Agent FAQ

Agents need to be certified to sell our WPS MedicareRx PDP plans. You must keep your certification current to continue to receive commissions. You do not need special certification to sell our WPS Medicare supplement plans. Contact your WPS Agency Manager for more details on our senior plans.

WPS works with more than 55,000 pharmacies nationwide.

Our prescription drug list is reviewed and updated quarterly or more often, as needed.

Once a group is underwritten and all required employer and employee paperwork is completed (no missing information) and received by WPS, the plan will be implemented, and ID cards and certificates will be sent out within 14 business days.

Each WPS agent must be licensed by the State of Wisconsin and held in good standing. We also require agents to have thorough knowledge of all our products and our health care provider base.

PDP requires an annual certification be taken and test be passed.

WPS provides free language services to people whose language is not English, such as:

• Qualified interpreters
• Information written in other languages

For assistance, contact Customer Service using the phone number on the customer ID card.

Contact your local WPS Sales office.

Contact your assigned Account Executive or Agency Sales Representative for assistance.

There may be times when a group or individual will request a switch to a different AOR. Per WPS policy, AOR changes are not permitted during the first 12 consecutive months during which coverage under a WPS insurance contract is in effect. After the first 12 months, changes may be permitted.

In general, we will honor AOR change requests for group business. It is not our policy to honor requests for Individual, Group, Medicare suplement, and Part D business. Exceptions may be made on a case-by-case basis, depending on the situation (ask your assigned Account Executive for details).

Group leaders follow these guidelines when submitting an AOR change request:

• The request should be in letter form, on company letterhead, signed by an officer of the group (e.g., CEO, CFO).
• The letter must name the new agent who is being requested as the AOR.
• AOR change requests must be received by the WPS Agency Manager before the 20th of the month prior to the requested effective date. This will allow time for the current agent to review the request and for WPS to change the payment of commissions.

This varies. Please contact your assigned Account Executive or Agency Sales Representative for assistance.

All WPS listed agents are automatically put on our email list for our agent-focused e-newsletters. The list is updated regularly. You may unsubscribe at any time. If you unsubscribed previously and wish to receive the Agent Advantage again, you can click the green button on the home page of the agent portal to sign up again. You have to resubscribe—we cannot reactivate you due to email laws.

The WPS Agent Resources section offers links to several Rate Calculators, which you can download and use to create your own quotes.

• Small Group Intake Checklist

Needed at time of enrollment:

• For Medically Underwritten Groups: Uniform or WPS Medically Underwritten applications with appropriate medical questions completed for each eligible employee
• Current WI Wage & Tax Statement (UC-101) with employee status indicated next to each employee’s name: FT=full-time, T=terminated, PT=part-time
• Most recent current carrier billing
• Current plan design (deductible, coinsurance, Max. OOP, Rx coverage, etc.)
• Renewal rates or increase, if available
• Claims experience, if available

Once the enrollment is approved and rates are accepted, group level paperwork will be provided by your WPS sales team for completion.

Needed at time of enrollment:

• For Medically Underwritten Groups: Uniform or WPS Medically Underwritten applications with appropriate medical questions completed for each eligible employee
• Current WI Wage & Tax Statement (UC-101) with employee status indicated next to each employee’s name: FT=full-time, T=terminated, PT=part-time
• Most recent current carrier billing
• Book Quote showing sold rates
• Current plan design (deductible, coinsurance, Max. OOP, Rx coverage, etc.)
• Renewal rates or increase, if available
• Claims experience, if available

Once the enrollment is approved and rates are accepted, an Employer Group Application and check for the first month's premium will be required (unless paying via ACH).

51–99 Risk

If the group in this size range does not have claims experience available, WPS Health Insurance and WPS Health Plan can provide a book-rated quote. However, this will require the group to be subject to full medical underwriting.

If the group has claims experience available, WPS Health Insurance and WPS Health Plan can provide an experience-rated quote if the following are provided:

• A minimum of 24 months of claims experience:
• Documentation needs to be on carrier or company paper/letterhead and should specify dates and claims amounts
• Experience must be within six months of the effective date requested
• Average or monthly contracts for each experience period: If the group has offered more than one plan, contract counts should be segmented accordingly
• Current group census:
• This should include any COBRA participants and should include coverage type (single/ES/EC/family), age/dates of birth, and gender of each employee
• If the group offers more than one plan, the plan election for each employee is also needed
• Current benefits: Benefit history is needed if there have been plan changes during the claims experience periods submitted
• Current rates and rate history
• Large/shock claims if the group has been self-funded

100+ Risk

WPS Health Insurance and WPS Health Plan can provide an experience-rated quote if the following are provided:

• A minimum of 20–24 months of claims experience:
• Experience must be within four months of the effective date requested for corporate groups and within six months for public groups (schools, municipalities, counties, etc.)
• Information must be on company letterhead, a prior carrier report, or formatted agent report; preferred: month-by-month, will accept: current year-to-date or prior 12 months
• Average or monthly contracts for each experience period: If the group has more than one plan offered, contract counts should be segmented accordingly; preferred: month-by-month, will accept: current year-to-date average count or prior 12-month average count
• Current group census:
• This should include any COBRA participants and should include coverage type (single/ES/EC/family), age/dates of birth, and gender of each employee (if possible, ZIP codes are helpful)
• If the group offers more than one plan, the plan election for each employee is needed as well
• Current benefits: Benefit history is needed if there have been plan changes during the claims experience periods submitted
• Current rates and rate history
• Large/shock claims Needed for each claims experience period with the following information: (1) Total amount for current loss experience paid, (2) Total amount for prior loss experience paid, (3) Diagnosis and/or prognosis, (4) Current status—active, disabled, COBRA (with effective date/end date)
• Current Attachment Points (for current self-funded groups
• Desired commission level

Self-funded

WPS Health Insurance and WPS Health Plan can provide an experience-rated quote if the following are provided:

• A minimum of 24 months of claims experience: Experience must be within four months of the effective date and month-by-month
• Average or monthly contracts for each experience period: Counts should be for single/family and month-by-month
• Current group census:
• This should include any COBRA participants and should include coverage type (single/ES/EC/family), age/dates of birth, gender of each employee, and ZIP codes
• If the group offers more than one plan, the plan election for each employee is also needed
• Current benefits:
• A complete booklet/certificate is required to match benefits
• A schedule is needed if we are matching deductible/copays/coinsurance, and then all other benefits will be based on our standard administration
• Benefit history will also be needed if there have been plan changes during the claims experience periods submitted
• Current rates and rate history: This includes specific rates, aggregate factors, COBRA/funding rates, and administrative fees (base administration, network fees, UR/LCM fees, Rx fee, Rx rebate %)
• Renewal rates, if available
• Large/shock claims: Needed for each claims experience period with the following information: (1) Total amount paid for each experience paid, (2) Diagnosis and prognosis for each individual listed, (3) Current status—active, disabled, COBRA (with effective date/end date)
• Pending claims report, if available
• Desired commission level/agent service fee