Agency Manual - d2zhgehghqjuwb.cloudfront.net · Wellmark Agency Manual Rev. 010116 1 Distribution...

Agency Manual J a n u a r y 1 , 2 0 1 6

Agency Manual Revised 1.01.16

Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., and Wellmark Blue Cross and Blue Shield of South Dakota are Independent Licensees of the Blue Cross and Blue Shield Association

Wellmark Agency Manual Rev. 010116 i

This Agency Manual is provided to the Wellmark Blue Cross and Blue Shield of Iowa,

Wellmark Health Plan of Iowa Inc. and Wellmark Blue Cross and Blue Shield of

South Dakota’s (hereinafter referred to as “Wellmark”) Agency community to

answer routine questions and assist with the effective marketing and distribution of

Wellmark products. This Agency Manual sets forth applicable

administrative/operational policies, rules and procedures.

This Agency Manual may be provided to Wellmark’s Agencies and Agents through a

Web-based system maintained and administered by Wellmark in a manner that

provides Wellmark’s Agencies with Internet access to this Agency Manual.

Wellmark may amend this Agency Manual from time to time pursuant to thirty (30)

days advanced notice from Wellmark to its Agencies, which notice may be

accomplished via email to the Agencies’ primary email contact email address (as

reflected in Wellmark’s records) or via regular first class mail, and any such notice

shall be deemed given on the day it is emailed by Wellmark or deposited by Wellmark

in the United States postal system. Notwithstanding the foregoing notice provision,

Wellmark may amend this Agency Manual immediately if Wellmark deems any such

amendment necessary, in its sole and absolute discretion, for compliance with any

federal or state law, regulation, directive or policy.

In the event of any inconsistency between this Agency Manual and the Agency or

Agent Agreement (or equivalent agreement), the terms and conditions of such

Agreement shall supersede this Agency Manual regarding the inconsistency.

Wellmark Agency Manual Rev. 010116 ii

Table of Contents Distribution Channel Definitions ............................................................. 1 Code of Conduct ....................................................................................... 4 Sub-Retail Agency Assignments to General Agencies .......................... 7 Agent and Agency Terminations ............................................................. 9

Agreement Termination, Dissolution or No Assigned Agent ............... 9

Retirement ......................................................................................... 9

Death ............................................................................................... 10

Permitted Compensation to Individuals Not Appointed with Wellmark.......................................................................................... 10

Agency and Agent Program: Policies and Procedures ........................ 12 Agency Transactions, Mergers, Acquisitions, or Change of Control . 12

Assignment ............................................................................. 12 Change of Control .................................................................. 13

Prohibited Investment/Ownership .................................................... 14

Agent Assignments and Transfers ................................................... 14

Agent/Agency Requirements ........................................................... 16

General Requirements ............................................................ 16 Specific Requirements ............................................................ 18

Training and Education Requirements ................................................. 20 General Requirement ...................................................................... 20

Medicare Part D Requirements .............................................................. 21 General Requirements ..................................................................... 21

Certification and Training Requirements .......................................... 24

Disciplinary Actions .......................................................................... 24

Agent of Record (AOR) ........................................................................... 25 AOR for Individual Policies .............................................................. 25

New ........................................................................................ 25 Renewal ................................................................................. 25

AOR for Small Group Policies (1–50 Groups) .................................. 26

New ........................................................................................ 26 Renewal ................................................................................. 26

AOR for Large Group Fully Insured Policies (51-100 and 101+) ...... 26

New ........................................................................................ 26 Renewal ................................................................................. 26

AOR Designation Transfers ................................................................... 28

Wellmark Agency Manual Rev. 010116 iii

Wellmark Direct Business ................................................................ 28

Group Policies ........................................................................ 28 Individual Policies ................................................................... 28

Independent Agency Business ........................................................ 28

Group Policies ........................................................................ 28 Individual Policies ................................................................... 29

Procedure for Requesting an AOR Designation Transfer ................. 29

Existing Group or Individual Policy.......................................... 29 Group and Individual Policies ................................................. 30

Frequency of AOR Transfer Requests ............................................. 30

Effective Date of and Commissions for Accepted AOR Transfer Requests ......................................................................................... 30

Group and Individual Policies ................................................. 30 Notification/Transfer of Information/Rescission ................................ 32

AOR Change Due to New Group Owner .......................................... 32

AOR Designations for Wellmark Dental Business (Iowa Only) ......... 33

Large Group Fully Insured Transparent Commissions ........................ 34 (51-100 and 101+) .................................................................................... 34

Large Group Policies ....................................................................... 34

New ........................................................................................ 34 Renewal ................................................................................. 36

Commission Allocation Exhibit ......................................................... 39

PCPM Commission Request Considerations ................................... 39

Wellmark Association, Trust and PEO Guidelines ............................... 41 Consultants ............................................................................................. 42 Assignment of Commissions ................................................................. 43

Sub-Retail Commission Assignment ................................................ 43

Override Commission Assignment ................................................... 44

Commission Administration .................................................................. 45 Fully Insured Group Business .......................................................... 45

Individual Business .......................................................................... 46

Under 65 Policy ...................................................................... 46 Over 65 Policy ........................................................................ 47

Commission Adjustments ................................................................ 47

Payments to Sub-Retail Agencies and Assigned Agents ................. 48

Producer Incentive/Recognition Programs ....................................... 48

Promotions .............................................................................................. 49 General Promotional Requirements ................................................. 49

Wellmark Agency Manual Rev. 010116 iv

Promotional Materials ...................................................................... 49

Website ........................................................................................... 50

Telephone Directories ...................................................................... 50

Letterhead, Envelopes & Business Cards ........................................ 50

Signage ........................................................................................... 50

Specialty Items ................................................................................ 51

Advertising ....................................................................................... 51

Cooperative Advertising Program .................................................... 52

Items Eligible for Reimbursement: .......................................... 52 Items Not Eligible for Reimbursement: .................................... 52 Reimbursement Guidelines .................................................... 53

Exhibits .................................................................................................... 55 DocuSign ................................................................................................. 66

Wellmark Agency Manual Rev. 010116 1

Distribution Channel Definitions

Wellmark utilizes contracted Agencies, contracted Agents and its employed sales staff to distribute products.

The following defined terms are used throughout this Agency Manual: Agency: A business entity or natural person that has entered into an Agency agreement (“Agency Agreement”) with Wellmark to conduct Wellmark’s Business. An Agency may represent both Wellmark and other carriers. An Agency is one of the following based on the nature of its distribution structure and the type of Agency Agreement that it enters into with Wellmark:

Retail Agency: A corporation, limited liability company, partnership or other business entity that enters into a Retail Agency Agreement with Wellmark and that conducts Wellmark Business through Agents who are employed by the Retail Agency, are owners of the Retail Agency or are otherwise assigned by Wellmark to work directly with the Retail Agency.

General Agency: A corporation, limited liability company, partnership or other business entity that enters into a General Agency Agreement with Wellmark and that conducts Wellmark Business:

• In conjunction with Sub-Retail Agencies; and/or

• Through Agents who are employed by the General Agency, are owners of the General Agency or are otherwise assigned by Wellmark to work directly with the General Agency.

Sub-Retail Agency: A corporation, limited liability company, partnership or other business entity or a natural person conducting business as a sole proprietorship that enters into a Sub-Retail Agency Agreement and that:

• Conducts Wellmark Business through one or more Agents who are employed by the Sub-Retail Agency, are owners of the Sub-Retail Agency or are otherwise assigned by Wellmark to work directly with the Sub-Retail Agency; and

• Is assigned by Wellmark to conduct Wellmark Business in conjunction with a designated General Agency that provides the Sub-Retail Agency with training, administrative and other supportive services.

Agent: An individual producer who has entered into an Agent Agreement with Wellmark to conduct Wellmark Business. Agent of Record or AOR: The Agency (which may be a Retail Agency or Sub-Retail Agency) that Wellmark determines, in its sole and absolute discretion, is entitled to commission and/or other compensation for a specific policy or contract (other than compensation earned by a General


Agency for policies and contracts for which the AOR is a Sub-Retail Agency assigned to the General Agency). Assigned Agency: The Agency to which an Agent is assigned by Wellmark. Assigned Agent: The Agent that is designated by Wellmark, in its sole and absolute discretion, as the Wellmark Agent that is primarily responsible for the sales, retention and servicing activities for a specific policy or contract. Book of Business: A term that is used to collectively refer to the policies and contracts for which an Agency/Agent is the currently designated AOR. Channel Management: Channel Management is responsible for all Wellmark distribution channel activities, including approving Agency/Agent contracts, communications with Agencies, Agency/Agent licensing, training, appointment, and Agency/Agent compliance. Channel Management is also responsible for the enforcement of all distribution channel policies and procedures. Consultant: A Producer or other entity that, with respect to certain business, assists and advises the employer in the selection of a carrier and the design, development and implementation of an employer’s benefit package. An individual or entity cannot act as both a consultant and a Wellmark Agent for the same group. In the case of a Producer acting as a consultant on a direct Wellmark account, the Producer can only be compensated by the employer group and is assigned to work with a Wellmark Employed Sales Staff who is a licensed and appointed Agent. The Agency and Agent Agreement and this Agency Manual do not apply to business where a Producer is acting as a consultant and not a Wellmark Agent. Refer to the Consultant Connection for additional information regarding how Wellmark does business with Producers acting as Consultants. DocuSign: A third party application used by Wellmark to securely distribute and obtain electronic signature of Agency and Agent contractual documents. (See the “DocuSign” reference section in the appendix for more information on accessing documents sent via DocuSign.) Downstream entity: Any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the Medicare Advantage benefit or Part D benefit below the level of the arrangement between an MAO or applicant or a PDP or applicant and a First Tier Entity.

• These written arrangements continue down to the level of the ultimate provider of both health and administrative services. See 42 C.F.R. §§ 422.2 and 423.4.

First Tier Entity: Any party that enters into a written agreement, acceptable to CMS, with an Medicare Advantage Organization (“MAO”), PDP or an applicant to provide administrative services or health care services to a Medicare eligible individual under the Medicare Advantage program or Part D program. See 42 C.F.R. §§ 422.2 and 423.4.


Producer: A person required to be licensed by the state under applicable law to sell, solicit or negotiate insurance, which may or may not be appointed as a Wellmark Agent or Agency. Related Entity: Any party that is related to the MAO or PDP by common ownership or control and:

• Performs some of the MA organization's or PDP’s management functions under contract or delegation; or

• Furnishes services to Medicare enrollees under an oral or written agreement; or • Leases real property or sells materials to the MAO or PDP at a cost of more than

$2,500 during a contract period. See 42 C.F.R. §§ 422.2 and 423.4. Wellmark: Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., and Wellmark Blue Cross and Blue Shield of South Dakota. Wellmark Business: The marketing, soliciting, sale and servicing of such insurance products as may be designated by Wellmark. Wellmark Employed Sales Staff: Wellmark employees who solely represent Wellmark in marketing to enrolled and prospective customers.


Code of Conduct

All Wellmark Agencies and Agents are expected to be thoroughly and consistently professional and courteous in their pursuit and servicing of customers, placing first and foremost priority on meeting the customer’s benefits needs.

All Agencies and Agents are subject to adherence with the “Code of Conduct” rules listed below. All undefined terms used herein shall have the meaning ascribed to them in the Agent Agreement. • The Agent agrees that at all times he/she shall be duly licensed and appointed in accordance

with applicable laws, rules, and regulations to solicit and service insurance products. The Agent who solicits a member application must be the Agent who signs the member application. A member application may not be solicited by one Agent and signed by another Agent even if the non-soliciting Agent is appointed with Wellmark. The Agency must have a member application properly completed and signed by (i) an Agent who is appointed by Wellmark at the time the member application is submitted to Wellmark; or (ii) by an individual who is appointed by Wellmark within 30 days in Iowa or within 15 days in South Dakota of the submission of the member application. If the member application is signed by an individual who is not an appointed Wellmark Agent at the time the member application is submitted to Wellmark, the member application may be accepted by Wellmark and enrolled, but the policy may become a Wellmark direct policy if (i) the soliciting individual does not submit appointment paperwork within 30 days in Iowa or 15 days in South Dakota of the submission of the member application to Wellmark; or (ii) the individual’s appointment paperwork is submitted to Wellmark within 30 days in Iowa or 15 days in South Dakota of the submission of the member application to Wellmark, but Wellmark does not appoint the individual as an Agent within 30 days in Iowa or 15 days in South Dakota of the submission of the member application to Wellmark. If the policy becomes a Wellmark direct policy, no commission will be paid on it.

• All Agencies and Agents agree to comply with all laws, regulations, rules, and bulletins

applicable to them and their performance under any applicable Agency Agreement or Agent Agreement with Wellmark.

• Each Agency and Agent represents and warrants that he/she/it has not been convicted of or

charged with, and shall not engage in, conduct constituting a felony, dishonesty or a breach of trust while engaged in the business of insurance (as provided in 18 U.S.C. § 1033). Each Agency and Agent agrees to notify Wellmark within 30 days of any circumstance in which the he/she/it has engaged (or allegedly engaged) in any such conduct.

• Each Agency and Agent shall not commit any fraud or misrepresent the provisions, benefits,

or premiums of any insurance contract. This includes, but is not limited to, the altering or changing of rates on the Wellmark rating exhibits. If any Agency or Agent, or any person acting on behalf of or in concert with them, alters or changes the rates, the rates will not be honored.


• No Agency or Agent shall commit an act of embezzlement, unfair method of competition, or

unfair or deceptive acts or practices, as those are defined by applicable laws, rules and regulations.

• Each Agency and Agent shall use his/her/its best efforts to:

a) Establish and maintain harmonious relationships with Wellmark’s customers and keep Wellmark advised of the attitudes and needs of members/customers that could affect present or future relationships;

b) Assist and support Wellmark employees in explaining to the members/customers and implementing any future coverage or premium modifications; and

c) Assist and support Wellmark in connection with the servicing and promotion of Wellmark business.

• No Agency or Agent shall withhold, misappropriate or fail to pay or return to Wellmark any

monies or debts due Wellmark or its subsidiaries or affiliates (whether such indebtedness arises out of his/her/its Agent Agreement, Agency Agreement or otherwise); this applies also to any proprietary information or other property pertaining to, authorized or printed by, or belonging to Wellmark or its subsidiaries or affiliates.

• No Agency or Agent shall engage in any conduct that in any manner subjects or may subject Wellmark to liability of any kind.

• No Agency or Agent shall directly or indirectly induce or attempt to induce any Agent, other insurance producer, or Agency to terminate its contract or relationship with Wellmark or to otherwise leave Wellmark’s service.

• Each Agency and Agent agrees that Wellmark customer information and Agent or Agency information, including, but not limited to, customer lists, Agent books of business identifying customers, or Agent listings is considered Confidential Information under the Agent and Agency Agreements.

• Each Agency and Agent agrees to comply with all manuals, rules, guidelines, and policies prescribed by Wellmark from time to time concerning Wellmark Business. Wellmark’s Sales Leadership will promptly address reports of alleged misconduct and behavior that it deems to be unprofessional.

• The failure of an Agency or Agent to conform to the rules, procedures, policies and guidelines set forth in this Agency Manual or any other Wellmark rule, procedure, policy or guideline may serve as the basis for the termination of an Agency’s Agency Agreement with Wellmark and/or an Agent’s Agent Agreement with Wellmark pursuant to the termination provisions set forth in the applicable Agency Agreement and/or Agent Agreement.


• As a First Tier, Downstream, and Related Entity, comply with, and Maintain records of, each Agent or Agency’s compliance with all regulations and guidelines related to the sale and marketing of Medicare Part D plans including:

o 42 CFR 422.503(b)(4)(vi)(C) and 42 CFR 423.504(b)(4)(vi)(C) o Medicare Managed Care Manual o Medicare Marketing Guidelines o The RAS Code of Conduct o Medicare Part D training and certification requirements

Additional information regarding Medicare Part D compliance is located on the Producer Connection at the following address: https://ebusiness.wellmark.com/brokerandagent/securecontents/MedicareCompliance.htm Refer to the Medicare Part D Requirements section for additional information.

https://ebusiness.wellmark.com/brokerandagent/securecontents/MedicareCompliance.htm


Sub-Retail Agency Assignments to General Agencies

Sub-Retail Agencies will be assigned to conduct Wellmark Business in conjunction with either:

• One General Agency that provides the Sub-Retail Agency with training, administrative and other supportive services for all Wellmark Business (Group and Individual) conducted by the Sub-Retail Agency; or

• Two General Agencies with:

o One General Agency that provides the Sub-Retail Agency with training, administrative and other supportive services for Wellmark Business conducted by the Sub-Retail Agency in one state (Iowa or South Dakota); and

o Another General Agency that provides the Sub-Retail Agency with training, administrative and other supportive services for Wellmark Business conducted by the Sub-Retail Agency in the other state (Iowa or South Dakota). This may occur when the Sub-Retail Agency is currently working with a General Agency in one state (Iowa or South Dakota) and the Sub-Retail Agency submits paperwork to start selling in the other state (Iowa or South Dakota) where the current General Agency is not contracted with Wellmark to do business. The Agency does not need to select one that does business in both states, unless they want to change to the same General Agency for both states during the contracting process. They can remain with two General Agencies in this situation. The Sub-Retail Agency may choose to move to a General Agency that does business in both states during the one-time annual Sub-Retail Agency movement, if they wish to do this at a later date.

For example, the Sub-Retail Agency, John Doe Agency, currently works with a General Agency in Iowa that does not have an agreement with Wellmark to provide services to Sub-Retail Agencies in South Dakota. The John Doe Agency decides it wants to start selling in South Dakota. The John Doe Agency cannot utilize the General Agency services from the current General Agency for South Dakota, so the Sub-Retail Agency can choose to work with a second General Agency that provides services in South Dakota. The John Doe Agency can work with two General Agencies in this scenario for business in both states.

Wellmark will allow open movement of Sub-Retail Agencies one time during a 12 month time period. No General Agency may provide any financial incentives to induce a Sub-Retail Agency to change General Agencies at any time. A Sub-Retail Agency’s request to change the Sub-Retail Agency’s General Agency assignment(s) outside of the one-time annual movement will generally not be granted, unless the Sub-Retail Agency receives a release from the current General Agency. Wellmark may, however, in its sole and absolute discretion, change a Sub-Retail Agency’s General Agency assignment(s) if:


• A change is initiated by the General Agency because the General Agency does not want

to continue to provide training, administrative and other supportive services (as set forth in Exhibit C to the General Agency Agreement, which is also Attachment 1 to the Sub-Retail Agency Agreement) to a Sub-Retail Agency; or

• A change is requested by a Sub-Retail Agency because the Sub-Retail Agency claims that its designated General Agency is not providing the Sub-Retail Agency with training, administrative and other supportive services (as set forth in Exhibit C of the General Agency Agreement, which is also Attachment 1 to the Sub-Retail Agency Agreement) that are required by the Sub-Retail Agency to effectively service Wellmark Business.

If Wellmark does reassign a Sub-Retail Agency to a new General Agency, the Sub-Retail Agency will generally continue to be the AOR on all policies and contracts for which the Sub-Retail Agency had previously been the AOR. Sub-Retail Agencies will also generally not be permitted to request a change of their status from a Sub-Retail Agency to a General Agency or to a Retail Agency unless any such change is approved by Wellmark. Wellmark retains sole and absolute discretion to reassign Sub-Retail Agencies to another General Agency, or to enter into any form of Agency Agreement with any producer, at any time.


Agent and Agency Terminations

Agreement Termination, Dissolution or No Assigned Agent In the event an Agency terminates its Retail or Sub-Retail Agency Agreement, terminates its existence (by dissolution or otherwise) or no longer has any Agent assigned to that Retail, or Sub-Retail Agency, the Agency will no longer be considered a Retail or Sub-Retail Agency and Wellmark Channel Management will work with the Agency or the successor to the owner(s) of the Agency to determine a new Assigned Agent and AOR designations for policies and contracts for which the Retail or Sub-Retail Agency was previously the AOR and an Agent associated with the Agency was the Assigned Agent, if applicable. In any such event; however, Wellmark retains the right to determine, in its sole and absolute discretion, new Assigned Agent and AOR designations for policies and contracts previously associated with the Retail or Sub-Retail Agency and may transfer the AOR designations to another Sub-Retail Agency, or to a Retail Agency and designate an Agent of the newly designated AOR to serve as the Assigned Agent for the policies and contracts. Wellmark also retains the right to assign such business to Wellmark Employed Sales Staff.

Retirement In the event an Agent in a Retail or Sub-Retail Agency retires and there are other Agents assigned to that Retail or Sub-Retail Agency, the business will be assigned to another one of those Agents in that Retail or Sub-Retail Agency. In the event that an Agent in a Sub-Retail Agency is the only Agent, the retiring Agent can:

(i) Release the business to that Sub-Retail Agency’s designated General Agency; or (ii) Request to transfer the business to any other Agent in any Agency.

Each situation is subject to submission of notification to Wellmark and that Sub-Retail Agency’s designated General Agency and Wellmark’s approval of the requested transfer of the business. Wellmark Channel Management will consider any reasonable requests made by a retiring Agent, but Wellmark retains the right to determine, in its sole and absolute discretion, new Assigned Agent and AOR designations for policies and contracts previously associated with the retiring Agent’s Sub-Retail Agency and may transfer the AOR designations to another Sub-Retail Agency or to a Retail Agency and designate an Agent of the newly designated AOR to serve as the Assigned Agent for the policies and contracts. Wellmark also retains the right to assign such business to Wellmark Employed Sales Staff.


Death In the event an Agent in a Retail or Sub-Retail Agency dies and there are other Agents assigned to that Retail or Sub-Retail Agency, the business will be assigned to another one of those Agents in that Retail or Sub-Retail Agency. In the event the only Agent in an Agency dies, Wellmark Channel Management will work with the administrator of the Agent’s estate to determine the appropriate new Assigned Agent and AOR designations for policies and contracts previously associated with the Sub-Retail Agency. Wellmark Channel Management will consider any reasonable requests made by the administrator of the Agent’s estate or other successor, but Wellmark retains the right to determine, in its sole and absolute discretion, new Assigned Agent and AOR designations for policies and contracts previously associated with the Sub-Retail Agency and may transfer the AOR designations to another Sub-Retail Agency or to a Retail Agency and designate an Agent of the newly designated AOR to serve as the Assigned Agent for the policies and contracts. Wellmark also retains the right to assign such business to Wellmark Employed Sales Staff. All communications regarding Sub-Retail Agency terminations should be directed to:

Wellmark Channel Management 1331 Grand Avenue, Station 3W491 Des Moines, IA 50309 [email protected]

Permitted Compensation to Individuals Not Appointed with Wellmark Wellmark in its sole and absolute discretion may permit a Retail Agency, Sub-Retail Agency or Agent to pay commission or compensation related to Wellmark Business to a person not under agreement with Wellmark, in the following circumstances:

1) An Agent or Agency entitled to commission as the current AOR may pay or assign their earned commission to any recipient who was licensed and appointed with Wellmark at the time of the sale, solicitation or negotiation; and

2) An Agent or Agency entitled to commission as the current AOR may pay or assign their earned commission to anyone else who does not sell, solicit or negotiate insurance, as long as:

a. The amount is not compensation for the act of selling, soliciting, or negotiating insurance (which would require a producer license); and

b. The arrangement is not considered an impermissible referral fee under Iowa Administrative Code §191-10.14(3) or South Dakota Administrative Code SDCL §58-30-174; and

mailto:[email protected]


c. The arrangement is not considered a rebate under Iowa Code Chapter 507B or South Dakota Code SDCL §58-33-24 and §58-33-36.

No insurance producer who is not appointed may act as an agent of Wellmark. If Wellmark pays a commission to an appointed insurance producer, Wellmark is not responsible for any act, statement, or omission made by an insurance producer who is not appointed but who receives compensation from an appointed insurance producer. Agents and Agencies shall comply with all applicable sections of this Agency Manual and Agent and Agency Agreements for any such compensation arrangement which otherwise requires notice to Wellmark (Change of Assigned Agent, Agent of Record, Agency Transactions, Mergers, Acquisitions, or Changes in Control, or Termination).


Agency and Agent Program: Policies and Procedures

Agency Transactions, Mergers, Acquisitions, or Change of Control Wellmark may acknowledge and approve mergers, acquisitions, changes of control and other business combinations or transactions related to Wellmark business involving or between Agencies as long as appropriate notice and documentation is provided, including the nature of the transaction, the resulting status of all Agents and Agencies involved, and a business plan acceptable to Wellmark. Information presented should generally include the following: • A letter outlining the nature of the transaction, the parties involved, proposed assignment of

Wellmark business at the completion of the transaction, and the plan for ongoing servicing of the Wellmark business involved.

• Definitive transaction documents, including any Agreements between the parties, Articles of merger, incorporation, organization, and/or all amendments (as applicable);

• Summary Sheet identifying the nature of the transaction, the anticipated effective date, allocation or disposition of commission payments, and desired crediting of future account production;

• Schedule K-1 (form 1065) for partnerships; and

• Proof of Errors & Omissions (E&O) insurance for the continuing Agency

• Agency Fact Sheet, W-9, and Agent Fact Sheets for all Agents in the Agency as well as Change of Assigned Agent (COAA) forms with signatures approving the movement of business from one Agent number to another Agent Number and designating the reason for the reassignment;

• Any proposed ongoing compensation arrangements for persons or entities which will no longer be appointed or under contract with Wellmark at the completion of the transaction.

Consistent with the following Assignment and Change of Control provisions of the Agency Agreements, notices must be provided to Wellmark as follows and Wellmark may condition its approval and consent to any noticed transaction: Assignment

An Agency must provide Wellmark with at least thirty (30) days advance written notice before entering into any agreement which may result in the sale, transfer, assignment, merger or any other disposition of the Agency or any interest therein or business thereof. Except for any company controlling, controlled by, or under, control with the Agency, an


Agency’s Agency Agreement or any commissions payable under an Agency’s Agency Agreement shall not be sold, assigned, transferred, pledged or hypothecated by the Agency, whether directly or indirectly (through sale, transfer, assignment, merger or any other disposition of the Agency, any interest therein or any business thereof), without the prior written approval and consent of Wellmark. Wellmark may condition its prior approval and consent to any such assignment of the Agency’s Agency Agreement or any commissions payable hereunder by requiring the Agency to reassign some or all of its Agents (and Sub-Retail Agencies in the case of a General Agency) to another Agency and/or satisfy such other conditions as Wellmark may, in its sole and absolute discretion, require.

Change of Control An Agency shall provide Wellmark with at least thirty (30) days advance written notice of any transaction or series of transactions (including without limitation any merger, consolidation, share exchange, transfer of equity interests, issuance or sale of equity interests, or reorganization) which would result in one or more parties that did not previously have the right or power to exercise a controlling influence over the management or policies of the Agency acquiring such right or power, directly or indirectly, including without limitation the ability to elect a majority of the board of directors or managers or any similar governing body of the Agency. Any such transaction or series of transactions shall not be effected without the prior written approval and consent of Wellmark. Wellmark may condition its prior approval and consent to any such transaction or series of transactions by requiring the Agency to reassign some or all of its Agents (and Sub-Retail Agencies in the case of a General Agency) to another Agency and/or satisfy such other conditions as Wellmark may, in its sole and absolute discretion, require.

Wellmark also reserves the right to require the new or surviving or acquiring entity to enter into a new Agency Agreement with Wellmark to supersede the prior Agency Agreement(s). Wellmark will determine in its sole and absolute discretion the manner in which it will contract with an entity that is owned, in whole or in part, by a General Agency or any Retail Agency. Wellmark Channel Management should be contacted when exploring investments in other entities to determine how the business will be set up when working with Wellmark. In the event that a General Agency merges with, is acquired by, or there is a change of control of the General Agency, a Sub-Retail Agency may request Wellmark to reassign the Sub-Retail Agency to another General Agency, and such request may be granted by Wellmark in its sole and absolute discretion. If a Sub-Retail Agency is re-assigned to another General Agency, Wellmark may also determine, in its sole and absolute discretion, whether the Sub-Retail Agency may retain the AOR designation for its Book of Business or whether the AOR designation will be transferred to another Agency as a condition of allowing the Sub-Retail Agency to be assigned to a different General Agency. The parties involved must prepare and provide a proposed form of the letter for Wellmark to use to provide its approval and consent, but Wellmark reserves the right to modify any such proposed letter to include any conditions required by Wellmark to provide its approval and consent to the


proposed transaction or to not provide Wellmark approval and consent to the proposed transaction. Further, Wellmark will generally not issue a letter approving and consenting to any such transaction prior to the effective closing date of the transaction. For purposes of compensation, Wellmark will only recognize mergers, acquisitions and partnerships at the beginning of a contract period. This means that for any group business the new or surviving or acquiring Agency may be acquiring as a result of the transaction, Wellmark will continue to pay commissions at the group’s pre-transaction commission rate until the effective date of the group’s first renewal policy following the transaction closing date. From and after that time, commissions will be paid in accordance with the commission schedule that then applies to the new or surviving or acquiring Agency.

Prohibited Investment/Ownership Agencies conducting Wellmark Business shall not permit any competitor of Wellmark or any former Agent or Agency of Wellmark whose contract or appointment has been terminated by Wellmark to directly or indirectly own an interest in or invest in the Agency without express written approval of Wellmark.

Agent Assignments and Transfers All Agents must sign an Agent Agreement that specifies a single Agency as the Agent’s Assigned Agency. An Agent’s Assigned Agency may be a Retail Agency, a General Agency, or a Sub-Retail Agency. While Wellmark must approve all Agent assignments in its sole and absolute discretion, an Agent will generally be assigned to the Agency of which the Agent is an employee or an owner. All Agencies must identify a specific Assigned Agent for each of the Agency’s group policies and each of the Agency’s individual policies for which the Agency is the AOR. An Agency may not designate any policy or contract as being held by an Agency’s “house account.” An Agency which has no Wellmark contracted and appointed Agents assigned to it may not be considered AOR on any Wellmark business, and is not entitled to compensation, and is subject to termination. All Agencies must notify Wellmark within ten (10) business days of any change of the Agency’s designation of the Assigned Agent for any group or individual policy by submitting a “Change of Assigned Agent” (COAA) form (an example of this form is included at the back of the Agency Manual). The Agency must also provide timely notice of any such Assigned Agent change to the Wellmark customer. The failure to follow this requirement may, in Wellmark’s sole and absolute discretion, result in the loss of the Agency’s agreement and the Agent’s appointments with Wellmark. Wellmark may conduct periodic audits to ensure compliance with this requirement. If an Agent desires to transfer to another Agency because the Agent is no longer an employee of or an owner of the Agent’s current Assigned Agency, or for any other reason:


• Wellmark will determine, in Wellmark’s sole and absolute discretion, whether to allow the Agent to transfer to his or her new desired Assigned Agency or whether to terminate the Agent’s Agent Agreement; and

• The Agent will not be permitted to continue to serve as the Assigned Agent for any policy or contract unless the Agent’s former Assigned Agency consents to allowing the Agent to continue to be the Assigned Agent for any such policy or contract and to having the AOR for any such policy or contract transfer from the Agent’s former Assigned Agency to the Agent’s new Assigned Agency, which transfer may only be made if it is also consented to by the Wellmark customer group or individual policy-holder and if the appropriate AOR transfer form is also submitted to Wellmark.

• If the Agent’s former Assigned Agency does not so consent, the AOR for such policies and contracts will remain with the Agent’s former Assigned Agency, and the Agent’s former Agency must notify Wellmark within ten (10) business days of the new Assigned Agent for the customers for which the departing Agent was the prior Assigned Agent by submitting a “Change of Assigned Agent” (COAA) form. The Agency must also provide timely notice of any such Assigned Agent change to the Wellmark customer. The failure to follow this requirement may, in Wellmark’s sole and absolute discretion, result in the loss of the Agency’s agreement and the Agent’s appointments with Wellmark. Wellmark may conduct periodic audits to ensure compliance with this requirement.

• Wellmark may in its sole and absolute discretion permit an Agent to continue to serve as the Assigned Agent for any policy or contract when the Agent moves to a different Agency as the result of the termination of an Agency’s agreement with Wellmark. In that event, Wellmark may recognize the Agent’s new Agency as the AOR, and Wellmark will coordinate with the Assigned Agent and AOR to communicate with Wellmark customers.

Note: The Change of Assigned Agent (COAA) Form is to be used to re-assign the business in the following situations:

• Retail Agency or Sub-Retail Agency changes the identity of the Assigned Agent for any group or individual policy from one Agent to another Agent within the same Agency.

• Designate the movement of business from one Agent to another Agent when the Agents are assigned to different Agencies, if the movement is the result of an Agency transaction, merger, acquisition or change of control.

• Designate the movement of business from one Agency to another Agency when the Assigned Agent is moving between Agencies and the business is released by the Agency who is the current AOR to move with the Assigned Agent to the new Agency which will be the new AOR.

• Designate the movement of Medicare PDP business when the current Agent is no longer certified to sell Medicare PDP business.

The Change of Assigned Agent Form (COAA) does not apply in any manner to a Sub-Retail Agency’s General Agency designation.


The following table displays the commission cycle process when Wellmark receives a Change of Assigned Agent (COAA) form: Date Changes Received Month Processed Example On or Before the 15th of the month

Following month’s commission cycle

Changes received by July 15th will be processed in the August commission cycle.

After the 15th of the month

Second month’s commission cycle

Changes received after July 15th will be processed in the September commission cycle.

Agent/Agency Requirements

The failure to comply with any or all of these requirements may result in the loss of an Agent’s Wellmark appointment.

General Requirements • Wellmark is not required to appoint any insurance producer as a Wellmark Agent. In order to

be compensated for the sale, solicitation or negotiation of insurance as an Agent of Wellmark, producers must be licensed, and must be contracted with and appointed by Wellmark under an Agent Agreement. Appointment paperwork must be submitted to Wellmark within thirty (30) days of submission in Iowa or within fifteen (15) days of submission in South Dakota of any member application(s) for Wellmark coverage. The Agent will be furnished an Agent ID as soon as Wellmark has received the signed agreement, and this Agent ID may be utilized on applications for Wellmark coverage as long as the Agent’s appointment is approved by Wellmark and completed within thirty (30) days in Iowa or fifteen (15) days in South Dakota. The failure of the Agent to provide the necessary paperwork or other information to become approved by Wellmark and appointed within thirty (30) days in Iowa or fifteen (15) days in South Dakota will generally result in the business submitted being assigned to a Wellmark direct account.

• An Agency shall provide to and maintain with Wellmark a full and current list of all persons or entities associated with that Agency.

o For Retail Agencies, this includes all Agents who are employed by the Retail Agency, are owners of the Retail Agency and are otherwise assigned by Wellmark to work directly with the Retail Agency.

o For General Agencies, this includes:

All Sub-Retail Agencies assigned to the General Agency and all of their Agents.


o For Sub-Retail Agencies, this includes all Agents who are employed by the Sub-Retail Agency, are owners of the Sub-Retail Agency or are otherwise assigned by Wellmark to work directly with the Sub-Retail Agency.

• All of an Agency’s Fact Sheets should be submitted to Wellmark with the following:

o W-9 form showing the legal entity name and Agency structure; and

o Information regarding the Agency’s General/Retail Agency which includes the Agency’s website address; and

o A general information profile which includes information regarding the primary contact for the Agency. The primary contact is the person with the authority to sign the Agency Agreement; and

o Disclosure of information regarding the

Agency structure, ownership and control, common ownership, commonly owned entities or owners in the Agency. The ownership structure, including names and percentages owned by each, is required to be submitted for each Agency; and

o Authorization Agreement for Direct

Deposit (ACH Form) and Commission Accounting Contact Form with payment information, if applicable at the General/Retail Agency level; or

o Such other information as Wellmark

may reasonably request.

• All of an Agency’s Agent Fact Sheets should be submitted to Wellmark with the following:

o Proof of E&O coverage; and

o A copy of the Agent’s license; and

o The identity of the Agent’s employer; and

o A general information profile with demographic information which includes information regarding the General/Retail Agency and Sub-Retail Agency, if applicable; and

o A W-2 or W-4 (new employee), or 1099 or W-9 (new 1099 agents) 1099 agents will require additional attestations to show that they are working exclusively for the Agency for all lines of business and that the Agency is the AOR on the business, or ownership documentation for owners; and

o Sole proprietorships will be required to provide ownership documentation (Schedule 941, 1040, or similar documentation); or

o Such other information as Wellmark may reasonably request.

• In addition, each General Agency should submit to Wellmark a list of all of the Sub-Retail

Agencies for which the General Agency provides training, administrative and other supportive services and such other information regarding the General Agency’s contractual and other


relationships with its Sub-Retail Agencies as Wellmark may reasonably request, at least annually.

• When changes to Agent demographic information occur, a new Agent fact sheet must be submitted.

• Agencies are responsible for reimbursement to Wellmark of state appointment and administration fees for the Agents assigned to the Agency. For General Agencies, this includes Agents of any Sub-Retail Agencies aligned with the General Agency. Appointment fees for new Agents will be deducted from the first commission check following the Agent’s appointment and, thereafter, the annual appointment fees will be deducted from the first commission check of the year after the reconciliation has been completed.

• Wellmark will define the education, training and performance requirements for Agent training in order to understand Wellmark products and in order to comply with Wellmark’s policies and procedures. However, all Agencies and Agents are independently responsible for complying with all applicable federal, state and local statutes, regulations and ordinances applicable to their business.

• According to South Dakota law 58-33-113, Agents in South Dakota are required to obtain not less than one hour of continuing education every four years covering:

o Identification of Unauthorized Health Insurance; and

o The Producer’s responsibilities regarding unauthorized health insurance under South Dakota law 58-33-93 to 58-33-116, inclusive.

• All Agencies and Agents must ensure that all renewal quotes are delivered to group customers within the statutorily mandated timeframe, which is at least thirty (30) days prior to the renewal effective date for Iowa customers and at least forty-five (45) days prior to the renewal effective date for South Dakota customers.

• All Agencies and Agents must ensure that consultative services that are provided to Wellmark customers are in their best interest, specifically as it relates to splitting contracts for family members. Split contracts are not allowed unless it is in the best interest of the customer. The customer must be fully informed of the available options, differences in benefits, the potential out of pocket costs and differences in commission for the Agent. Discussions around the splitting of contracts should be addressed with your Wellmark Employed Sales Staff team for review and approval before they are submitted.

Specific Requirements • Knowing, understanding and adhering to all laws and regulations applicable to producer sales

and marketing activity, ethical practices, and fair market practices.

• Meeting all state producer license continuing education requirements in a timely manner.

• Maintaining and retaining proof of E&O coverage.

• Attending Wellmark training and meeting events related to products and procedures, state and federal regulatory developments, sales and/or marketing activity, administrative procedures, and supporting technology.


• Keeping email address updated with Wellmark and reading Wellmark publications, Blue Briefings Online (BBOs), and other Wellmark Special Alerts and messages.

• Meeting Wellmark’s minimum book of business requirement of five (5) contracts (This includes Group, Individual Under 65 and Individual Over 65 business. Medicare Part D contracts do not count toward the minimum book of business). This is counted at the Agency level. Failure to meet Wellmark’s minimum book of business requirement will result in the Agency, and all associated Agent appointments, to be terminated for two years. Wellmark will not re-appoint the Agents or contract with the Agency for two years.

• Meeting Wellmark’s Agent Certification training requirement described in the Training and Education Requirements section under the General Requirements.

• Knowing, understanding and adhering to all laws and regulations regarding the submission of online applications. This includes, obtaining permission from the client to submit the application online on the client’s behalf, maintaining a copy of the original paper application for 11 years, and making the application available to Wellmark upon request.

• Meeting other training, certification, and education requirements as may be specified by Wellmark, or required by federal or state laws.

• Providing a summary of benefits and coverage (“SBC”) and the uniform glossary of insurance-related terms to applicants, members and customers in accordance with Wellmark’s directions.

o Refer to the Accountability Chart, the FAQ, and Roles and Responsibilities documents for an overview and detailed responsibilities for supplying SBCs to Wellmark participants and beneficiaries. These documents are available on Wellmark’s Secure Producer Connection home page at:

https://ebusiness.wellmark.com/brokerandagent/securecontents/HealthCareReform/SBC.htm

• Utilizing Wellmark’s technology resources and tools available on Wellmark’s Secure Producer Connection Home Page. These resources include: Agency/Agent Resources and forms, Sales Toolkit, communications on Health Care Reform, Legislative Updates, tools for Viewing Eligibility & Benefits, Ordering ID Cards, Reporting, SBC Finder, and electronic enrollment tools.

o It will be necessary for you to register on Wellmark’s website for BlueConnections to obtain access to all of the secured Producer Tools. Register online through the following link:

https://welcome.wellmark.com/registration/agent/terms.aspx o You will be directed to the registration area. When filling in the required fields, it

will ask for your Agent ID. Please type in your assigned eight digit Agent number.

• Complying with applicable Federal and State rules, regulations, standards, sales and marketing guidelines and reporting requirements, including Centers for Medicare and Medicaid (“CMS”) requirements and compliance program guidelines and Medicare Part D Plan (“PDP”) user manuals, and all RAS Policies and Procedures. Refer to the Medicare Part D Requirements section for additional details.



https://welcome.wellmark.com/registration/agent/terms.aspx


Training and Education Requirements

General Requirement Wellmark requires and may provide training and education specifically related to maintaining professional competence on Wellmark products and procedures, and also may provide training and education with respect to state and federal regulatory developments, sales and/or marketing activity, administrative procedures, and supporting technology. Wellmark reserves the right to require completion of specifically designated education courses from time to time. All new Agents contracted to sell individual and/or group products must successfully complete a Wellmark approved new Agent certification course within one hundred eighty (180) days of their appointment. Phone training is not permitted for the completion of a new Agent certification course. The failure to successfully complete a new Agent certification training within the prescribed time period may result in the suspension and/or termination of the Agent’s appointment until training has been completed. All Agents contracted to sell or service individual and/or group products must successfully complete all required Wellmark Agent certification courses on an annual basis. All modules related to the business that an Agent sells or services must be completed with a 90% pass rate. Each Agent will have three attempts to pass the exams for each module. The failure to successfully complete the Wellmark Agent certification training within the prescribed time period and at the 90% pass rate will result in termination of the Agent’s appointment for two years. Wellmark will communicate the timeframe for the annual certification, and provide a link and instructions for completing the certification training modules at that time.


Medicare Part D Requirements

General Requirements All Agents selling and/or servicing Medicare Part D must comply with all Federal health care laws and all Centers for Medicare and Medicaid Services (“CMS”) policies, including CMS marketing guidelines, to ensure that beneficiaries receive accurate information. All Agencies and Agents of Wellmark selling or servicing Medicare Advantage and PDP plans for Wellmark are considered First Tier, Downstream and Related Entities (FDRs) Wellmark will perform random audits each year, and any audit deficiencies or failures may result in corrective actions, up to and including termination of the Agency or Agent agreement(s) with Wellmark and reporting to regulating agencies.

o Duties of Wellmark Agencies and Agents as FDRs

i. Distribution of the Code of Conduct. Agencies and Agents as FDRs shall distribute the RAS Code of Conduct to its employees and downstream and related entities upon hiring or contracting and each year thereafter. The RAS Code of Conduct is found on the Wellmark Producer Connection. Additionally, the RAS Code of Conduct may be distributed to the FDRs via a “BBO” (Blue Briefings Online) communication to FDRs with internet access or the MedicareBlue Rx training website.

ii. Required Training. Agencies and Agents as FDRs must ensure that all of its

employees, contractors, consultants, downstream or related entities and other related persons or entities that are involved in the FDR’s Medicare Part D business have received, completed and passed all required training, including general compliance training, including annual conflict of interest training and disclosure, and CMS approved Fraud, Waste and Abuse (FWA) training. Wellmark will provide each FDR with access to required training via the Wellmark Producer Connection.

All employee, contractor, consultant and related person training must occur within 90 days of hire or of the date that the person becomes involved in Medicare Part D business, and each year thereafter. All Downstream and Related Entities must complete required training prior to beginning business with an FDR.

iii. Review of Personnel Against Office of Inspector General (OIG)/General

Services Administration (GSA) Exclusion lists. Agencies and Agents as FDRs must perform exclusion list validations for all of its employees, contractors, consultants and its Downstream and Related Entities parties


prior to hiring or contracting, as applicable, and each month thereafter. FDR may be required to validate against other or additional lists as designated from time to time by Wellmark, CMS, OIG, GSA or another governmental agency. FDRs must keep a record of each validation scan performed. Links to these exclusion list websites are on the Wellmark Producer Connection.

iv. Exclusion from federal health care program. Agencies and Agents as FDRs

shall provide written notice to Wellmark within three (3) business days of discovery that it or a Downstream or Related Entity, or any employee, contractor, consultant or other person or entity is excluded from a federal health care program. Upon such discovery, the FDR shall immediately remove such excluded person or entity from the provision of services to FDR or Wellmark.

v. Reporting to Wellmark. Agencies and Agents as FDRs shall cooperate with

Wellmark in Wellmark’s monitoring of the FDR. In addition, a FDR shall comply with Wellmark requests for information, records, and reports related to the Agencies and Agents or their subcontractors compliance with this Policy. Such requests may include, but are not be limited to, the following: results of periodic monitoring by the FDR; certificates of completion of training; and results from periodic reviews of the OIG and GSA exclusion lists.

vi. Mechanism for Reporting of FWA and other non-compliance. Wellmark

has provided its Agencies and Agents as FDRs with information about how to report FWA and other non-compliance to Wellmark and to RAS, including through the use of the Wellmark and RAS compliance hotlines, both anonymous reporting systems, and through Wellmark’s Sales Compliance Department and Special Investigations Unit (SIU). Agencies and Agents as FDRs must provide similar reporting information to its employees, related persons and Downstream and Related Entities for their use in reporting suspected FWA or other non-compliance by any person or entity involved with Wellmark’s Medicare Part D plan.

vii. No Retaliation. Wellmark has a no-tolerance policy for retaliation or retribution against any employee, FDR, or FDR employee who reports potential FWA. All Wellmark Agencies and Agents as FDRs are required to have an equivalent policy and may choose to adopt Wellmark’s policy or create one of their own.

viii. Record Retention. Agencies and Agents as FDRs must maintain all records

relating to Wellmark’s Medicare Part D plans for the current year, plus 10 years (11 years). Required records include, but are not limited to, applications, scope of appointment forms, documentation of compliance, FWA and other training, OIG/GSA scanning results, FWA reporting


mechanism documentation, conflict of interest forms and fax or online confirmation records.

ix. Obsolete Marketing Materials. Periodically, Wellmark will notify FDRs

that certain identified marketing materials are obsolete, and as such, the FDRs shall recycle or destroy said materials and no longer utilize these materials.

x. Conflict of Interest. Agencies and Agents as FDRs will certify that the

Agencies and its Agents are free from any conflict of interest in administering or delivering Medicare Part D benefits. Agencies and Agents must provide copies of their certification upon request.

xi. Offshore Subcontractors. Each Agency and Agent as an FDR

acknowledges and agrees that it is prohibited from performing any service for Wellmark that involves the Medicare Part D business or using any person (individual or entity) to perform services in connection with Wellmark’s Medicare Part D Plan if the services are performed or the person is physically located outside of one of the fifty United States or one of the United States territories (i.e., American Samoa, Guam, Northern Marianas, Puerto Rico, and Virgin Islands) (“Offshore Entities”), unless Wellmark, in its sole discretion and judgment, agrees in advance and in writing to such offshore activities or the use such Offshore Entity. In addition, an FDR shall not make any use or disclosure of protected health information (“PHI”) to an Offshore Entity without Wellmark’s prior written consent. Wellmark Agencies and Agents may not conduct any Wellmark business through independent subcontractors without Wellmark’s prior express written approval.

xii. FDR Oversight. Agencies and Agents as FDRs must provide oversight of

any Downstream and Related Entities to ensure that such entities comply with all FDR requirements. Said oversight includes ensuring that any downstream and related entities are complying with the same requirements as the FDR has for its employees and downstream and related entities, i.e. downstream and related entities are delivering the Code of Conduct to their employees, scanning their employees, providing FWA training to all applicable employees, retaining documents, etc.

Additional information regarding Medicare Part D compliance, including FAQ, is located on the Producer Connection at the following address: https://ebusiness.wellmark.com/brokerandagent/securecontents/MedicareCompliance.htm

https://ebusiness.wellmark.com/brokerandagent/securecontents/MedicareCompliance.htm


Certification and Training Requirements All Agents marketing Medicare Part D must comply with the following:

• Successfully complete the Wellmark Medicare Part D certification training prior to marketing Medicare Part D.

• Agents who continue to sell and service Medicare Part D business must complete the Wellmark Medicare Part D re-certification course annually as a condition to continuing to service and in order to be compensated for existing Medicare Part D business.

Example: An Agent signing an application for a 2016 effective date must successfully complete the requisite Medicare Part D Certification or Re-certification training for 2016 prior to signing the application.

• Agents and their Assigned Agencies must maintain copies of all Medicare Part D applications and Scope of Appointment Forms for at least ten (10) years plus the current year.

Disciplinary Actions If an Agent sells a Medicare Part D product and has not successfully completed the Medicare Part D Certification or Re-certification requirements, the business will be assigned to a Wellmark direct account. No commission will be paid to the Agent or the Agency. In addition, the Agent and the Agent’s individual business Agency may be subjected to disciplinary action and penalties for violating CMS guidelines.


Agent of Record (AOR) Consistent with Wellmark’s Agency Agreements, the recognition of any Agency as the Agent of Record (AOR) for any policy or account shall be in Wellmark’s sole and absolute discretion. The AOR may be a Retail Agency, or a Sub-Retail Agency, and the AOR will generally be assigned to the Agency for which the current Assigned Agent is an employee or owner or otherwise assigned by Wellmark to work directly with the Agency. Initial AOR designations and transfers of AOR designations for Wellmark business will generally be made in accordance with the policies and procedures set forth in this Agency Manual. Renewal quotes for Wellmark business will generally be delivered by the Agency that is the AOR, but they may also be delivered directly to the customer. Wellmark may require, in Wellmark’s sole and absolute discretion, a Wellmark Employed Sales Staff representative to participate (in person or by other means) in any individual or group sales activity conducted by an Agency or an Agent with respect to any prospective new Wellmark Business or any renewal Wellmark Business.

AOR for Individual Policies New Applications for new individual policies must designate the Agent submitting the application on behalf of the prospective insured, and the designated Agent shall be the initial Assigned Agent. If the application is accepted by Wellmark, the initial AOR for the new individual policy shall be the Assigned Agent’s Agency. Renewal The AOR for an individual policy may be transferred from one Agency to another Agency or to a Wellmark Employed Sales Staff member if the individual’s policy changes for one of the reasons listed below:

• Changes in plans to an existing Wellmark policy when the policyholder moves from under 65 coverage to Medicare Supplement and/or Medicare Part D; or

• When the policyholder makes a plan change during an open enrollment or a special enrollment event period and receives the assistance of an Agent who is not previously the designated AOR, unless that policyholder is enrolled in a plan only available through an Agent in an exclusive Agency.


AOR for Small Group Policies (1–50 Groups) New

The initial Assigned Agent for a new 1-50 small group customer shall be the Agent designated on the sold paperwork signed by the new 1-50 small group customer. The AOR for the new 1-50 small group customer shall be the Assigned Agent’s Agency.

Renewal Renewal quotes for 1 - 50 small group policies will be delivered to the Agent and Agency that is the Agent of Record for the subject 1 - 50 small group as of the date the renewal quote is released; provided, however, that if the Agent of Record for the subject 1 - 50 small group is a Sub-Retail Agency, the renewal quote will be delivered to the Sub-Retail Agency’s designated General Agency for group Wellmark Business, as well as the Agent. Wellmark may also deliver renewals directly to the customer. Changes in benefits to an existing Wellmark group (i.e. moving to an ACA compliant plan or any other change in benefit plan) that are assisted and submitted via an Agent who is not the designated Agent of Record for the subject 1-50 small group, will not result in an Agent of Record change to that subject group. The standard AOR Transfer Request – Group Policy (AOR-1) form is required in order to change the Agent of Record designation on a group. The process is covered under the AOR Designation Transfers section.

AOR for Large Group Fully Insured Policies (51-100 and 101+) New

The initial Assigned Agent for a new 51-100 or 101+ large group fully insured customer shall be the Assigned Agent designated on the sold paperwork signed by the new 51-100 or 101+ large group customer. The AOR for the new 51-100 or 101+ group customer shall be the Assigned Agent’s Agency. See the section of this Agency Manual regarding Large Group Fully Insured Transparent Commissions for more information about the manner in which the initial Assigned Agent for a new 51-100 or 101+ large group customer is determined.

Renewal Renewal quotes for 51-100 and 101+ large group fully insured policies will be delivered to the Agent and Agency that is the Agent of Record for the subject 51-100 and 101+ fully insured large group as of the date the renewal quote is released; provided, however, that if


the Agent of Record for the subject 51-100 and 101+ fully insured large group is a Sub-Retail Agency, the renewal quote will be delivered to the Sub-Retail Agency’s designated General Agency for group Wellmark Business, as well as the Agent. Wellmark may also deliver renewals directly to the customer. Also see the section of this Agency Manual regarding Large Group Fully Insured Transparent Commissions for information about the manner in which the renewal quotes are processed for renewal policies for 51-100 and 101+ large group customers.


AOR Designation Transfers

Wellmark Direct Business Group Policies Individual Policies

Wellmark will review and consider any requests for Wellmark group business currently assigned to a Wellmark Employed Sales Staff member (“Wellmark Direct Business”) to be transferred to an Agency and that the transferee Agency be designated as the AOR for that group business as long as they are unsolicited and initiated by the client. Each request will be reviewed on its own merit for approval.

Wellmark will review and consider any requests for Wellmark individual business currently assigned to a Wellmark Employed Sales Staff member (“Wellmark Direct Business”) to be transferred to an Agency and that the transferee Agency be designated as the AOR for that individual business as long as they are unsolicited and initiated by the policyholder. Each request will be reviewed on its own merit for approval.

Independent Agency Business Group Policies

Except as otherwise provided in this Agency Manual, a group customer may: Agency to Agency Agency to Wellmark Direct Business • Submit a request to transfer the

designated AOR for any group insurance policy from one Agency to another Agency, as long as the request is unsolicited and initiated by the group customer.

• Submit a request to convert the customer’s group business to a direct Wellmark Employed Sales Staff member at any time as long as the requested is unsolicited and initiated by the group customer.

In addition, Wellmark may, on its own or pursuant to a group customer request, transfer the designated AOR for any existing group policy from one Agency to another Agency or to a direct Wellmark Employed Sales Staff member, if one of the following conditions or reasons occurs, as determined in Wellmark’s sole and absolute discretion:

• Acts of fraud or customer abuse; • Agency, Agent or customer misrepresentation; • The current Agent of Record no longer has an Agency Agreement with Wellmark; or • Any other reason that Wellmark decides, in its sole and absolute discretion, is an

adequate basis for changing the AOR designation on a group policy from one Agency


to another Agency or to a direct Wellmark Employed Sales Staff member.

Individual Policies The AOR for an individual policy may be transferred from one Agency to another Agency or to a Wellmark Employed Sales Staff member if the individual’s policy changes for one of the reasons listed below: • The policyholder moves from under 65 coverage to Medicare Supplement and/or

Medicare Part D;

• The policyholder makes a plan change during an open enrollment or a special enrollment event period and receives the assistance of an Agent who is not previously the designated AOR, unless that policyholder is enrolled in a plan only available through an Agent in an exclusive Agency.

A policyholder may also submit documentation (letter, memo, email, or Individual AOR Transfer Request form) to request to change the AOR from one independent agent to another independent agent or to a Wellmark Employed Sales Staff member one time every 12 months. This request must come directly from the customer (emailed, mailed or faxed directly to Wellmark or forwarded to Wellmark via an Agent/Agency at the direction of the customer).

• In addition, Wellmark may, on its own or pursuant to a policyholder request, transfer the designated AOR for any existing individual policy from one Agency to another Agency or to a direct Wellmark Employed Sales Staff member if one of the following conditions or reasons occurs, as determined in Wellmark’s sole and absolute discretion:

• Acts of fraud or customer abuse; • Agency, Agent or customer misrepresentation; • The current Agent of Record no longer has an Agency Agreement with Wellmark; or;

or • Any other reason that Wellmark decides, in its sole and absolute discretion, is an

adequate basis for changing the AOR designation on an individual policy from one Agency to another Agency or to a direct Wellmark Employed Sales Staff member.

Procedure for Requesting an AOR Designation Transfer Existing Group or Individual Policy To request that Wellmark consider granting a request to transfer the AOR designation for an existing group or individual policy, the customer must complete, sign and submit an AOR Transfer Request - Group Policy (M-4317) or an AOR Transfer Request – Individual Policy (M-4315). These forms are hereinafter also referred to as an “AOR Transfer Request”).


Upon Wellmark’s receipt of an AOR Transfer Request or other documentation requesting the change and outlining the reason for the change, Wellmark will notify the former AOR, the new AOR, any impacted General Agencies, and the customer.

Frequency of AOR Transfer Requests An AOR transfer (other than those resulting from a plan change or special enrollment event) may only occur once during any twelve (12) month time period for any customer. If a customer submits more than one AOR Transfer Request during any twelve (12) month time period, Wellmark may deny the request for the change, although Wellmark retains the right to make a final determination with respect to multiple AOR Transfer Requests in its sole and absolute discretion.

Effective Date of and Commissions for Accepted AOR Transfer Requests Group and Individual Policies

An AOR Transfer Request for a group or individual policy may be submitted at any time.

• If an AOR Transfer Request is received by Wellmark on or before the 10th of a month

and all paperwork is complete and accurate to process the AOR Transfer Request, Wellmark may accept the AOR change and the AOR change will become effective on

Form Available Location AOR Transfer Request – Group Policy (M -4317)

Wellmark’s Producer Connection website

AOR Transfer Request – Individual Policy (M-4315)

Wellmark’s member website and on Wellmark’s Producer Connection website

Group and Individual Policies All AOR Transfer Forms or other documentation:

• Must be fully completed and signed by the individual policyholder or group customer; • Must not be completed (in full or in part) or signed by an Agent; • Must state the reason why the individual policyholder or group customer requests an

AOR transfer; and • Wellmark Agents and Agencies may not solicit current members to submit an AOR for

their individual or group policies.


the first of the month immediately following the submission of the AOR Transfer Request to Wellmark;

• If an AOR Transfer Request is received by Wellmark on or before the 10th of a month with incomplete information to process the transfer request, the AOR will be denied. The AOR may be accepted by Wellmark once all complete information has been received. If the additional information is not received by the 10th of the month, the AOR change will become effective on the first of the second month following the submission of the AOR Transfer Request to Wellmark; and

• If an AOR Transfer Request is received by Wellmark after the 10th of the month and all paperwork is complete and accurate to process the AOR Transfer Request, the AOR change will become effective on the first of the second month following the submission of the fully completed AOR Transfer Request.

Example

Date AOR Transfer Request is Received by Wellmark

Date AOR Transfer Request will become effective

A February 8 (incomplete form)

Denied

B February 8 (complete form)

March 1st

C February 10 (incomplete form)

Denied

D February 10 (complete form)

March 1st

E February 11 (incomplete form)

Denied

F February 11 (complete form)

April 1st

If an AOR Transfer Request or Documentation from the group or individual is received to convert the customer’s group or individual policy to a direct Wellmark Employed Sales Staff member, the request, if accepted by Wellmark, will generally become effective on the 1st of the month following Wellmark’s receipt of the request. Until the accepted AOR Transfer Request is effective, the AOR and commission payments for the group or individual policy will remain with the Agency that is the current AOR for the group or individual policy and will be determined by the current AOR Agency’s Commission Schedule (or, if applicable, the Commission Allocation Exhibit then in effect for the Wellmark customer group policy).

From and after the date the accepted AOR Transfer Request is effective, the new AOR Agency will receive commission payments with respect to the group or individual policy, but the commission payments will generally be based on the old AOR Agency’s Commission Schedule (or, if applicable, the Commission Allocation Exhibit then in effect for the Wellmark customer group policy) until the next policy renewal effective date. The preceding sentence will be true unless the new AOR Agency submits a revised commission rate via a new Commission Allocation Exhibit for the AOR Transfer Request which is


accepted by Wellmark in its sole and absolute discretion or unless Wellmark otherwise approves a change of commission rate.

Notification/Transfer of Information/Rescission Within five (5) business days of Wellmark’s receipt of an AOR Transfer Request (other than one resulting from a plan change or special enrollment event), Wellmark will deliver by email a notification to the Agent and Agency that would receive the AOR and to the Agent and Agency that would lose the AOR designation for the Wellmark customer policy, as well as the customer, if the transfer request is accepted by Wellmark. The Agent/Agency that would lose the AOR designation has fifteen (15) calendar days from the date of notification, to request that Wellmark permit it to retain the business for the Agent/Agency. The request must be supported by providing Wellmark with the customer’s rescission of the previously submitted AOR Transfer Request, which rescission must be verified by the customer completing and signing the “rescission section” of the AOR Transfer Request or providing other documentation of the rescission request directly from the customer. During the fifteen (15) day rescind period, no information will be provided to the newly designated AOR Agency unless it is acquired from the group or individual policyholder. After the fifteen (15) day rescind period, the newly designated AOR Agency can receive the information from the group or individual policyholder or the customer’s Wellmark Employed Sales Staff team member. After the effective date of an accepted AOR Transfer Request, the newly designated AOR Agency will be the AOR for the group or individual policyholder and the Agency will then have such access to the group or individual policyholder’s information as is normally provided by Wellmark to an Agency that is the AOR for the group or individual policyholder. Notwithstanding the preceding paragraph, if the customer has requested to have their policy become Wellmark direct business, or if the current Agent releases the business to the new Agent, Wellmark will not be required to provide the Agency that would lose the AOR designation with notice of the AOR Transfer Request or fifteen (15) calendar days to request that Wellmark permit it to retain the business for the Agency. Wellmark will consider any AOR Transfer Request and any tendered rescission of the AOR Transfer Request and make a final determination with respect to the designated AOR for the Wellmark customer policy, which determination will be made by Wellmark in its sole and absolute discretion.

AOR Change Due to New Group Owner If a Wellmark insured group is sold, merged or otherwise acquired by a new owner, the new owner must furnish the new owner’s Tax ID or employer identification number to Wellmark and must also complete the new owner section, sign and submit an AOR Transfer Request – Group Policy (M-4317) to Wellmark to specify the new owner’s desired Assigned Agent and AOR Agency (an example of this form is included at the back of the Agency Manual). The new owner may request a new Assigned Agent and AOR Agency designation regardless of any current Wellmark Direct Business involvement with respect to the acquired or acquiring business. All documentation


concerning any such ownership change must be received by Wellmark within six (6) months of the ownership change, and Wellmark reserves the right to determine, in Wellmark’s sole and absolute discretion, whether or not to honor the submitted AOR transfer request.

AOR Designations for Wellmark Dental Business (Iowa Only) A customer will generally only have one Assigned Agent and Agency AOR for all of the customer’s lines of Wellmark business (health and dental), and the Assigned Agent and Agency AOR for the customer’s group or individual health business, if applicable, shall generally govern the Assigned Agent and Agency AOR for the Wellmark dental business.

• Adding Dental business to an existing Wellmark Direct Business health insurance account or policy may be done only by the Wellmark Employed Sales Staff member assigned to the group or policy.

• Conversely, adding Dental business to an account or policy for which there is an Agency AOR for the customer’s health insurance policy may be done only by the customer’s health insurance Agency AOR.

• However, if a customer has current Dental business through Wellmark, but does not currently have Wellmark health insurance, another Agent/Agency may obtain a quote for and attempt to sell Wellmark health insurance to the customer and, if successful, the Agency involved in selling Wellmark health insurance to the customer would become the AOR for both the new health insurance policy as well as for the customer’s Dental line of business – whether the existing Dental business was previously with an Agent/Agency or Wellmark direct business.

If Then Wellmark accepts the new owner’s AOR Transfer Request,

The change will become effective when determined by Wellmark in its sole and absolute discretion, and the manner in which commissions are calculated and paid on the policy after the effective date of AOR transfer will also be determined by Wellmark in its sole and absolute discretion.


Large Group Fully Insured Transparent Commissions

(51-100 and 101+) Commissions for all new policies for 51-100 and 101+ fully insured large groups will be quoted and paid on a Per Contract Per Month (PCPM) basis. Requests for the commissions to be included in the total premium rate quote will be requested via email and agreed to using the Commission Allocation Exhibit (an example of this form is included at the back of the Agency Manual). The Commission Allocation Exhibit displays the total health commission rate on a PCPM basis and the commission allocation between the General Agency and Sub-Retail Agency. This form is required to be submitted to Wellmark for any new or renewal Large Group Policy. This form will be submitted to the General Agency or Retail Agency via DocuSign approximately 30 days prior to the group’s effective date.

Large Group Policies

New Commissions for all new policies for 51-100 and 101+ fully insured large groups will be quoted on a “per contract per month” (“PCPM”) basis. Any Agent or Agency appointed to write Wellmark large group policies must request a rate quote for a new 51-100 or 101+ large group policy and must propose the PCPM commission rate to include, as part of the total premium rate quote, by providing Wellmark with an e-mail and following up by signing and submitting a Commission Allocation Exhibit.

The quote request email message must set forth:

• The desired total PCPM commission rate, • The name of the writing Agent; • The name of the Sub-Retail Agency, if applicable; and • The portion of the PCPM commission rate to be paid to a Sub-Retail Agency.

For any total premium rate quote for a policy for which a Sub-Retail Agency will be the AOR, any email requesting the desired PCPM commission rate must be sent or confirmed by both the subject Sub-Retail Agency and by its designated General Agency. The Commission Allocation Exhibit will be completed by Wellmark based on this information, and sent to the Agencies to be electronically signed via the DocuSign application. (Refer to the DocuSign Instructions document located in the appendix of the Agency Manual for more information.)

There will be no default commission rate that will apply to a new 51-100 or 101+ large group. Even if the requested PCPM commission rate is zero, no quote will be provided


unless and until an email has been sent to Wellmark requesting a quote with a stipulated PCPM commission rate.

If no Agency submits a requested PCPM commission rate for a prospective new 51-100 or 101+ large group policy, Wellmark may consider the Wellmark customer group to be Wellmark direct business and may release a Wellmark direct business quote to the group that does not include any PCPM commission rate. In such an event, the new 51-100 or 101+ large group policy will be considered Wellmark direct business if the direct business quote is accepted by the group and no Agency will receive any commission with respect to the policy. Once an Agency has submitted a stipulated PCPM commission rate and been provided with a quote for a new 51-100 or 101+ large group policy, the same Agency will generally be allowed to submit no more than one revised PCPM commission rate request to Wellmark in order to obtain an updated rate quote for the new 51-100 or 101+ large group policy, and the second requested PCPM commission rate must generally be less than the initially requested PCPM commission rate.

Wellmark will not release an initial premium quote with a zero PCPM commission rate and later provide a second quote with an increased PCPM commission rate.

Agencies may not agree to or present premium changes to a group without first receiving a new quote from Wellmark and in no event may Agencies negotiate commissions with any group. Until the prospective new 51-100 or 101+ large group customer enters into a group policy agreement, Wellmark may also provide quotes for the same prospective 51-100 or 101+ large group customer to other Agents or Agencies qualified to write Wellmark large group policies if they submit their own PCPM commission rate request along with a complete and accurate quote request. Consistent policy rate quotes for any prospective 51-100 or 101+ large group will be provided to all qualifying Agencies regardless of the distribution channel they will use to sell and service the policy. Therefore, all Agencies will be marketing the same quoted policy rates to any prospective 51-100 or 101+ large group customer, but the overall quotes may differ based on the different transparent PCPM commission rates offered by the different Agencies.

In order to accept an outstanding total premium rate quote and become a new Wellmark 51-100 or 101+ large group customer, a prospective 51-100 or 101+ large group customer must accept a total premium rate quote showing the transparent PCPM commission by signing the New Account Enrollment Form for 51-100 new business and the Fully Insured Alternates rate page for 101+ new business before it expires.

The initial Assigned Agent for a new 51-100 or 101+ large group customer shall be the Assigned Agent designated on the sold paperwork signed by the new 51-100 or 101+ large group customer and the AOR for the new 51-100 or 101+ group customer shall be the Assigned Agent’s Agency.


If Then A new rate quote, that has been established through an email submission of a requested PCPM commission rate, is accepted by a new 51-100 or 101+ large group customer,

Wellmark will electronically complete and send (via DocuSign) a Commission Allocation Exhibit to the Agency or Agencies to document the amount of the transparent PCPM commissions and how it will be allocated between the agencies (as applicable). The Agency must sign and submit the Commission Allocation Exhibit back to Wellmark.

Wellmark will not remit any commissions to the Agency or Agencies until the Agency or Agencies have electronically signed and submitted a Commission Allocation Exhibit to Wellmark via the DocuSign application. The following table discusses the commission cycle procedure for submitting a Commission Allocation Exhibit and the time when any commission change will be implemented: Date Changes Received Month Processed Example On or Before the 15th of the month


Changes received by July 15th for a new commission rate effective as of August 1 will be processed in the August commission cycle.



Changes received after July 15th for a new commission rate effective as of August 1 will be processed in the September commission cycle. In the case of a changed commission rate that was to have been effective as of August 1, the September commission cycle will include an adjustment to reflect the new commission rate that was to have been effective as of August 1. For a new policy without any prior commission rate, the September commission cycle will include payments for both August and September based on the new commission rate that was to have been effective as of August 1.

Renewal

Commissions for all renewal policies for 51-100 and 101+ fully insured large groups will be quoted on a “per contract per month” (“PCPM”) basis. Requests for the commissions to be included in the total premium rate quote will be requested via email and agreed to using the Commission Allocation Exhibit (an example of this form is included in this Agency Manual).


In order to obtain a renewal quote for a 51-100 or 101+ large group renewal policy, the Agency that is the AOR for the Wellmark customer policy will need to propose a transparent PCPM commission rate to include as part of the total premium renewal quote by providing Wellmark with an e-mail and following up the email by signing a Commission Allocation Exhibit. The quote request email message must set forth:

• The desired total PCPM commission rate; • The name of the writing Agent; • The name of the Sub-Retail Agency; and, if applicable • The portion of the PCPM commission rate to be paid to a Sub-Retail Agency.

For any rate quote for a policy for which a Sub-Retail Agency will be the AOR, any email requesting the total premium rate quote must be sent or confirmed by both the subject Sub-Retail Agency and by its designated General Agency. The Commission Allocation Exhibit will be completed by Wellmark based on this information and sent to the Agencies to be electronically signed via the DocuSign application. (Refer to the DocuSign Instructions document located in the appendix of the Agency Manual for more information.) There will be no default commission rate that will apply to a 51-100 or 101+ large group renewal policy. Even if the requested PCPM commission rate is zero, no renewal quote for such a policy will be provided unless and until an email has been sent to Wellmark requesting a quote with a stipulated PCPM commission rate to be included in the renewal quote.

If Then

The Agency that is the AOR for the Wellmark customer policy (and the AOR’s designated General Agency, if the AOR is a Sub-Retail Agency) does not request a stipulated PCPM commission rate more than four (4) months prior to the policy’s renewal Effective Date,

Wellmark may consider the Wellmark customer policy to be Wellmark direct business and may release a Wellmark direct business quote to the group that does not include any PCPM commission rate for the Agency that was the AOR for the group (or for the AOR’s designated General Agency if the AOR is a Sub-Retail Agency).

The Wellmark customer group then renews its policy as Wellmark Direct Business,

The Agency that was previously the AOR for the Wellmark customer policy will no longer be the AOR for the policy and the AOR (and the AOR’s designated General Agency if the AOR is a Sub-Retail Agency) will not receive any commissions after the policy’s renewal Effective Date.

Once an Agency has submitted a request for a stipulated PCPM commission rate and been provided with a total premium renewal quote for an existing 51-100 or 101+ large group policy, the Agency will generally be allowed to submit no more than one revised PCPM commission rate request to Wellmark in order to obtain an updated rate quote for the renewal 51-100 or 101+ large group


policy, and the second PCPM commission rate request must generally be less than the initially requested PCPM commission rate for the renewal quote.

Wellmark will not release an initial renewal premium quote with a zero PCPM commission rate and later provide a second quote with an increased PCPM commission rate. Agencies may not agree to or present premium changes to a group without first receiving a new renewal quote from Wellmark and in no event may Agencies negotiate commissions with any group. If Then

A renewal rate quote that has been established through an email submittal of a requested PCPM commission rate is accepted by signing the 51-100 Group Renewal Acceptance page of the exhibit or the Fully Insured Renewal Premium page for a 101+ large group customer,

Wellmark will electronically complete and send (via DocuSign) a Commission Allocation Exhibit to the Agency or Agencies to document how commissions will be allocated between the agencies (as applicable) and sign and submit back to Wellmark.

Wellmark will not remit any commissions to the Agency or Agencies until the Agency or Agencies have electronically signed and submitted a Commission Allocation Exhibit to Wellmark via the DocuSign application. The following table discusses the commission cycle procedure for submitting a Commission Allocation Exhibit and the time when any commission change will be implemented: Date Changes Received Month Processed Example On or Before the 15th of the month


Changes received by July 15th for a new commission rate effective as of August 1 will be processed in the August commission cycle.



Changes received after July 15th for a new commission rate effective as of August 1 will be processed in the September commission cycle. In the case of a changed commission rate that was to have been effective as of August 1, the September commission cycle will include an adjustment to reflect the new commission rate that was to have been effective as of August 1. For a new policy without any prior commission rate, the September commission cycle will include payments for both August and September based on the new commission rate that was to have been effective as of August 1.


Commission Allocation Exhibit The form of the Commission Allocation Exhibit can be found at the back of the Agency Manual. As noted on page two (2) of the form, the PCPM commission rate set forth on any Commission Allocation Exhibit shall only apply to the period commencing on the Wellmark customer group policy’s new policy Effective Date or renewal policy Effective Date and until the next renewal of the Wellmark customer group policy or the cancellation of the Wellmark customer group policy, whichever is earlier. PCPM commission rates set forth on any Commission Allocation Exhibit will, therefore, not apply to any future renewal policy for the Wellmark customer group. In order to obtain a renewal quote for the group that contains the Agency’s (or Agencies’) requested PCPM commission rate for the subsequent renewal time period, in which the requested PCPM commission rate may be the same as, or different from, the PCPM commission rate applicable to the group’s current policy term, the Agency that is the AOR for the Wellmark customer group (and the AOR’s designated General Agency if the AOR is a Sub-Retail Agency) will need to notify the applicable Wellmark Employed Sales Staff team of the requested renewal PCPM commission rate in writing via email at least four (4) months prior to the policy’s renewal Effective Date. Once the rate is accepted by the group, Wellmark will electronically complete and send a Commission Allocation Exhibit via the DocuSign application to the Agency or Agencies which must be fully executed (electronically signed) prior to any commissions being paid.

PCPM Commission Request Considerations As Agencies consider what PCPM commission rate to request on large group fully insured business, the following should be kept in mind:

• Commission rebates are prohibited. [Iowa Code Sec. 507B.4(8)] [South Dakota SDCL §58-33-24 and §58-33-36]

• Agencies may only present groups with total premium quotes authorized and provided by Wellmark.

• Agencies may negotiate commissions with Wellmark, but not with the group.

• An Agency may not sell a policy for a stated premium which includes commission, and also charge a separate fee to the account that is not included in the stated premium, unless the separate fee is for services other than selling, soliciting or negotiating insurance, and the fee is documented by a written agreement between the Producer/Consultant and the employer group which complies with Iowa Administrative Code §191-15.8(3) or South Dakota Administrative Code SDCL §58-30-174 (Note: With respect to such services, the Producer is not considered an Agent of Wellmark but is considered a Consultant or service provider retained by the account).


• Accounts where no commission is included in the premium, and where a Producer is acting as a Consultant for the employer, are considered Wellmark direct business and Wellmark will recognize and work with the Consultant to communicate information to the employer group.

• An Agency may request a policy quote with a PCPM commission of zero, and the business will still be considered Agency business as long as the Agency does not receive a separate consulting or other fee from the insured.


Wellmark Association, Trust and PEO Guidelines

Wellmark has multiple arrangements with associations and trusts. These arrangements may not be consistent with the normal quoting and Agent of Record guidelines outlined in this Agency Manual. Consult with your Wellmark Employed Sales Staff team for these specific guidelines when working with customers looking to obtain quoting information related to an association or trust. In addition, Wellmark administers quotes for PEO’s consistent with requests from the PEO and pursuant to our current guidelines within each PEO.


Consultants

This Agency Manual applies to Wellmark business on which a Producer is acting as a Wellmark authorized Agent or Agency. This Manual is not applicable to self-funded business, or any fully insured business where the Producer involved is considered a consultant or service provider retained by the employer or account. Wellmark recognizes that licensed Producers often act in the role of consultants in the marketplace rather than an Agent of Wellmark. A consultant represents an employer entity and works directly with the employer entity with respect to the design, development and implementation of an employer’s benefit package. At times, entities holding Agency or Agent agreements with Wellmark may act as a consultant, and not as an Agent of Wellmark. Independent consultants and Wellmark contracted Agencies can be recognized as consultants by providing documentation to Wellmark Channel Management from the group recognizing the Agency as a consultant. All decisions regarding Wellmark’s activities with consultants are made at the discretion of Wellmark Sales Leadership. In the case of a producer that is acting as a consultant for a group that is a direct Wellmark account, the consultant can only be compensated by the employer group and is assigned to work with a Wellmark Employed Sales Staff member. All quotes for the group must be obtained through the Wellmark Employed Sales Staff member. In no case, will Wellmark release group information or provide online access to group information to an entity acting as a Consultant unless the group:

• Provides Wellmark with the group’s authorization to release information to the Consultant, which authorization may be documented by the group submitting a written authorization to the group’s Wellmark Employed Sales Staff that states that Wellmark may release employer group information to the group’s Consultant; or

• Through its Designated Security Coordinator (which must be an employee of the group), provides the Consultant with an employer user ID and password that provides the Consultant with access to online information that is provided by Wellmark to the group through Wellmark’s Employer Portal.

For information regarding Wellmark’s options for billing and payment of service fees agreed to between employers and consultants, refer to the Consultant Connection at Wellmark.com.


Assignment of Commissions As is more fully set forth in the Exhibit A Commission Schedules attached to Wellmark’s General Agency Agreements and Sub-Retail Agency Agreements, health insurance policies sold on a “per contract per month (“PCPM”)” basis for which a Sub-Retail Agency is the AOR are sold pursuant to a commission structure that provides for:

• A PCPM Sub-Retail Commission to be paid to the Sub-Retail Agency • A PCPM Override Commission to be paid to the General Agency; and

• A PCPM “Pay for Performance” Commission to be paid to the General Agency. This section is not applicable to compensation arrangements between Retail Agencies and their Agents.

Sub-Retail Commission Assignment Sub-Retail Commissions earned by the Sub-Retail Agency are currently being paid by Wellmark to the General Agency to hold in Trust as Wellmark’s Commission Payment Administrator for the benefit of the Sub-Retail Agency. The General Agency, as part of the training, administrative and other supportive services provided by the General Agency to the Sub-Retail Agency, is obligated to act as Wellmark’s Commission Payment Administrator and must, within thirty (30) calendar days of receipt from Wellmark, remit the entire Sub-Retail Commission to the Sub-Retail Agency that is the AOR for the policy, unless:

• A separate agreement for the assignment of Sub-Retail Commissions to the General Agency exists; and

• The General Agency and the Sub-Retail Agency comply with any Agency Manual Requirement to complete, sign and submit a Sub-Retail Commission assignment or other form to Wellmark to disclose any such assignment of all or a portion of the Sub-Retail Commission.

However, the assignment of Sub-Retail Commissions to a General Agency is only permissible to compensate a General Agency for services not outlined in Exhibit C (which is also Attachment 1 to the Sub-Retail Agency Agreement) to the General Agency Agreement. General Agencies and Sub-Retail Agencies may not agree to assign any portion of Sub-Retail Commissions to the General Agency as compensation for services outlined in Exhibit C to the General Agency Agreement, for which the General Agency receives compensation from Wellmark. A Sub-Retail Commission Assignment Form (an example of this form is included at the back of the Agency Manual) must be completed, signed by both the General Agency and Sub-Retail Agency and submitted to Wellmark in order to disclose any instance in which the Sub-Retail Commission earned by a Sub-Retail Agency is not fully paid to and fully retained by the Sub-Retail Agency. In the event of any assignment of commissions, the Sub-Retail Agency remains the Agent of Record on the business.


Override Commission Assignment The Override Commission is paid by Wellmark to the General Agency and is to be retained by the General Agency. A General Agency is prohibited from sharing the Override Commission with the Sub-Retail Agency in any circumstance. A General Agency cannot induce a Sub-Retail Agency by any means. These actions are strictly prohibited and may be punishable up to and including termination of the General Agency.


Commission Administration

Wellmark is committed to ethical business practices and full disclosure of Agent compensation to customers. Wellmark believes in “fully transparent” producer compensation, which means that customers have a right to know what their Agent or consultants are being paid for servicing their products. Wellmark encourages Agents to share their compensation arrangements with Wellmark customers. The commission rates, as set forth on the “Exhibit A Commission Schedule” to an Agency’s Wellmark Agency Agreement, are applied to all new and currently enrolled business. Wellmark may amend the “Exhibit A Commission Schedule” from time to time upon thirty (30) days advanced notice in accordance with the terms outlined in the Agency Agreement. Notice of the amendment may be sent electronically via DocuSign to the Agency’s email address for notice purposes or by any other notice method permitted by the Agency Agreement. (See the “DocuSign” section for more information on accessing electronic notices of amendment.) “PCPM” Commission Rates set forth on the “Exhibit A Commission Schedule” to an Agency’s Wellmark Agency Agreement refer to “Per Contract Per Month” commission rates, and the applicable contract count for each monthly “PCPM” commission calculation shall be as determined by Wellmark pursuant to its then applicable standard monthly contract count policies and procedures, which policies and procedures may be subject to change from time to time in Wellmark’s sole and absolute discretion. Wellmark supplies a monthly accounting of all commissionable activity for each Agency’s assigned block of business. Note: If Wellmark has paid commissions and an enrolled member or group does not pay their premium, Wellmark reserves the right to recoup any commission overpayment. Wellmark will provide the following to the Retail Agencies and General Agencies:

• Monthly statement detailing activity and the commission paid; • ACH commission remittance; and • Informational memos.

Fully Insured Group Business Commissions will be paid monthly to the General Agency or Retail Agency, as applicable. For small group business, commissions on new policies will be paid for a full 12 months from the group’s original effective date based on the commission schedules in effect during that 12 month time period, which commission schedules are subject to change from time to time. Wellmark will


pay the applicable new group commission rate until each account’s renewal effective date is reached. For large and mid-sized group fully insured business, commissions will be paid for 12 months from the group’s effective date as documented on the Commission Allocation Exhibit. The commission rate on large group business must be re-evaluated at each group’s renewal date.

Individual Business Commissions will be paid monthly to the General Agency or Retail Agency, if applicable. Changes in benefits, addresses, billing modes, etc., on existing individual business constitute neither a new sale nor a transfer. Therefore, these changes do not affect the commission paid for the individual business. Note: For individual applications received without an Agent number or with an illegible Agent number, payment of commissions may be delayed due to necessary research needed to determine the correct Agent. Individual applications without an Agent signature and Agent number may be placed in a Wellmark direct account with no commissions paid until an AOR request is received and processed. Under 65 Policy New Business Commissions are paid for a new individual policy for 12 months under the

following conditions:

• The applicant had prior coverage with another carrier; • The applicant had prior coverage with a Wellmark employer group; • The applicant had prior coverage as a dependent on an existing

Wellmark policy, and is obtaining coverage as the primary contract holder due to a qualifying event such as a death or divorce; or

• The applicant had no prior coverage.

Renewal Renewal commissions are paid for an individual policy under the following conditions:

• Transitioning an applicant from an existing Wellmark individual policy to a new Wellmark plan.

• The applicant is in the 13th month or greater of individual coverage.


Over 65 Policy New Business New commissions are paid for Medicare Supplement for 12 months only if:

• The applicant had prior under-age-65 coverage with another carrier; • The applicant had prior under-age-65 coverage with a Wellmark employer

group; • The applicant had prior individual under-age-65 coverage with Wellmark;

or • The applicant had no prior coverage.

Medicare Part D new commissions are paid in accordance with CMS guidelines.

Renewal • Medicare Supplement renewal commissions are paid if the applicant is in the 13th month or greater of coverage.

• Medicare Part D renewal commissions are paid in accordance with CMS guidelines.

Replacement Renewal commissions are paid for replacement policies as follows:

• The applicant had previous group or individual Medicare Supplement coverage with another carrier and has purchased Medicare Supplement coverage with Wellmark;

• The applicant had previous group Medicare Supplement coverage with Wellmark and has purchased individual Medicare Supplement coverage with Wellmark; or

• For purposes of Medicare Supplement commission, first year commission or compensation rates are applied only if there is no existing Medicare Supplement policy in force either with Wellmark or any other replaced insurer.

Commission Adjustments Regardless of the type of business, retroactive adjustments to commission payments will only be made retroactively for up to ninety (90) days with respect to added or deleted contracts/members for a group, and all other commission adjustments will only be made for a period of twenty-four (24) months. Example: A discovery by Wellmark in March of 2016 that commissions had been incorrectly paid because of incorrect information for added or deleted contracts/members for a group, adjustments would be made for the prior 90 days – going back to December of 2015. For all other commission adjustments, a discovery by Wellmark in March of 2016 that commissions had been underpaid or overpaid since January of 2013 would only allow correction retroactively to March of 2014.


Payments to Sub-Retail Agencies and Assigned Agents As long as Wellmark elects to distribute Sub-Retail Commissions to the designated General Agency, it is the responsibility of each General Agency to distribute timely payment of all Sub-Retail Commissions to its assigned Sub-Retail Agencies (within 30 days of receipt of commissions from Wellmark). Wellmark provides monthly statements on the Producer Connection to the Sub-Retail Agencies detailing activity and the commission earned.

Producer Incentive/Recognition Programs

From time to time, Wellmark may announce opportunities for earning additional compensation through a Producer Incentive/Recognition Program. Producer Incentive/Recognition Programs are designed to reward Agents and Agencies for excellent performance in sales, retention, and service for Wellmark customers. The rules, policies, terms and conditions of each program will be included in any Producer Incentive/Recognition Program announcement. All producers must comply with terms and conditions of their Wellmark Agent, or Agency Agreement, and this Agency Manual to be eligible for any compensation described in such a program. Agents and Agencies are responsible for complying with all applicable state and federal statutes and regulations related to the sale of Wellmark products and reporting of producer compensation for federal, state, and local income taxes. Wellmark may modify or terminate any or all Producer Incentive/Recognition Programs at any time and for any reason without prior notice. Wellmark is committed to ethical business practices and full disclosure of Agent and Agency compensation to customers, including eligibility for Producer Incentive/Recognition Programs. Wellmark has the sole and absolute discretion to interpret the terms of any Producer Incentive/Recognition Program and to determine amounts payable under any such program.


Promotions

General Promotional Requirements As an authorized Agent for Wellmark, you help us keep our promises with our members and improve the health and well-being of the communities we serve. Your ability to effectively market and promote yourself and Wellmark are important for mutual growth. To maintain the integrity of the Wellmark brand, we have developed these promotional requirements. Adhering to the requirements will protect Wellmark's reputation and make your job of selling that reputation easier by promoting our products and services in ways that do not misrepresent our company or mislead our members. As a licensee of the Blue Cross and Blue Shield Association (the “Association”), Wellmark and all of its representatives (Wellmark Employed Sales Staff, Agencies and Agents) must follow specific promotional material requirements and restrictions set forth by the Association and the Iowa and South Dakota Insurance Divisions. The following requirements regarding promotional materials are intended as a non-exhaustive guide. These instructions apply to all Agencies and Agents. If any Agency has questions about this process, please consult Wellmark Employed Sales Staff. Sub-Retail Agencies with questions about this process may consult with their assigned General Agency, or contact Wellmark Employed Sales Staff. An Agent must represent himself/herself as “an Authorized Independent Agent for Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., or Wellmark Blue Cross and Blue Shield of South Dakota” An Agent cannot represent himself/herself as an “employee” of Wellmark or Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., or Wellmark Blue Cross and Blue Shield of South Dakota.

Promotional Materials Wellmark is pleased to offer convenient, speedy delivery on a wide assortment of promotional materials including: corporate-image and benefit brochures, benefit highlight sheets, health and wellness educational material, and personalized marketing and direct-mail materials. Agents/Agencies may order the most up-to-date material through the Sales Toolkit located in the Producer Connection of www.wellmark.com.


Agents/Agencies may not develop their own materials (brochures, benefits documentation, etc.) to promote Wellmark, its subsidiaries and/or its products without Wellmark’s prior approval. Wellmark’s affiliation with the Blue Cross and Blue Shield Association and regulation by the Iowa and South Dakota Insurance Divisions hold Wellmark to a stringent use and approval process. Agents/Agencies shall not issue or circulate any publication, electronic communication, website, written advertising, pamphlets, tabulations, schedules, proposals, illustrations, or any other materials or information or any other media of any type bearing the names or trademarks of Wellmark, or the names or trademarks of Wellmark’s products or services, or of the Blue Cross and Blue Shield Association without the express written approval of Wellmark. If an Agency has suggestions for the development of materials not currently available, please contact the Wellmark Employed Sales Staff. Wellmark relies on the feedback of the entire distribution team to develop materials that meet customers’ needs.

Website All proposed display of any Wellmark information on an Agent or Agency’s website, including the Wellmark Blue Cross and Blue Shield name and logo, and product information, or any other promotional information related to Wellmark products or services must be approved by Wellmark. At Wellmark’s option, Wellmark is entitled to have the Wellmark Blue Cross and Blue Shield name and logo displayed on the Agent’s website, if an Agent website exists. An electronic file containing the appropriate language and logo for Wellmark Blue Cross and Blue Shield will be provided by Wellmark, at Wellmark’s expense. If the Agent chooses, the Wellmark logo on the Agent’s website may link to the home page of Wellmark.com. The Agent is not authorized to link to any other page within Wellmark.com without prior written consent from Wellmark.

Telephone Directories An Agent/Agency may not create a telephone directory or similar directory advertisement under the listing or heading of “Blue Cross and Blue Shield”, “Wellmark”, “Wellmark Blue Cross and Blue Shield of Iowa”, “Wellmark Blue Cross and Blue Shield of South Dakota”, or similar wording.

Letterhead, Envelopes & Business Cards An Agent/Agency may not display the Wellmark Blue Cross and Blue Shield name or logo on letterhead or envelopes. Wellmark authorization is required for use of the logo on business cards.

Signage Signage containing the Wellmark Blue Cross and Blue Shield name or logo on automobiles or vehicles of any sort is not allowed. Wellmark authorization is required for use of the logo on office and building signage. Any signage that uses the Wellmark name or logo must receive prior authorization from our Brand Communications Team. An electronic proof for all customized


signage must be submitted to Wellmark for written approval prior to production. Proofs must be submitted to [email protected].

Specialty Items Specialty items (materials with the Wellmark logo such as pens, pencils, bandage holders, etc.) are available in small quantities for health fairs, trade shows, and other highly visible, image-building events. To discuss the purchase of larger quantities, contact the Wellmark Employed Sales Staff. A complete catalog of items is available under BlueStore Online within the Sales Toolkit located in the Producer Connection on Wellmark.com.

Advertising Use of pre-approved advertising is required. Pre-approved advertising materials are available on the Sales Toolkit within the Producer Connection on Wellmark.com. To make sure all advertising is compliant and current; all advertising must be downloaded directly from the Sales Toolkit prior to use. In addition, if an Agent would like to use existing advertising from the previous calendar year, it must be resubmitted for approval prior to placement. The advertising contained on the Sales Toolkit has been designed to allow the Agent to personalize the ads with current Agent photos, Agency name, and address and phone number (where applicable). The design, format, wording, logos and references to Wellmark may not be altered or omitted on any pre-approved materials. The content of these advertising materials has been developed to adhere to regulatory requirements and Blue Cross Blue Shield Association licensure requirements. Any alteration of the materials may inadvertently cause misrepresentation of Wellmark, Wellmark’s health insurance products, or Wellmark’s relationship with Agents and Agencies. An Agent/Agency may not produce or publish, or cause to be produced or published, its own Wellmark advertisement without obtaining prior authorization from Wellmark’s Brand Communications Team. An electronic proof for all customized advertising must be submitted to Wellmark for written approval prior to production. Proofs must be submitted to [email protected]. Advanced planning is required, allowing sufficient time for Wellmark to review the advertisement, make any necessary changes, and file the advertisement with the insurance division. This is particularly important with regard to Medicare advertisements, which have additional regulatory guidelines. Most media vendors also have deadlines well in advance of the targeted in market date.

• For review and approval of non-Medicare advertisements, please allow for 10 business days.

• For review and approval of Medicare advertisements, please allow for 20 business days.



Cooperative Advertising Program Wellmark has developed a Cooperative Advertising Program to help eligible Retail Agencies and General Agencies promote their relationship with Wellmark using pre-approved materials. Contracted Agencies receive an annual pool of dollars to apply from Wellmark’s Cooperative Advertising program. Sub-Agents should discuss their eligibility and allotments with their contracted Agency representative. Wellmark will directly reimburse contracted Agencies for 50 percent of the cost of eligible cooperative advertising purchased by their Sub-Agents that meets all established requirements, up to the annual allotment amount. Contracted Agencies will then distribute reimbursement amounts to the appropriate Sub-Agents. The Sales Toolkit on Wellmark.com contains links to the Cooperative Advertising Program guidelines as well as current pre-approved materials. Unless otherwise approved in advance in writing by Wellmark’s Brand Communications Team, the only materials eligible for reimbursement under the program are those contained on the Sales Toolkit. In addition, materials used in previous years, but not on the current Sales Toolkit, do not automatically quality as pre-approved and must be reviewed for compliance before each use. Wellmark will directly reimburse contracted Agencies for 50 percent of the eligible cost. Wellmark will continue to reimburse contracted Agencies until allocated dollars for the year have been depleted. Once the annual co-op allotment has been depleted, Independent Agents or Contracted Agencies are responsible for the full cost of all advertising and direct mail. Items Eligible for Reimbursement: • Print ads • Radio commercials • Out-of-home ads (i.e. billboards, gas pump toppers, transit ads) • Digital ads (i.e. online and mobile display/banner ads) • Direct mail • Social media ads (i.e. ads and promoted posts on Facebook, Twitter and LinkedIn) Items Not Eligible for Reimbursement: • Telephone directory advertising (White or Yellow Pages) • Television advertising • Community or event sponsorships, including signage on scoreboards, or office and building

signage • Sales promotion materials • Specialty items (pens, t-shirts, golf items, etc.) • Trade show or event exhibits


Reimbursement Guidelines Agencies/Agents may request reimbursement by using the Cooperative Advertising Reimbursement Form. The form is available to download from the Sales Toolkit in the Producer Connection on Wellmark.com. Independent Agents should submit the reimbursement form and proper supporting documentation, outlined below, to their contracted Agency. The contracted Agency will review the reimbursement request and forward it to Wellmark for reimbursement. Requests for reimbursement must be submitted to Wellmark within 90 days after eligible advertising has appeared or direct mail pieces were mailed. Please email reimbursement forms and supporting documents to: [email protected]. Completed forms and supporting documents may also be sent to:

Coop Advertising Reimbursement Wellmark Blue Cross and Blue Shield 1331 Grand Avenue, Station #3W713 Des Moines, IA 50309

Wellmark’s budget year ends on December 31st. All coop reimbursement requests for expenses incurred in the current calendar year must be submitted by December 15th of each year to be reimbursed through that year’s cooperative budget. All reimbursement requests must include a copy of the paid invoice and the supporting documentation outlined below:

1. Print Ad Reimbursement Guidelines – To be eligible for reimbursement, a full-page tear sheet of the newspaper page or magazine page containing the ad must be submitted with the reimbursement forms and invoice. Print ads must be placed in publications that have published rate cards.

2. Radio Commercial Reimbursement Guidelines – Radio commercials must air on radio stations that have published rate cards. All scripts must be produced as written, and may not be altered or information omitted. The original Affidavit of Performance provided by the radio station must be submitted along with the reimbursement form and invoice to qualify.

3. Out-of-Home (Billboards) Reimbursement Guidelines - Out-of-home advertising must be

placed through outdoor vendors that have a published rate card. A photo of the ad must be submitted along with the invoice and form to qualify for reimbursement. Only media costs will be reimbursed, not the production costs to produce the board.

4. Digital Advertising Reimbursement Guidelines - Digital advertising must be placed through vendors that have a published rate card. A screen grab of the digital ad, as it appears



on the website, must be submitted along with the invoice and reimbursement form to qualify.

5. Social Media Advertising Reimbursement Guidelines – Social media advertising must be placed on a social media channel with an advertising platform and comply with the advertising and/or promoted post guidelines of that particular social media channel. In addition, social media ads must include authorized Wellmark agent disclosure in the copy of the post – not within the image used in the post. The only exception to this is Twitter; the agent disclosure is allowed within the image only on Twitter. A screen grab of the social media ad, as it appears on the social media site or feed, must be submitted along with the invoice and reimbursement form to qualify.

6. Direct Mail Reimbursement Guidelines - To be eligible for reimbursement, direct mail campaigns must follow these guidelines:

a. The goal of the piece must clearly be to generate sales. b. The piece must solely promote Wellmark products and/or services (along with

the Agency/Agent name that can sell them those Wellmark products/services). c. Printing and postage for the direct mail piece are the only reimbursable costs. d. The direct mail piece must be sent to [email protected] 30 days

prior to printing for approval. When sending the direct mail piece in for approval, you must include this information or it will not be considered:

i. Goal/intended outcome of the piece ii. Audience who will receive the piece

iii. Timing of when it will be mailed

Reimbursements will be declined if: • The reimbursement request does not include the appropriate documentation listed in the

previous paragraph; • It is for an ad that is not part of the current pre-approved ads available on the Sales

Toolkit; • It is an ad created by the Agent that was not approved by the Wellmark Brand

Communications Team prior to placement in the current year; • It contains incorrect Wellmark Blue Cross and Blue Shield branding; • The advertisement or direct mail piece includes competitive brand names or products; • It is one of the items that does not qualify for reimbursement (listed on the previous

page); • The reimbursement request is not submitted within 90 days after eligible advertising has

run; or • The annual coop allotment has been depleted by the Agency or Agent.

For more information about the Cooperative Advertising Program, please email [email protected] or visit the secured Coop Advertising Program guidelines under the Sales Toolkit on Wellmark.com.


Exhibits Exhibits include: • AOR Transfer Request – Group Policy [M-4317] • AOR Transfer Request – Individual Policy [M-4315] • Assignment of Sub-Retail Commission Form [M-2318235] • Commission Allocation Exhibit for Fully Insured Group Business 51+ • Change of Assigned Agent Form [M-53906] • Agent Information Fact Sheet [M-53902] • Sub-Retail Agency Information Fact Sheet [M-53911]












DocuSign DocuSign is a third party application used by Wellmark to provide a quick, easy and secure method for electronic signing of Agency and Agent Agreements and Commission Allocation Exhibits. Wellmark also uses DocuSign for electronic distribution of Amendments to the agreements, such as updated versions of the “Exhibit A Commission Schedule”. This section provides information about the DocuSign process. IMPORTANT NOTE: To ensure you will receive all Wellmark notices and documents sent electronically via DocuSign, please adjust your email and/or firewall settings to allow emails from [email protected]. Receiving an Email Notification The process begins when you receive an email requesting that you electronically sign a document. The email is sent by DocuSign on behalf of the Wellmark employee who initiated the request. (See Illustration 1) The contents of the email will provide information about the document sent to you and tell you what actions are needed. It will also include the Wellmark sender’s contact information in case you have questions or need assistance with the DocuSign process. (See Illustration 2) Illustration 1 Example of how a DocuSign email request may appear in your email “Inbox”.



Illustration 2 Example of DocuSign email contents after email has been opened.

To access the document(s) sent by Wellmark, click “View Documents”. A new web browser window will open which will connect to the secure DocuSign website and display the Request for Signature page. (See Request for Signature section for next steps.) (Note: See Illustration 3 for an alternate approach for accessing the document(s) from the DocuSign web site.)

Security code to access documents

via DocuSign


Illustration 3 Alternate Approach to Access Documents In your web browser, go to the DocuSign web site at www.docusign.com. Click on the Access Documents link to open the Access Your Document window, enter the security code that was sent to you in the DocuSign request email and click “Go”.

http://www.docusign.com/


Request for Signature Page The Request for Signature page provides information about the sender and the document(s) being sent to you. It also provides the consumer disclosure, which covers conducting business electronically with the sender. Review the disclosure, and then click in the checkbox to consent to use electronic records and signatures. Next click the Review Document box to open the document(s) sent to you. (See Illustration 4) Important! You must consent to use electronic records and signatures in order to view and sign the documents. Illustration 4 Example of Request for Signature Page

Signing or Acknowledging Receipt of the Document Once you have completed the above steps, the first page of the document sent will show in the window. The yellow indicator on the left side of the document is used to guide the signer through the process of filling in/signing and or acknowledging receipt of the document. Click “START” to begin the signing process. The indicator will change to a “NEXT arrow which, upon clicking, will direct the signer to the next area of the document that requires information to be filled (if applicable) or requiring a signature or acknowledgement. To sign the document, click the “Sign Here” tag. If it’s the first time signing a document in DocuSign, the signer is asked to adopt their signature and initials (see Illustration 5). To adopt a signature, the signer should:


• Verify the name and initials in the “Adopt Your Signature” window are correct (and change them as needed by typing in the Full Name and Initials fields).

• Click on the “Change Style” to change to a different pre-formatted signature style

(optional). • Click “Adopt and Sign” to adopt and save signature information and return to the

document. Illustration 5 Example of the “Adopt Your Signature” window.

Complete Signing After the signer has completed all required steps in the signing process, the arrow indicator will change to a “Confirm Signing” indicator (See Illustration 6). Click “Confirm Signing” to save the signature and any other information entered.

Click link to view/select other styles


Illustration 6

Next, your signing information is saved and a “You have completed your documents” window will open (See Illustration 7). You will have the option to download or print the signed document and create a DocuSign account. You can bypass these options because you will be emailed PDF copies of the documents for your records. To bypass the above options, simply click on the “X” in the upper right hand corner to close the message window. Illustration 7 Example of a “Completed” message window.

When you see the “You have completed your documents!” message, you are done. Check your email inbox for a “Completed” email confirmation. This email will have the PDF copies of the documents attached which you can save or print for your records.


Our goal in developing this Agency Manual of administrative guidelines is to help

ensure superior service to prospective customers and members of Wellmark. The

group and individual market information contained herein will aid you in selling our

products and maintaining and retaining business placed with our Company. Thank

you for contracting to represent Wellmark. We look forward to working with you

and building a mutually successful relationship!

Date post:	29-May-2020
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