LPRT Points Calculator Explainer

Your LPRT award level can be determined in two different ways, income or points. You receive a different level of points for different types of coverage you place or keep in force. The points levels for various categories are shown on this calculator Excel spreadsheet. 


In the Individual market, you can receive points for each person and each line of coverage you sell or renew for Health Insurance, Medicare Supplements, Medicare Advantage, and Medicare Part D plans, Dental Insurance, Life Insurance, Disability Insurance, Long-Term Care Insurance, Critical Illness, Cancer, and Accident Insurance.  You receive points for both the coverage you place and coverage you renew.  You receive credit for each line of coverage you sell or renew for a given person. 

For your individual market business you will need to know the number of lives you sold or renewed during the past year for each line of coverage to apply for your LPRT award.

Example:

You have a Medicare client that you sell a supplement, Part D, Dental, Life Insurance, and Long-term Care insurance to.  You receive 5 points for the supplement, 1 Point for Part D, 15 points for the Dental, 15 points for the Life Insurance, and 15 points for the Long-term Care coverage.

In the Group market, you count the number of lives for various lines of coverage that you place or renew.  Covered lines are Health Insurance, Group Medicare Products (supplements, Medicare Advantage, Part D), Group Long-term care, Group Disability (LTD & STD), Group Dental Insurance, Group Life Insurance, Group Vision Coverage, Group Critical Illness, Cancer, and Accident Coverage, and Administrative Plans (FSAs, POP plans, COBRA administrative service plans,  HRA (Including QSERA and ICHRAs), HSA, Stop-loss, TPA services.
 
For your individual market business you will need to know the number of lives you sold or renewed during the past year for each line of coverage to apply for your LPRT award.

Note:  
  1. While you count each line of coverage separately, Health Insurance and Stop Loss are considered the same line of coverage, so for a self-funded client you use one category or the other. However, if your business is TPA services, you may count TPA services and stop loss separately.
  2. If HRA or HSA coverage is separate from the medical plan, you can count it as two lines of coverage.  If it is wrapped with the medical plan, it is one line of coverage.
  3. COBRA administrative service plans means a plan for COBRA administration.  COBRA continuation on an employer plan by an employee is counted as a health or stop loss life.
  4. If your business is TPA services, TPA services are covered as a separate line.  If you are a broker and are using a TPA in conjunction with a self-funded plan and stop loss, it is one line of coverage for TPA, health, and stop loss.  
  5. Points calculation is not different based on whether the employer pays or the employee pays for the coverage.

Example 1:

You have a client with a fully insured health plan and a variety of other benefits, some employer paid and some voluntary.  If an employee is covered by health insurance (4 points), dental coverage (2 points), LTD (3 points), STD (3 points), Group Life (2 points), Vision (2 points), and Voluntary Cancer (3 points), you get 19 points for that employee. 

Example 2:

You have a client with a self-funded health plan with a TPA and stop loss coverage.  Some of the employees have elected HSA coverage and there is a separate administrator for the HSA accounts. You also have sold COBRA administrative services to the employer.  Employees are covered by LTD, Dental, and Group Life Insurance Coverage. They have voluntary Vision coverage available to employees.    If an employee is covered by the health plan (4 points), HSA account plan (4 points), COBRA Administration plan (4 points), dental coverage (2 points), LTD (3 points), Group Life (2 points), and Vision Coverage (2 points) you get 21 points for that employee.  

Example 3:

Same as above but you are the TPA and providing services for health, dental and COBRA administration.  You get (4) points for the TPA services, (4) points for the stop-loss, (2) points for the dental, (4) points for the COBRA or a total of 14 points per covered person.

Example 4:

Same as Example 2 except you are the HSA administrator.  You get 4 points for the HSA administration for each covered employee. However, if you provide more than one type of account you can count the number of covered lives in each type of account.  For example, if you provide HSA, HRA, and FSA administration for a client, you can count the number of lives in each type of account, even though a given employee may have more than one type of account.