Broker Compensation Disclosure Sample Form (Word Version)
Section 202 of the Consolidated Appropriations Act of 2021 (CAA) requires that agent, broker and consultant compensation related to all group health plans and individual health insurance policies be disclosed for arrangements entered into, renewed or extended on or after December 27, 2021. This law requires agents, brokers and/or consultants (and their subcontractors) to disclose their compensation to plan fiduciaries. Specifically, any covered service provider that receives compensation in excess of $1,000 annually must provide this disclosure. The disclosure must include amounts paid directly and those received indirectly related to group and individual health plans. This requirement applies to contracts with both fully insured and self-funded group health plan arrangements.
This sample form can assist you in complying with this statute.