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Service is an Attitude…Tips for Evaluating Brokers

In discussions with clients, we hear that their customers continue to expect more and more of them. In the benefit area, good service, technical expertise, and problem resolution have become the minimum standard that employers expect from their brokers.

There are thousands of insurance sales people in this country. All can sell health insurance products and services to your firm. With that number of “suppliers” to choose from, how do you select the best organization to which you will entrust your employee benefits?

Be assured, TransparentRx, LLC is committed to customer service for our clients and the employees of our clients. Competitors have said, “When it comes to service, we are just like TransparentRx.” We are proud of the comparison but encourage you to dig a little deeper.

How should you evaluate the service attitude of one insurance agency vs. another? Open-ended questions are one of the best ways to get an in-depth look at someone’s service attitude. Some questions you might ask:

  • What is the best way for my employee to resolve a claim problem?
  • Are employees encouraged to call the agency for personal assistance or to call the insurance company themselves?
  • What is the “problem resolution process” in your agency?
A well thought out process is like a well-oiled machine; things get done and that’s what you want. With written ISO 9002 type procedures, problem resolution becomes routine and successful most of the time.
  • Tell me about your staff.
  • One person can only do so much; depth of staff is critical to an agency’s “service attitude”. What is your “commitment to service”?
  • Is it written, verbal, or off the cuff? A written Commitment to Clients is one benchmark that an agency takes service seriously.
  • Can I have a copy of your mission statement?
  • Does the agency mission statement talk about growth and new sales or… focus on an attitude of service?
  • What is your hiring process for service personnel?
  • How do they uncover the “service attitude” of prospective employees… interviews, personality testing, references, or has it not been thought out?
  • What do I do if I have a question about COBRA?
COBRA is benefit related and is your largest unfunded and uninsured liability. Does the broker embrace your COBRA problems as his or her own or are you handed off like a hot potato?

Q. An insured employee did not enroll her spouse for the new plan year at open enrollment. She and her spouse were separated at the time, but the divorce was not yet final. The spouse is furious that his coverage was dropped without his knowledge. What is the employer’s obligation to him?

A. If coverage is reduced or eliminated in anticipation of an event, the reduction or elimination is disregarded in determining whether the event causes a loss of coverage. For example, if an employer eliminates coverage in anticipation of an employee’s termination, or if an employee cancels the coverage of his or her spouse in anticipation of a divorce or legal separation, that loss of coverage is disregarded for purposes of COBRA. That is, the individual whose coverage was terminated in anticipation of a qualifying event is still considered eligible for COBRA and must be offered the coverage, effective at least from the date of the qualifying event.

The final rules note that if an employee cancels a spouse’s coverage in anticipation of a divorce or legal separation, “Upon receiving notice of the divorce or legal separation, a plan is required to make COBRA continuation coverage available, effective on the date of the divorce or legal separation (but not for any period before the date of the divorce or legal separation).”

Alternatively, the plan can treat the qualified beneficiary’s use of the plan’s health services as a constructive election of COBRA continuation coverage and, if it so notifies the qualified beneficiary prior to the use of services, can require payment for COBRA continuation coverage.

Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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