1 Ethics For the Employee Benefits Agent. Ethics – defined as a principle of right or good conduct; a system of moral principles or values; the rules.

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EthicsFor the Employee

Benefits Agent

Ethics Defined Ethics – defined as a principle of right or

good conduct; a system of moral principles or values; the rules or standards governing the conduct of the members of a profession

Professional Ethics - defined as the set of principles or values we use to guide us professionally

The Importance of Ethics

Provide guidance when we are confronted with a new or unfamiliar situation.

Critical in maintaining trust between an insurance professional and the clients he or she serves.

Provide guidance beyond just doing what is a legal or regulated practice.

Frequently Subjective Do you always do the right thing when

faced with an ethical dilemma?◦ When given too much change do you return it?◦ Do you lie to make the sale?◦ Do you use company resources improperly?◦ Do you mislead customers?◦ Do you falsify records?◦ Do you have a conflict of interest?

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A Review of Prohibited Practices

Rebating Twisting Churning Misrepresentation Fraud Failure to Remit Premiums

Looking for Guiding Principles

Some say, “If it’s legal, it’s ethical.” Building long-term relationships means

going well beyond what is legal. You have to do what is “right” for the

client.

Translating Personal Character Lessons Into Business Principles

1. Don’t deceive or mislead to get ahead. 2. Always do what is in the client’s best

interest.3. Don’t let anger or frustration influence

your future actions. 4. Clients come first; prospects come second.5. Clients, co-workers and competitors

deserve to be treated with dignity and respect.

6. Always tell the truth.7. Conduct yourself in a professional

manner.

8. If you make a mistake, go back and fix it.9. Your professional success and reputation

are the result of the way you conduct your business.

10. If you provide a valuable service, you will be rewarded.

11. Before you speak, think about being considerate and respect your client’s confidentiality.

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Translating Personal Character Lessons Into Business Principles

Conflicts of Interest Representing or advising clients who have

opposing needs, goals or interests. Identify and disclose any conflicts of interest as

soon as possible.

Resolving Conflicts of Interest Recognize that the conflict exists.

Disclose the conflict to the people involved.

Search for a solution that does not compromise your professional integrity.

Looking for the Answers About Conflict

1. Recognition 2. Disclosure3. Solution4. Communication5. Feedback

Social Responsibility As life and health insurance agents, we

possess information and expertise the average person does not possess.

We are the trusted choice when it comes to insurance matters. We have a responsibility to always look out for our clients’ best interests, and offer our expertise within the communities we work.

Suggestions for Social Responsibility

Education –may be one of our primary responsibilities.

◦ One-on-one meetings with benefit administrators or owners

◦ One-on-one conversations with a client’s employees

◦ Writing a newsletter for prospects and clients ◦ Accepting an invitation to speak at a local

church, service club, Rotary, public or civic organization

◦ Putting on a seminar for the local chamber of commerce

Privacy

HIPAA In 1996 the federal government passed the

Health Insurance Portability and Accountability Act (HIPAA), which provides specific rules for how we must protect personal medical information.

Privacy Who is required to comply with HIPAA?1. Covered Entities – Includes health plans, health care

clearing houses and most health care providers. (Includes employer group health plans.)

2. Business Associates – Includes a business or an individual who works with a Covered Entity and creates, uses, receives or discloses protected health information.

3. Employer and Other Sponsors of Group Health Plans – Includes all employers that receive protected health information as well as other organizations that sponsor group health plans, e.g., a union plan.

Privacy

What is Protected Health Information (PHI)?

HIPAA defines as any individually identifiable health information that is created or received by a health care provider, health plan, employer or health care clearinghouse. (PHI includes a person’s name and address.)

Privacy

HIPAA requires that a group health plan not disclose this information except for the following permitted or required disclosures:

To the individual. To carry out treatment, payment or health

care operations. With a valid authorization.

Privacy

Business Associates – As life and health agents, we fall under the definition of a “Business Associate,” consequently, we are required to enter into a “BA” contract with the health plans with which we work. These contracts are required to have the following provisions:

Business Associate Contract Provisions

Establish the permitted uses and disclosures of protected health information.

Provide that the business associate will not use or further disclose the information other than as allowed under the contract or required by law.

Provide that the business associate will use appropriate safeguards to prevent the unauthorized disclosure of information.

Business Associate Contract Provisions

Require the business associate to report to the health plan any unauthorized uses or disclosures of the information.

Ensure that any agents or subcontractors to whom the business associate discloses protected health information agrees to these same restrictions.

Provide that the business associate will make protected health information available for inspection.

Business Associate Contract Provisions Require that the business associate agrees

to make its internal practices, books and records available to the secretary of HHS for inspection, if necessary.

Provide that the business associate agrees to return or destroy, all information and limit future uses and disclosures to those purposes that make its return or destruction infeasible.

Authorize the termination of the contract if the business associate has violated a material term of the contract.

Ethics – A Test

When you find yourself in a situation where there is more than one possible course of action and you are having trouble deciding which action would produce the most ethical result, consider these questions:

1. Is the action legal? If there is any question as to the legality of a potential act, seek legal counsel.

Ethics – A Test

2. Would I want an account of my actions published in the local newspaper? If the thought of a public review of your actions creates any reservations or concern, the action you are considering is probably not the best solution.

Ethics – A Test

3. Does this action support my commitment to building long-term relationships? If the action you are considering creates a win/win situation for everyone involved, then move forward. If there’s a chance that your action will damage a relationship, reconsider your position and look for better alternatives.

Remember, for this discussion, “action” includes both the actions we take AND the actions we don’t take. A lack of action can be damaging, and to do nothing is still a choice you make.

Thank you!

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