incentives. For example, you may find that your broker earns higher commissions for recommending certain carriers or plans. Armed with this knowledge, you can ask critical questions about why a specific plan is being proposed and consider whether it’s the best fit for your workforce.
  
  
• Cost Control and Accountability: Health insurance is a significant expense for businesses. By understanding how brokers are compensated, you can identify potential conflicts of interest and ensure that your company’s money is being spent wisely. Transparency can also help drive competition among brokers, potentially leading to better service and more competitive rates.
  
  
• Building Trust with Employees: Employees expect their health benefits to be fair and in their best interests. By using brokers who comply with these disclosure rules, you’re demonstrating a commitment to integrity and transparency, which can enhance trust within your organization.
  
  
  

What Employers Should Do

• Request and Review Disclosures: As an employer, you now have the right to request detailed compensation disclosures from your broker. Take the time to review these documents carefully. Look for any red flags, such as bonuses tied to specific carriers, and don’t hesitate to ask your broker for clarification.
  
  
• Document Your Process: To ensure compliance with your fiduciary duties document your decision-making process. This includes keeping records of the disclosures provided, the questions you asked, and why you chose a particular plan.
  
  
• Evaluate Your Broker: The new requirements are an opportunity to reassess your relationship with your broker. Are they being proactive in providing disclosures, or are you having to chase them for information? A broker who embraces transparency is likely a better partner for your business in the long run.
  
  
• Consider Alternatives: If your current broker’s compensation structure raises concerns, it might be time to explore other options. Look for brokers who offer fee-based services instead of commission-based models, as these arrangements can minimize conflicts of interest.
  
  
• Challenges and Opportunities: While positive, these changes may also lead to additional paperwork and administrative tasks for employers. However, the benefits of greater transparency outweigh these challenges. With more insight into how brokers are compensated, employers can make better decisions, avoid hidden costs, and ensure they’re acting in the best interests of their workforce.

Your Takeaway

The new disclosure requirements for agents and brokers related to group health insurance are a win for employers. By shedding light on compensation structures, they empower us to make informed decisions, hold brokers accountable, and provide our employees with health benefits they can trust.

As you navigate these changes, approach your broker relationships with a focus on transparency and collaboration. In doing so, you will not only ensure compliance with the law but also foster a stronger foundation for your company’s health benefits strategy.

To learn more about LGT and how we can serve you, contact us here.