2022 Ambetter Commission Schedule

This Commission Schedule Addendum applies to Ambetter Qualified Health Plans (QHPs) sold inside or through the Marketplace, or Off-Exchange Plans enrolled directly with the Plan, for Benefit Year 2022, even if such QHPs and Off-Exchange Plans were sold prior to the commencement of the Benefit Year.

In accordance with the Producer Agreement, Ambetter reserves the right to change this Commission Schedule at any time without advance notice. The Commission Schedule is reviewed periodically and may be adjusted to reflect market conditions.

Section 1: Definitions

The following are defined terms for purposes of the Commission Schedule:

1.1  Benefit Year means a year of health insurance benefits coverage under a QHP or an Off-Exchange Plan. The Benefit Year for policies bought inside or through the Marketplace or Off-Exchange Plans enrolled directly with the Plan, begins January 1 of each year and ends December 31 of the same year.

1.2 Marketplace means a governmental agency or non-profit entity established under the Affordable Care Act through which individuals purchase QHPs. Sometimes referred to as “Exchanges,” this term includes the Federally facilitated Marketplace (FFM), Federally-supported State-based Marketplace (SSBMs), State- partnership Marketplaces (SPMs), and State-based Marketplaces (SBM).

1.3 Member means each individual enrolled with coverage under a single Ambetter QHP insurance policy selected through the Marketplace or an Off-Exchange Plan purchased from the Plan.

1.4 Open Enrollment Period (or OEP) means the annual period of time during which individuals can enroll in a QHP through the Marketplace or for an Off Exchange Plan through the Plan. For the 2022 Benefit Year, the annual Open Enrollment Period begins on November 1, 2021 and extends through January 15, 2022. For purposes of this Commission Schedule, the term OEP includes any extensions or “in line” enrollment policies issued by the U.S. Department of Health & Human Services (HHS) which in effect extend the time for individuals to enroll during OEP beyond January 15, 2022.

1.5 PMPM (per Member per month) means the method in which payment is calculated for a sale of a QHP and for an Off-Exchange Plan and paid for each Member.

1.6 Qualified Health Plan (or QHP) means an individual health insurance policy that is certified to be offered for sale through the Marketplace. A QHP is a single policy issued by Ambetter which provides self-only, child- only, or family coverage.

1.7 Special Enrollment Period (or SEP) means the period of time during which an individual who experiences certain qualifying events may enroll in, or change enrollment in, a QHP through the Marketplace outside of the Open Enrollment Period or they may enroll with an Off-Exchange Plan directly with the Plan.

1.8 Off-Exchange Plans means an individual health insurance policy that is purchased directly from the Plan, outside of the Marketplace.

Section 2: Commission Schedule

2.1 Commission rates are calculated by the Member’s state of residency based on PMPM and are as follows: 

Section 3: Monthly Commission Payments

3.1  Commissions payments will be distributed on a monthly basis based on the Section 2: Commission Schedule.

Section 4: Important Notes Applicable to Commission Schedule

4.1 In order to be eligible to earn a monthly commission on an Ambetter QHP and/or an Off-Exchange Plan, the Producer and Sub-Producer, if applicable, must:

• Be licensed and appointed to sell Ambetter QHPs and Off-Exchange Plans;
• Meet all additional state and federal requirements to sell Qualified Health Plans, including but not limited to Marketplace training and certification;
• Be in compliance with all provisions of the Producer Agreement and Sub Producer Agreement, if applicable;
• Be identified as the producer of record on the 834 with Producer’s correct name and National Producer Number (NPN) (Benefit Enrollment and Maintenance) file received during the Open Enrollment Period from the Marketplace or listed as a producer on an Off-Exchange enrollment application; and
• Must be appointed in accordance with the following established State rule:
  • PA: Pre-appointment state; any enrollments received prior to appointment date are ineligible for commission.

4.2 Commissions will be paid for enrollments received through Special Enrollment Periods for Benefit Year 2022*.

4.3 Maintaining Producer’s appointment with Ambetter requires a minimum enrollment of ten (10) Members annually during the Open Enrollment period. Failure to meet this minimum enrollment requirement may** result in termination of appointment .

4.4 This Commission Schedule and any related documents are the confidential and proprietary information of Plan. By receiving the Commission Schedule, the Producer and Sub-Producer, if applicable, agrees that he or she will use the Commission Schedule only for the purpose contemplated by this Agreement  and not disclose it or any information within the Commission Schedule or any related documents to any other person without the prior written authorization of Plan.

Notwithstanding anything to the contrary elsewhere in the Agreement, this Commission Schedule, and any related documents, shall remain confidential indefinitely. Each party recognizes that monetary damages would not be a sufficient remedy for breach of this provision and that the parties are entitled to equitable relief as a remedy for the breach, including all costs and expenses as well as attorney’s fees incurred by Plan. Such equitable relief is in addition to all other remedies available in law or at equity, including termination of the Agreement and termination of any commission payments. The Producer and Sub-Producer, if applicable, must notify Plan immediately upon discovery of any unauthorized use or disclosure of the Commission Schedule and any related documents, and cooperate with any and all efforts to help regain possession of the Commission Schedule and any related documents and prevent its further unauthorized use.

* Plan reserves the right to modify or discontinue Commission payments for enrollments received through an SEP at any time.

**Enrollments made outside of OEP or during an SEP may count toward the minimum production requirement.