What Does a Health Insurance Broker Do?

Those seeking to understand who is involved in the nebulous system that is contemporary American healthcare will discover a wide variety of individuals, each with unique roles. One such role is that of the health insurance broker, also known as an “independent agent” or “health insurance agent.” This article seeks to shed some light on who the health insurance broker is, what they do and, ultimately, what role they play in the selection of health insurance policies.

A health insurance broker’s job is to provide clients with the most appropriate health insurance policy. Authorized by specific insurance companies to act on their behalf, the broker essentially guides clients through the process of selecting a policy for themselves or for employees. A broker makes his living (and demographics show the broker is usually a “he”) off commissions – sometimes as much as 15%. The rates quoted by broker or by direct contact with insurance provider will be the same because, if the insurance company is contacted directly, the person who makes the sale (known as a “captive agent”) will collect the same commission a broker would collect. Some states even mandate the use of insurance brokers.

In most instances, an individual seeking to be a licensed health insurance broker must take a series of courses then take and pass one or more examinations. Once licensed, a state or employer may require health insurance brokers to take additional classes. Because policies and laws change constantly, a broker involved in continuing education will be more current on applicable law and guidelines and, ideally, better prepared to assist clients. Each state makes its own laws to govern the practices of insurance brokers. While no two states have the same law, increasingly states are recognizing licenses granted in other states. This allows brokers to move without retaking examinations or to operate in more than one state simultaneously.

An individual going into their first day of work as a licensed health insurance broker tends to be older than the average person entering into a given area of employment. This is because the typical health insurance broker has transferred into the industry, usually from a sales position in another healthcare field – hospital equipment sales, for example. An individual with a sales background tends to be comfortable with the demands of the job – like providing excellent customer services, working to maintain a client base, and living on a commission-based salary.

While many come into the health care broker industry having worked professionally in other fields, some do enter the field directly after getting a university diploma. Those coming straight from college are likely to have majored in business or sales. In some cases, health insurance brokerage houses will directly mentor undergraduates – and even offer tuition assistance or loan pay-back plans – provided the undergraduate agrees to work for the brokerage house for a pre-determined number of years.

Active health insurance brokers have the option of joining the National Association of Health Underwriters (NAHU) and the umbrella organization of the American Insurance Association (AIA). Both organizations have ethical guidelines that must be followed to maintain membership in good standing. A health insurance broker must divide a typical day between two general tasks: meeting with current and potential clients and fulfilling administrative duties. The broker acts as an agent on behalf of the insurance companies in his or her portfolio, so administrative duties include processing claims, cutting checks and delivering payment. The meetings will be with current clients, to ensure they are being kept abreast of all changes or trends, or potential clients, to present options with the hopes of generating additional business.

Some hire administrative assistance to help but the salary is usually taken from an insurance broker’s earnings. It is usually only the seasoned veterans (who may earn over $100,000 annually) who hire help, rather than those relatively new to the industry (who often earn about $40,000 annually).

The health insurance broker functions as the liaison between insurance company and policyholder, but the nature of the industry is changing. Access to the Internet is available to a tremendous number of Americans and, with online access, consumers are more aware than ever before of the healthcare options available to them. This means that any potential client, if they have done their research, will be aware of a variety of policy offerings. Because not every agent is licensed by every company, a broker may not be able to offer the policy that interests a given client. This places the burden on the broker to be aware of all policies available and to be able to present comparable offerings to those that they may not be able to sell.

Just as the Internet has empowered consumers, so has it empowered health insurance brokers. When once the task of acting as conduit between insurance company and policyholder required long administrative hours, computers now allow broker and insurance company to instantly transfer information. Still, time saved by computer must be made up by competing for a limited and educated client base. The new technology has in part driven a trend towards specialization: brokers are marketing themselves as specialists in a given industry. One might be the specialist in non-profit health insurance while another may specialize in the travel industry. This allows brokers to be aware not just of policy options but also of the typical wants, needs and budgets of a given industry.

What directions technology will propel the industry will be revealed only with time. One thing that remains clear is that Americans do not want to worry about their health coverage and will look to experts for help securing the best service at the right price.