For Brokers
Showing all 139 FAQs

Are AHS plans available to my Small Group clients?
No, AHS’s Dental, Accident, Critical Illness, and Life plans are only available for members under 65 years old with Individual & Family Plans.
Does AHS have a broker portal?
It does! AHS Agent Back Office is your one-stop business portal to see and search your book of business. Create your account when you get appointed. Once you have your account, just sign in.
How can I sell Allstate Health Solutions (AHS) plans?
How can I update my commission payment method?
How do I access my broker account?
Log in here with your email address and password to access your Oscar Broker account, including enrollment tools, commission statements, and more.
Haven’t logged into your account before, or aren’t sure if you have one? Create an account here.
To get up to speed on all things portal, visit our Broker Training library for guides, or watch our Broker Portal video tour to see exactly how to navigate your new account.
How do I get appointed to sell AHS if I have an Oscar Broker Account?
How do I update my agency and general agency affiliation?
To update your agency affiliation: If you have not submitted an appointment yet, you can update your agency affiliation form here (opens in new tab).
If you have already submitted an appointment, please contact brokers@hioscar.com with the following details:
Please note that if the effective date of the change has passed, we will not be able to retroactively change any commission payments that have already been assigned and released.
To update your general agency affiliation: We allow general agency affiliation changes annually between August and October, taking into effect on January 1 of the following year. Please contact brokers@hioscar.com with the following details:
Please note that if the effective date of the change has passed, we will not be able to retroactively change any commission payments that have already been assigned and released. It takes two weeks to implement the change. During that time, we'll notify the old GA and the new GA of the transition.
How do I update my personal information?
You can update your personal information in your Oscar Broker account.
If you are changing your name: To ensure that commissions are processed accurately, please make sure that your name and NPN match what is listed in NIPR’s database. If you are unsure what your NPN is, please visit [www.nipr.com/PacNpnSearch.htm][3].
If you are the principal of your agency and wish to make a change to the agency’s address, you can make this change on your Agency details page at [business.hioscar.com/account/info/agency][4].
[1]: http://business.hioscar.com/ [2]: http://business.hioscar.com/account/info/broker [3]: https://www.nipr.com/PacNpnSearch.htm [4]: https://business.hioscar.com/account/info/agency
I can’t enter my license information. It keeps erroring out. What should I do now?
After entering your or your agency’s license number on the 'Request appointment' page, you may see an error message indicating that the license number is not valid or that there was an error. This could be for a few reasons:
I didn't get an email confirmation. What do I do now?
We currently send two different confirmation emails from your Oscar Broker account. Be sure to check your spam folder for emails from brokers@hioscar.com or commissions@hioscar.com. Otherwise refer to each specific email below:
Account activation email
This email is sent during the account creation process. If you are a broker who is already appointed with Oscar, we require you to activate your account via email. The email will have the subject line 'Action Required: Complete your Oscar Broker account setup' and will be sent from brokers@hioscar.com. If you did not receive the email, it may be because we have a different email on file for your account. Please reach out to brokers@hioscar.com to confirm the email on file.
Account verification email
This email is sent at the end of the account creation process. If you are not already appointed with Oscar, and you are creating your Broker account, you will be requested to verify that the email entered is valid. The email will have the subject line 'Action Required: Verify your email address' and will be sent from brokers@hioscar.com. If you did not receive the email, but you can login to your Broker account, click the 'Resend email' link on the red header on your My Account page.
If you cannot login it may be because we have a different email on file for your account. Please reach out to brokers@hioscar.com to confirm the email on file.
I need to update my email address. How do I do that?
You can update your email address in your Oscar Broker account.
If you are the principal of your agency and wish to make a change to the agency’s email address, you can make this change on your Agency details page at business.hioscar.com/account/info/agency (opens in new tab).
I need to update my name. How do I do that?
You can update your name in your Oscar Broker account.
To ensure that commissions are processed accurately, please make sure that your name and NPN match what is listed in NIPR’s database. If you are unsure what your NPN is, please visit https://www.nipr.com/PacNpnSearch.htm (opens in new tab).
In what states can I sell AHS plans?
You can sell them in every state they’re offered. Here’s info on where each plan is available:
See all of the state availability here as well.
I’m selling supplemental plans to my Covered California clients. What useful information should I be sharing with them?
Here’s what you need to make clear:
While explaining these details is only required in the state of California, it’s also helpful for all of your clients to know.
What AHS plans can I sell?
You can sell AHS Select Dental PPO, Dental Indemnity, Cancer and Heart/Stroke, Term Life, or Plan Enhancer plans. See the ‘Product and State Availability PDF’ for more info.
What can I do in my Oscar Broker account?
Oscar provides a fully digital, self-service tool for brokers and their teams to have access to everything they need to work with Oscar.
Your Broker account (opens in new tab) allows you to easily:
What is a Plan Enhancer?
Plan Enhancers fill gaps that primary health insurance doesn’t cover. These affordable, high value plans start with Accident Medical Expense coverage and have optional Cancer & Heart/Stroke (CHS) and Sickness Hospitalization (SIP) riders available in some states.
What is the commission and bonus structure and how will I be paid out?
Check out the commission schedule for all the details. (You’re gonna like it.)
When will I receive my commissions?
Oscar releases commission payments monthly around the third week of the month. You should receive an email confirming your payment was released. If you do not receive your monthly commissions, please check the Commissions page in your Broker account (opens in new tab) or reach out to commissions@hioscar.com.
Where is my commission? Where are my agency's commissions?
If you are appointed through Oscar directly (not through an agency), you can view your commission payment statements through the Commissions page in your Broker account (opens in new tab). You can also update your commission payment method (opens in new tab) in your Broker account.
If you are appointed through an agency, your commission payments are sent to your agency. If you’re not sure if you are appointed through an agency, you can check your appointments on your Broker account (opens in new tab).
If you are the principal of your agency, then you will be able to access your agency’s commissions information via your Broker Account.
Why am I being asked for my W-9?
Oscar requires your completed and most up-to-date W-9 on file in order to pay commissions.
If you are writing business directly with Oscar, we will need your personal W-9 with your personal Tax ID Number (Social Security Number). You can upload this by logging in to your Broker Account (opens in new tab) and clicking on ‘My account’ in the top right Menu bar. In your ‘My account’ page, click on ‘Payment requirements’ in the ‘My details’ section, then submit your W-9 and update your Tax Identification Number.
If you are an agency principal, we will need your business’s W-9 with your agency’s Tax ID Number (Employer Identification Number). You can upload this by logging in to your Broker Account (opens in new tab) and clicking on ‘My account’ in the top right Menu bar. In your ‘My account’ page, click on ‘Payment requirements’ in the ‘Agency details’ section , then submit your W-9 and update your agency’s Tax Identification Number.
Does the Commission view show bonus payment statements?
We do not display bonuses in the Broker Account tool. For a copy of your bonus statement or general questions, please reach out to brokers@hioscar.com.
How do I access my commission statements?
Log in to your Broker account (opens in new tab). Once you have logged in, click on top right 'Menu' bar, then click on the Commissions option. You can also access the Commission view page directly at https://business.hioscar.com/commissions (opens in new tab).
The Commission view page will show all of the monthly direct commission payments you have received from Oscar. Click on any month to expand and display payment details. If you assigned commissions to an agency, please reach out to the agency for commission details.
In the expanded view, click on 'Download statement' to access your commission statement.
Your statement will detail approved and blocked commissions (opens in new tab). Blocked commissions also include an error reason, such as the member did not pay their monthly bill.
How do I view and update my current commission payment method?
If you are a broker, you can do this by logging in to your Broker Account (opens in new tab) and clicking on 'Payment requirements' in the My details section. If you need to update any information, you can enter it on this page and then hit 'Save changes'.
If you are an agency principal, you can do this by logging in to your Broker Account (opens in new tab) and clicking on 'Agency payment setup' in the Agency details section. If you need to update any information, you can enter it on this page and then hit 'Save changes'.
How many commission statements does the Commission view show?
The Commission view shows details and statements for all commissions paid directly from Oscar. There is no limit to the number of statements shown, but will not include any commissions paid indirectly. If you are looking for help with commissions paid through an upline agency or General Agency, please reach out to your upline.
The Commission view in my Broker account says that I was paid my commission, but I didn’t receive it. What should I do?
Please contact brokers@hioscar.com. If you elected for ACH payments, there is a chance that the payment was returned in our bank due to invalid ACH account information. If you elected for check payments, there is a chance your check was mailed to a dated address. To avoid this, please ensure your payment information is up to date in your Broker Account (opens in new tab).
What do each of these commission payment statuses mean?
When can I expect my 1099 tax form from Oscar?
Oscar will provide a 1099 form in early February. This will include details for your commissions earned from the previous year and Oscar’s EIN information.
When can I expect to see my small group commission details in the Commission view?
Soon! We’re working on this product and will let the broker community know once it’s live.
Why wasn’t I paid commission? Why is my commission payment showing as Blocked?
Commissions may be blocked for a variety of reasons, like the member did not pay their monthly premium on time or we’re missing the broker’s information on the enrollment application. As a reminder, members must pay their premium by the first of the month in order for commissions to be remitted in a timely fashion. If Oscar receives the member’s premium payment late, commissions for the policy will remit during the following month. You can check the block reason on your most recent commission statement. If you are missing commissions for a policy or need more information on blocked commissions, please reach out to brokers@hioscar.com.
Visit our COVID-19 Resource Center
Click here (opens in new tab) to visit the COVID-19 Resource Center
On this page you'll find:
After I submit the enrollment, will the client automatically be listed in my Individual Book on the Oscar Broker Portal?
Once the enrollment is completed, it takes the Marketplace 24-48 hours to send the enrollment back to Oscar. You can expect to see the client in your book of business 1-2 days after completing the EDE application.
Getting started with the Broker Portal
Create an account (opens in new tab) and log in to the Oscar Broker Portal. If you plan to enroll members through Oscar’s EDE platform, you will need to take additional steps to verify your identity within the platform to complete your registration.
If you see the following message at the top of the screen within your Broker Portal account, you have not yet verified your identity. You will be unable to enroll clients until you complete your broker registration and verify your identity. These additional steps are easily completed once you select “Click here” in the banner.
How can I get hands-on help with Oscar’s EDE Platform?
We can help! Watch a Oscar EDE Platform 101 recorded webinar training at hioscar.com/brokers/training (opens in new tab) or read our Quick Start Guide (opens in new tab).
How do I submit the binder payment for my client?
After you enter the electronic signature to confirm the client’s plan selection, you’ll see a page with the plan name, start date, and premium amount with the option to Pay the first premium now. This will direct you to Oscar's secure payment site to make the binder payment.
How long is the enrollment process?
Enrolling a client in their health plan should take 10-30 minutes. The more information you have on hand and ready to go, the faster the enrollment process.
If I complete enrollments through HealthSherpa, will they be visible in my Oscar Broker Portal dashboard?
Your entire book of Oscar business will be viewable in your Oscar Broker Portal book of business. However, you will not be able to manage enrollment activities for any applications submitted through HealthSherpa directly. Only the Oscar Broker Portal gives you the ability to manage both your book of business and your enrollment/renewal application statuses.
I’m encountering an error when attempting to enroll a client on Oscar's EDE platform. What should I do?
Even with an existing Broker Portal account, you may still need to complete your registration on Oscar’s EDE Platform. To do this you will need to:
Once you complete these steps, you’ll be routed back to your enrollment in progress.
I’m experiencing an issue within the renewal flow for my Florida clients in which subsidies are not populating. What should I do?
As of Tuesday morning, November 5, 2024, we have resolved a reported Florida Plan Display issue within the Oscar Renewal Flow in which subsidies were being applied yet eligible CSR & CSR $0 deductible plans were not populating. Please follow your standard processes.
To report new issues, submit a Broker Support Request. Log in to your Oscar Broker Portal (opens in new tab) account and navigate to ‘Report an issue’ in the top right Menu bar. A new page will open for you to submit a Broker Support Request. Complete all required fields accurately to help us process your request. Attach any relevant documents, and click Submit. Oscar’s Broker Support Team will respond as soon as possible.
I’m getting an FFE ID error. What do I do?
Log in to your Broker Account (opens in new tab) and click on ‘My Account’ in the top right Menu bar. On your ‘My Account’ page, click on ‘Basic details’ in the ‘My Details’ section. Review the existing information, including FFE ID and name to confirm they are correct. If any of these identifiers do not match the identifiers in your error message, navigate to 'Report an issue' in the top right Menu bar of your Broker Account. A new page will open for you to submit a Broker Support Request.
In the Broker Support Request, enter your name, email address, and NPN. Select and enter the following details:
Click Next. Upload any files that may be useful to the Broker Support team. Click Submit.
This submission will be confirmed through an email response with an assigned case number and Broker Support will advise on a resolution. !Screenshot 2024-11-03 at 3.04.47 PM
I’m in the Explore Other Plans feature with a renewing member and do not see expected subsidy amounts reflected. What do I do?
If you are in the Explore Other Plans experience for a renewing member, you will not see the member’s subsidy amount carry over. You will need to confirm and add your client’s income to ensure the qualifying subsidy is reflected in the plan quote.
I’m renewing members who have no plan changes. Are there any steps I need to take?
No action is needed! Your member will enroll into plan year 2025 automatically and be notified by both Oscar and CMS.
What client information will I need to submit the enrollment?
To submit the enrollment, you will need the following client information:
What if I have not completed FFM training for plan year 2025?
Brokers must complete registration and required training for the upcoming plan year in order to assist consumers with the Marketplace.
If you are new to the Marketplace, you'll want to create an account with CMS and register for training. You can view more information for new agents here (opens in new tab).
What is an EDE platform?
The preferred EDE or “Enhanced Direct Enrollment” streamlines the subsidy application by enabling individuals and brokers to complete a health plan enrollment application without visiting healthcare.gov (opens in new tab).
Oscar's EDE platform is integrated within the Oscar Broker Portal to help brokers guide clients through the process of selecting and enrolling in an Oscar plan.
Where can I find details on Oscar’s plan offerings before starting an application?
Visit hioscar.com/brokers/plans (opens in new tab) for information about Oscar’s plans and networks.
Where do I find my FFM/FFE username?
Your FFM or FFE username is the username you used to register your portal with CMS at portal.cms.gov. If you cannot remember your CMS username, navigate to the CMS portal at portal.cms.gov (opens in new tab) and select *Forgot your User ID or your Password?*.
If you run into trouble recovering your username or if you are unsure if you have an account with CMS, please contact the Marketplace Service Desk at 1-855-267-1515 or CMS_FEPS@cms.hhs.gov for assistance, rather than creating a new account.
Brokers must complete registration and required training for the upcoming plan year in order to assist consumers with the Marketplace.
If you are new to the Marketplace, you'll want to create an account with CMS and register for training. You can view more information for new agents here (opens in new tab).
Why am I being asked to confirm my identity?
The first time you enter the EDE flow, you’ll be required to go through broker registration. You’ll be prompted to register automatically, and you’ll only have to do this once. To complete registration, brokers will need to confirm their agent information, including their FFM username, and pass identity proofing.
IMPORTANT: It is important to confirm your registration and verify your identity. You must complete this step before you're able to enroll clients.
If you see the following message at the top of the screen within your Broker Portal account, you have not yet verified your identity. You will be unable to enroll clients until you complete your broker registration and verify your identity. !verify identity
Note: Experian is CMS's identity proofing partner. If you do not answer Experian's identity proofing questions correctly on the site, you will need to call Experian at 1-866-578-5409 with the provided reference number. Experian will ask additional questions to verify your identity. Once verified, then you can return back to the registration page and continue.
Why is my CMS account not linking in the Oscar portal?
CMS now requires brokers to reintegrate their CMS accounts with EDE partners every 12 hours. If you receive an error in your Oscar Broker Portal when logged in for more than 12 hours, you will need to re-sync your CMS account.
Why is the enrollment status of my client listed as "Permissions Lost" within the enrollment dashboard?
Within the the Oscar enrollment dashboard, if the enrollment status of a client is listed as "Permissions Lost", this is because an application for the same client has been accessed by the broker on another enrollment surface and Oscar no longer has permissions to fetch data on that enrollment.
If this was intentional, you should ignore the status. If you would like to continue with the application within the Oscar enrollment dashboard, clicking 'Resume' will re-enable the application, remove the "Permissions Lost" status, and allow you to submit the application.
Do I need to be FFM certified before enrolling a FFM policy?
Yes. The FFM requires that all brokers are certified before writing business through the FFM. If you are not certified prior to writing a FFM policy, Oscar will not be able to pay you commissions on that policy. Additionally, you must renew your certification every year prior to Open Enrollment in order to receive commissions on new business.
Does Oscar have a participation requirement for small group coverage?
Oscar has different underwriting guidelines and participation requirements across states. Please check the Underwriting Guidelines for your market on the Broker Resources Page (opens in new tab).
How do I enroll clients?
Individuals & Families
You may enroll members a few different ways depending on whether you are enrolling them on-exchange or off-exchange. Please note you must be appointed with Oscar in the state you're enrolling to receive commissions. For FFM on-exchange policies, you must be FFM-certified to receive commissions.
Off-exchange (no subsidies) enrollment options:
On-exchange (subsidy eligible) enrollment options:
How do I generate a personalized enrollment link (PURL) to share with my clients?
Currently, we only support personalized broker enrollment links for Individual & Family plans.
To generate your custom enrollment link to share with IFP clients: Simply add your NPN to the end of this link: hioscar.com/get-quote/[your NPN here]
Example: hioscar.com/get-quote/0123456789
How do I get a quote for an Oscar individual plan?
You can get a quote by going to your book of business (opens in new tab) and clicking 'Enroll new policy'. Once you enter the required subscriber information (zip code, tax household size, and coverage type), you will be directed to the plan selection page.
On the Plan Selection page, you’ll be able to see premium, deductible, max out of pocket, Rx costs, and link to the summary of benefits and coverage per plan. Once you’ve selected a plan, you can email the quote to your client by clicking the 'Email plan' button.
How do I get added as Broker of Record (BOR) to an existing policy?
Oscar has created a Standardized BOR Letter. Please email brokers@hioscar.com for a copy of the letter. Once you’ve filled out the letter with your client, email it to brokers@hioscar.com for processing.
I’m being asked to submit additional documentation (such as payroll information) for my group. Why?
We require that recently formed businesses submit additional documentation, including payroll, to show eligibility if they don’t have quarterly tax documentation. Please refer to the notice you received for specifications on what documentation is required. The required documentation must be submitted to brokers@hioscar.com within 30 days of the enrollment.
What documentation do you require for small groups that aren’t able to provide 6 weeks of payroll records?
We review these applications on a case-by-case basis. Please email brokers@hioscar.com for what documentation will be required.
Why does the individual quoting platform ask for my client’s household income?
We ask for income level in order to identify whether your client is subsidy eligible. If they are subsidy eligible based on their income, we will direct them to contact their broker in order to enroll on-exchange.
Why does the small group coverage application ask for contribution amounts?
We ask for a contribution amount during the enrollment process so we can show employees what they’ll be asked to pay for coverage during the employee enrollment process. We strongly encourage brokers to enter accurate amounts here. However, if you are not email employees to let them select their plans you may select “No Contribution” or an estimated contribution amount to continue forward in the application.
Can I update the FMO affiliation that I indicated in my Oscar Medicare Certification?
We will allow FMO changes up until September 1, 2019. To make this change, please contact our Broker Support Team by calling 1-855-672-2713 or emailing brokers@hioscar.com. Please allow up to two weeks for this change to be processed once requested.
Does Oscar offer Medicare Advantage plans?
Oscar Medicare Advantage plans are available in Florida (Broward County).
Learn more about getting certified to sell Oscar Medicare Advantage here (opens in new tab).
How can I access my Oscar Medicare commission statements?
Please contact Oscar’s Commissions Team at commissions@hioscar.com or 1-855-672-2713 for a copy of your Medicare commission statement.
How can I enroll clients to Oscar’s 2020 Medicare Advantage plans?
Starting on October 15, 2019, you can enroll your clients to Oscar’s 2020 Medicare Advantage plans. Online enrollments are the preferred and fastest method, but we also accept enrollments via mail and fax. You can enroll clients online through your Oscar Broker account at business.hioscar.com (opens in new tab) through your “Medicare book” (top right of the page).
Prior to October 15, you can add leads to the Oscar Medicare enrollment portal. For full instructions, see page 4 of our Guide to Oscar Medicare Certification.
How do I get certified to sell Oscar Medicare Advantage?
Oscar is aiming to launch 2020 Medicare Advantage plans. The first step to making sure you’re ready to sell on October 15, 2019 is to get certified:
For more information, check out our Guide to Oscar Medicare Certification.
Please note: For 2020, Oscar Medicare Advantage will be available in New York and Texas only.
How do I view my Oscar Medicare Advantage book of business?
Visit business.hioscar.com (opens in new tab) and log in with your Broker account credentials.
From the home page, you will see “Medicare book” on the top right of the page. Click this link to load your MA book of business.
I am having difficulties finishing my Oscar Medicare Certification. What can I do?
Our Broker Support Team is here to help! Call 1-855-672-2713 or email brokers@hioscar.com and someone will be able to assist you.
What information can I view in my Medicare book of business?
On the Medicare book of business main page, you will see:
You can see full details per client by clicking into their client details page. Learn more here (opens in new tab).
What information can I view per Medicare Advantage policy?
If you click into each Medicare Advantage client’s page, you will be able to see:
Why can I only see some policies in my Medicare book of business?
If you are missing policies that you believe are active and for which you are the broker of record, please contact Oscar’s Broker Support Team at brokers@hioscar.com or 1-855-672-2713.
Can I assign commissions to my agency?
Absolutely. You can easily route your payouts straight to your agency during the digital portal onboarding process.
Can I get appointed via email or fax?
Unfortunately not.
All producers must complete the Appointment request process available through business.hioscar.com (opens in new tab). Because the application must be electronically signed, it cannot be completed via email or fax.
Can I write through multiple GAs?
For Individual: You must write under only one GA per state. If you are appointed in multiple states, you may write under multiple GAs across states. As part of the appointment request process, you’ll select one of our GA partners for each state in which you’re getting appointed.
Do I have to get appointed in each state separately to sell there?
Yes, appointments are state-specific. The good news: You don't have to fill out paperwork for each. Just request multiple states right on your initial application. If you want to add new markets later, simply submit a quick update request in the portal.
You can sell Oscar plans in Alabama, Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Mississippi, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, and Virginia.
Does Oscar work with General Agencies?
Yes, but only if you want to. We partner with top General Agencies on a state-by-state basis to give you access to extra training, marketing assets, and administrative support. However, you’re never locked in. You can write business directly with us, or bring your preferred GA along for the ride.
How do I check the status of my appointment?
For the status of your appointment application, log in (opens in new tab) to your Broker account and find the appointment dropdown. Your status will be listed there.
How do I get appointed?
Starting your appointment takes just minutes. Here’s what to expect:
If I am appointed with Oscar, can I sell both individual and small group plans?
Yes, you can. If you’re appointed with Oscar to sell in a state, your appointment covers any lines of business (Individual and/or Small Group) underwritten by the Oscar Insurance entity within that state.
If I was already appointed, do I have to get reappointed?
No, if you have an existing appointment, you do not need to renew your state appointments. Action is only needed to get appointed in a new state. However, there are a couple of exceptions:
What do I do if I'm having technical issues getting appointed?
Oscar’s Broker Support team is here to assist. You can reach them at brokers@hioscar.com.
What does “pending” appointment mean?
Oscar reviews every appointment request, so there will be a lag between when you submit your appointment and when Oscar has processed it. You will see “pending” while we are reviewing your request. Once Oscar has reviewed your appointment request and you have written your first policy in a state, Oscar will approve or reject the request.
What is an Oscar writing number?
You will receive an Oscar writing number after your first appointment is approved. Your writing number can be found in the approval email or by logging into your Broker account (opens in new tab) and looking at the top right corner of your 'My Account' page.
When will I know if my appointment is approved?
We’ll email you the second you’re cleared to start selling (usually within about two weeks of applying). If you want to check your progress before then, simply log into your broker account and click the "Appointments" link on your profile page to view your live status.
Why does my appointment say it was rejected?
Oscar may reject appointments for various reasons. Please reach out to brokers@hioscar.com to understand why your appointment request was not approved.
Contact our dedicated Broker Support Team.
Our dedicated Broker Support Team is here to support you with any issues or questions you have about working with Oscar. Email brokers@hioscar.com to get in touch with us.
How should referrals be submitted?
Providers should submit referrals for TX Guided Care HMO members through the Oscar portal for review. Referrals are active immediately upon validation and can always be viewed in the Oscar portal.
Can employers offer both an ICHRA and a traditional group health insurance plan to employees?
Hmm, yes and no. Here’s why: Employers can offer an ICHRA to one segment of employees while offering a traditional group plan to a different segment of employees.
However, employers are not allowed to offer both an ICHRA and a traditional group plan to the same segment of employees. To determine allowable class distinctions, just refer to official IRS ICHRA regulations or talk to a tax professional.
Is a third-party administrator (TPA) required for ICHRA management?
No, it’s not a legal requirement. That said, it is strongly advised to administer an ICHRA through a third party to ensure compliance with IRS regulations such as HIPAA.
To learn more about ICHRA compliance, please refer to official IRS ICHRA regulations or talk to a tax professional.
Wait, what is ICHRA?
ICHRA means Individual Coverage Health Reimbursement Arrangement. It’s a new type of Health Reimbursement Arrangement (HRA) created in 2020. It’s great because it allows businesses of any size to provide tax-free reimbursements to employees for health insurance premiums and qualified medical expenses.
Who can use ICHRA?
Employers of any size can offer an ICHRA so long as they have at least one employee who isn’t a self-employed owner or the spouse of a self-employed owner. If designed correctly, an ICHRA satisfies the Affordable Care Act (ACA) employer mandate for Applicable Large Employers (ALEs).
To determine if ICHRA is right for your business, take a look at the official IRS ICHRA regulations or talk to a tax professional.
Can I filter on the ‘Billing & payments’ page?
You can filter by clicking on the ‘Outstanding bills’ dropdown, and selecting one of the following filter views:
Can I search for clients by name or policy number in my book of business?
Yes, you can enter the your client’s name (first, last, or full) OR OSC number (OSC followed by a string of numbers) in the search field in your book of business (opens in new tab).
Can I submit premium payments on behalf of my clients?
Yes, you can submit one-time premium payments on behalf of your Individual clients in your Broker account. Here's how:
To find which clients need to submit premium payments:
To make a payment on behalf of your client, either:
How can I check on how my clients are utilizing their Oscar health plan?
Your clients can get the most value from their health plan by taking advantage of all of the special benefits included with every Oscar plan.
You can check which of the benefits your clients have activated with the 'Engagement' tab on their Member details page (opens in new tab). The first step is to create a member account, and from there they will be able to access the Oscar app, step tracking, and Virtual Urgent Care.
Learn more about the 'Engagement' tab here (opens in new tab).
How can I view all of the 'At risk' policies in my book of business?
You can filter your individual book of business (opens in new tab) by policy status with the 'Filter by status' button to the right of the search bar. Click on the drop-down, and select the status you'd like to see.
You can also sort by policy status by clicking the 'Policy status' column header on the right, or you can export (opens in new tab) your book of business to CSV and sort by policy status in the CSV.
How can I view my client's member and contact information? Where can I view enrolled dependents?
You can view your clients' member information through your individual book of business (opens in new tab) in your Broker account. From there, click on any client’s name to access their Member details page and find the 'Member info' tab.
Under the 'Member info' tab, you can:
How can I view my client's plan details?
You can view your clients' plan details through your individual book of business (opens in new tab) in your Broker account. From there, click on any client’s name to access their Member details page.
Once you're on the Member details page, you'll see top-level details of the current active plan directly underneath your client’s name:
Underneath that, the Member details page is split into three tabs. Click below to learn more about each section:
How do I access my client's billing & payment history?
From your Broker account homepage, click on Individual book (opens in new tab) on the top right corner of the page. Then click on a client’s name to head to the Member details page. Click on the tab labeled 'Billing & payments'.
From there, you will be able to:
Please note: There may be a delay with on-exchange bills due to batch processing.
How do I export or download my book of business?
You can export your book of business (opens in new tab) to CSV to see all policy details for your book. Simply click on the blue 'Export CSV' button on the top right of the page. Once you export, it may take a few seconds to download the file.
How do I view my book of business?
You can view your individual book of business by logging into your Broker account (opens in new tab). Once you’ve logged in to your Broker account, you will see “Individual” on the top right of the page. Click this button to view your book of business.
You can also access the individual book of business directly at https://business.hioscar.com/book/ivl (opens in new tab).
How far back can I see my client’s billing & payment history?
You will be able to see your client’s billing & payment history (opens in new tab) for as long as your client has been an Oscar member.
How long does my client have to pay an overdue bill?
The payment grace period is typically 30 days from the bill post date. However, this depends on your client’s enrollment status (on- or off-exchange, subsidized or unsubsidized). The payment due date is shown in the box on the right side of the ‘Billing and payments’ page (opens in new tab).
To find out more about a specific client, please contact Oscar’s Broker Support team at brokers@hioscar.com or 1-855-672-2713.
How long is the grace period for Individual policies? Will claims be paid during grace period?
Grace period and termination rules for Individual policies vary by subsidy status and state. Partial payments do not extend the grace period and will be refunded once the member is terminated.
Is this an Initial Binder Payment or ongoing payment?
Initial Binder Payment: Individual members initial premium payment is due on the first day of coverage. If payment is not received by the due date, members have a 30 day binder payment extension before risk of termination. During this period:
For plans in NY, members have a 10 day binder payment extension before risk of termination.
Ongoing Payments: Please see the section for either “Subsidized Individuals” or “Unsubsidized Individuals” below.
Subsidized Individuals
Subsidized individual members enter a 3-month grace period if their premium bill is not paid by the 1st of month. Oscar will continue paying claims for the first calendar month of grace period (payment due date counts as day 1).
Starting on the first day of the second calendar month through the end of the third month, the member will be in delinquency. During delinquency period:
If the full outstanding premium payment isn't made by the end of the delinquency period, the policy will be terminated and any claims on hold will become the members responsibility to pay in full.
Unsubsidized Individuals
Unsubsidized individual members enter a one month grace period if their premium bill is not paid by the 1st of the month (payment due date counts as day 1). During grace period:
If the full outstanding premium payment isn't made by the end of the grace period, the policy will be terminated and any claims on hold will become the members responsibility to pay in full.
How often is my book of business updated?
Your book of business (opens in new tab) is updated every 8 hours, you can find the last update date/time, on the title page within your Individual Book of Business.
It’s taking a long time to load my book of business. Can I make this faster?
We’re working on speeding up the load time for your book of business (opens in new tab). The best way to see all details is to export (opens in new tab) your book of business through the top right button “Export CSV” – this may take a few minutes if you have more than 100 policies enrolled. Once it’s downloaded, you will be able to view all details.
My client is showing as “Past due” or “At risk”. What does that mean?
If your client's status shows as 'Grace period' or 'Delinquent' or a bill shows as 'Past due', that means your client has not paid their full bill amount by the posted due date (typically, the first day of the premium month).
To see details about how much of the bill is unpaid, click on the box on the right side of the 'Billing & payments' page (opens in new tab). Once a bill is in 'Past due' status, Oscar requires full payment before updating the bill status to 'Paid' and removing your client from an 'At Risk' enrollment status.
What do each of the statuses in my book of business mean?
What is the difference between effective date, enrollment date, and effectuation date?
What is the “Engagement” tab in the Member details page? How do I use the “Engagement” tab?
Please note this feature is available to you only for clients enrolled in Oscar Individual & Family (IFP) plans only.
The 'Engagement' tab in the Member details page (opens in new tab) shows how your clients have been utilizing their Oscar plan benefits. We’ve identified four key milestones:
Below is an overview of the main features of the 'Engagement' tab:
Where can I view details on each of my Oscar clients? What information can I find on the Member details page?
You can view your clients' details through your individual book of business (opens in new tab) in your Broker account. From there, click on any client’s name to access their Member details page.
On this page, you’ll find the following sections (click below to learn more):
Where can I view renewals? What are the plans?
Renewal information is generated for all active policies prior to or during Open Enrollment.
If a renewal is available for your client, you can view the details of the renewal plan and benefits changes using the following steps:
If you do not see the 'Renewals' tab, then the renewal information is not yet available and will be coming soon.
You can also view upcoming renewals by exporting (opens in new tab) your book of business using the 'Export CSV' button at the top right.
Who can see my book of business? What can agency principals and GA users see?
For individual brokers not writing business through an agency, only you can view your book of business.
For individual brokers writing business through an agency, you will be able to view the policies for which you are the writing agent. You will not be able to see all of your agency's business.
For agency principals, you will be able to see all of your brokers’ enrolled policies. You will also be able to export a CSV (opens in new tab) with your agency’s full individual book of business.
For GA users, you will be able to see all policies that are attributed to your GA. You will also be able to export a CSV (opens in new tab) with your GA's full individual book of business.
If you, or anyone at your GA, don’t have an account, please email brokers@hioscar.com a list of the names, email addresses, and roles of the people who need an account created.
Why don’t I see some policies that I enrolled in my book of business?
Currently, your individual book of business (opens in new tab) shows active, inactive (terminated or cancelled), and not effectuated policies. If your individual book of business is missing policies you’ve enrolled, please contact brokers@hioscar.com for assistance.
*Important to note enrollment transmission to your Broker portal display does have a delay.
I've already started enrolling/renewing clients through the Oscar Broker Portal. What should I do?
Good news - you can continue to complete your Oscar enrollments through the Oscar Broker Portal - and just a reminder that any client with no plan changes will automatically renew. No action needed.
I’ve moved my book of business to Oscar’s Broker Portal. Will I also see it reflected in HealthSherpa?
Oscar’s enrollment dashboard activity will not be reflected on HealthSherpa. You will not be able to see the status of pending applications you’ve submitted through Oscar directly. If an application has been started in the Oscar Broker Portal but is not yet complete and you want to continue in HealthSherpa, you will have to start a new application.
How does my client access the pediatric dental and vision benefits included in all plans?
For Individual plans: Our pediatric vision partner is Davis Vision, and our pediatric dental partner is Liberty Dental. You can find more information about what’s covered in the Schedule of Benefits found on our Forms (opens in new tab) page.
I need general support.
We're here to support your Individual client needs!
For individual: For general support, please email our Broker Support Team at brokers@hioscar.com. This is your go-to source for any questions related to our plans, policies, or general inquiries.
My client enrolled in an HSA-compatible plan, how do they set up their HSA?
You can enroll your HSA-eligible client in a health savings account through our partner, HealthEquity (opens in new tab).
My client just had a baby. What do I need to do to ensure they have health insurance coverage?
If the baby isn’t added within 60 days, claims for care between days 31 and 60 will be denied, and your client will be responsible for 100% of those costs (Let’s avoid that!)
a. After 60 days, the client will need to wait until Open Enrollment or another Qualifying Life Event (like moving) to add their baby to a plan.
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Note: Before enrolling their baby on their coverage, check to see if they are eligible for CHIP (opens in new tab).
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¹ Infant coverage dates vary for New York (NY) and New Jersey (NJ). If you live in NY, baby is only automatically covered for the first 48 hours post a vaginal birth, or 96 hours after a c-section birth. In New Jersey, baby is automatically covered for 60 days.
Oscar could improve on some things, where do I leave feedback?
As a growing company, we love receiving feedback - both positive and constructive! Please email any feedback to brokers@hioscar.com.
What is the Children’s Health Insurance Program (CHIP)?
What is the Children’s Health Insurance Program (CHIP)?
After your client’s baby is born, your client has up to 60 days (opens in new tab) to add them to their health insurance plan.
Before doing that, check if your client’s baby can get health insurance through CHIP. CHIP is a health insurance program run by the government that provides low-cost health coverage to children and pregnant women in families that earn too much money to qualify for Medicaid.
Each state has its own CHIP program and works with Medicaid. To see if your client’s baby can get CHIP, visit: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/
What should I do if an emergency interrupts Oscar’s regular business operations?
In the event of an emergency that impacts Oscar’s normal processes, Oscar will send an email outlining any changes to normal operating procedures relevant to the sale and service of Oscar products. This email will be sent to all appointed agents who are affected. In addition, a copy will be sent to all GA partners with a request that they should distribute to their brokers/agents.
Do I have an Oscar Rep?
Yes! Oscar has sales teams that cover our various markets and product lines. Please reach out to your GA or email our Broker Support Team at brokers@hioscar.com, or call 1-855-672-2713 who can put you in touch with the Oscar Sales Executive in your market.
How can I get training on Oscar’s insurance products?
You can get information about Oscar’s products a few ways:
How can I print out a list of in-network providers?
To find and print a list of providers, follow these steps:
This solution is not supported on PCs, we’re working on a solution and will update this resource when available.
How do I know if my client's provider is covered?
Check out our Doctor and Drug Search Tool (opens in new tab) where you can find providers by name or speciality. You can find a summary of our network by state on the Broker Resource page (opens in new tab).
What is my Writing Number or Broker ID?
If you are already appointed with Oscar, your Writing Number/Broker ID can be found in the top right corner of your Broker account (opens in new tab) home page. You should have also received an email from us with your writing number.
If you are having trouble logging into your account or locating your unique email, please contact our Broker Support Team at brokers@hioscar.com.
What payment options does my client have?
There are three ways to make client payments:
Where can I find forms and official documentation?
The Forms Section (opens in new tab) of our website is your go-to source for SBCs, SOBs and HIPAA Auth forms.
Where can I get educational material and marketing collateral?
Visit our Brokers Resource Page (opens in new tab) for rate sheets, member experience one-pagers, enrollment forms, network information, and more.
Where can I learn more about your Network?
You can learn more about our networks on the Plans & Network portion of our Broker Resources Page (opens in new tab).
Where can I learn more about your plans and rates?
Our Rates and Plan Grids are posted on the Broker Resources Page (opens in new tab).
Can I edit an application for a passive renewal?
If you need to edit any member detail, like an income adjustment or the number of dependents, you will have to start a new application for the member and it is no longer a “passive” renewal.
How do I enroll a client during Special Enrollment Period?
If your client has a Qualifying Life Event (QLE) and qualifies for a Special Enrollment Period (SEP), you can work with them to submit an application and the QLE documentation in the following ways:
Off-exchange (no subsidies) enrollment options:
On-exchange (subsidy eligible) enrollment options:
Please note you must be appointed with Oscar in the state you're enrolling to receive commissions. For FFM on-exchange policies, you must be FFM-certified to receive commissions.
How do I know if my clients are eligible to enroll?
For small group: To see if your client is eligible to enroll in our Small Group product, please check the Underwriting Guidelines for your market on the Broker Resources Page (opens in new tab).
For individual: To be eligible for off-exchange policies, your client must have their primary residence in one of our Coverage Areas. During Special Enrollment Period (SEP) other restrictions apply. Please see your market’s online (opens in new tab) or paper application (opens in new tab) for a list of Qualifying Life Events. If your client is enrolling on-exchange, other restrictions may apply.
If I’m enrolling an off-exchange client during Special Enrollment Period, how long do I have to submit their qualifying documents?
Qualifying documents must be provided to sepdocuments@hioscar.com within 14 days of the effective date. All documents must be dated within the past 60 days from submission.
You can enroll clients online through your Broker account (opens in new tab). Afterwards, you and your client will receive an email providing further guidance on what documentation is required.
SEP documentation for on-exchange policies must be submitted directly to the exchange. The exchange will send you and your client instructions regarding the required SEP documentation.
What documentation is required for off-exchange Special Enrollment Period applications?
After Oscar has processed the SEP enrollment application, you and your client will receive an email providing further instructions on what documentation is required and how to submit documentation.
Below you can find a list of the most common Qualifying Life Events and the required documentation for each. Please note that this is not an all-inclusive list.
!SEP documentation requirement examples
If you have questions regarding a different QLE, you can contact our Broker Support Team at brokers@hioscar.com.
SEP documentation for on-exchange policies must be submitted directly to the exchange. The exchange will send you and your client instructions regarding the required SEP documentation.
What happens after my client or I submit an application for coverage during Special Enrollment Period?
After Oscar processes the SEP enrollment application, you and your client will receive an email providing further instructions on how to submit required documentation. After you've submitted documentation, you and your client will either an approval or a request for additional documentation within 2-3 days.
If we do not accept the documentation provided, you and your client will receive a notice of cancellation by email along with clear instructions on how to provide additional documentation and request reinstatement.
If we do not receive any documentation following the enrollment, you and your client will receive several reminders to submit the appropriate documentation. If nothing is submitted within 14 days, the enrollment will be canceled.
SEP documentation for on-exchange policies must be submitted directly to the exchange. The exchange will send you and your client instructions regarding the required SEP documentation.