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PRISM - Stop, Do Not Quote Health Net

Health Net Is Exiting the California Group Market
Health Net will no longer offer small or large group coverage in CA. In-force groups terminate February 28, 2027. Your Claremont team is ready to help find alternatives. Call 800.696.4543 or email quotes@claremontcompanies.com.

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Agent Certification

How will Covered California for Small Business underwrite start-ups (i.e. payroll records)?

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See the list of required documents for the various business entities on page 1 of the Covered California for Small Business employer application:
https://www.coveredca.com/hbex/agents/PDFs/CC_shop-employer-application%20092513.pdf

Will employers be allowed to offer varying plans/benefits and/or premiums among their employees based on job description and/or tenure?

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A plan cannot discriminate in favor of highly compensated individuals as to eligibility to participate; and the benefits under the plan cannot discriminate in favor of highly compensated individuals. Highly compensated individual is defined as (1) one of the 5 highest paid officers; (2) a shareholder who owns more than 10 percent in value of the stock of the employer; or (3) among the highest paid 25 percent of all employees.

Moreover, in Covered California for Small Business, employers will not be able to have different contribution levels within their selected metal tier based on employee classification.

Is there a time limit for the exam?

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There is no time limit, however, the website cannot be inactive for 20 minutes.  If it is, it will time-out and it will count as one attempt at the exam.

Can commissions in the individual marketplace be set-up to pay an agency and then the agency pays agents down the line?

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Since commissions will be paid by each health insurance company it will depend on the health insurance company’s policies and procedures.

In Covered California for Small Business, agents have to be certified independently, however, they will be given the option following certification to identify payment as either the individual agent or the agency.

Note: Certified Insurance Agents are permitted to split or share commissions provided the other agent is also a Certified Insurance Agent authorized to sell through Covered California.

If certified insurance agents are not allowed to share or split commission, does that mean Claremont or another GA cannot help with Covered California for Small Business programs?

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Certified Insurance Agents are permitted to split or share commissions provided the other agent is also a Certified Insurance Agent authorized to sell through Covered California. GAs that have a contract with Covered California for Small Business are able to assist agents with Covered California for Small Business.  GAs that have a contract with Covered California for Small Business will be paid separately and directly by Covered California for Small Business.

Is the exam taken online at your office/home or at a testing facility?

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The agent certification exam is taken online at a time and place of your convenience.

How many questions are on the exam?

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75 multiple choice questions.

What is the passing score?

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80%

HHS/CMS has a certified agent process. How does this impact the Covered California certification?

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HHS’ certified agent process is for the federally-facilitated exchanges.  California has opted to operate its own exchange.

Do agents have to be recertified with Covered California annually?

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Agents certified as IFP/CCSB or IFP-only through Covered California are required to complete annual training to uphold their certification and remain in compliance with program standards. This mandatory training ensures that agents stay informed about policy updates, enrollment procedures, and best practices for assisting consumers. Failure to complete the required training may result in the suspension or termination of their certification, which would impact their ability to provide enrollment assistance or access the enrollment portal.

However, agents who are certified as CCSB-only are not subject to the annual training requirement, as their certification is governed by separate guidelines specific to small business enrollment support.

In our library, you’ll find carrier forms, applications, enrollment kits, broker bonuses, marketing resources, and more (video tutorial). However, not all carrier forms are available online.

If you don’t find what you are looking for, contact our team for help at 800.696.4543 or materialsrequest@claremontcompanies.com.