Question

Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on February 12th because he did not understand that the plan did not cover services furnished by several of his longtime providers. Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation?a. Agent Lopez’s compensation is not impacted because Ralph’s disenrollment occurred more than 30 days after the effective date of coverage.
b. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February.
c. Agent Lopez’s entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment.
d. Agent Lopez’s compensation is not impacted because Ralph’s disenrollment occurred after the Annual Open Enrollment Period.

Answer 1

Answer:

c. Agent Lopez’s entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment.

Explanation:

Health plans, such as Top Choice Medicare Advantage, provide a document listing all clauses relating to the plan, such as withdrawal deadlines, service agreements, reimbursement, among other things. In the case of Top Choice Medicare Advantage, there is a clause stating that the agent responsible for enrolling the client in the plan will have compensation restored if the client cancels the enrollment within 3 months. With this, we can conclude that, in relation to the case shown in the above question, Agent Lopez's full compensation must be recovered because Ralph annulled himself within the three month period.