Where health brokers get paid from
A health broker's commissions come from carriers and, increasingly, third-party payment aggregators:
- Group medical carriers — UnitedHealthcare, Anthem, Cigna, Aetna, Kaiser, and regional Blues
- Ancillary lines — dental, vision, life, disability, each with its own rate
- Individual / ACA marketplace commissions (where still paid)
- Payment aggregators and GA statements that consolidate multiple carriers
- PEO and level-funded plan arrangements with non-standard commission terms
Where the money leaks
The health-broker leaks track the thing that never stops changing — group enrollment:
- PMPM underpayment
- A per-member-per-month rate paid on 42 members when the group actually enrolled 47. If the carrier's member count lags your census, you're underpaid every month until it's caught.
- Enrollment-count drift
- New hires, terminations, and dependent changes hit the carrier's count on a delay. Reconciling billed/enrolled membership against commissioned membership is where health brokers recover the most.
- Missing groups
- An entire small group that renewed but never appears on a commission statement — quietly dropped from the payment feed.
- Rate / tier errors
- A composite vs. age-banded rate mix-up, or an ancillary line paid at the wrong percentage.
- Retro adjustments not reconciled
- Retroactive terminations and additions generate adjustments that must net out correctly — when they don't, the error compounds monthly.
Common mistakes to avoid
- Reconciling health commissions quarterly or annually instead of monthly, when enrollment moves weekly.
- Trusting the carrier's member count without checking it against the group's actual census.
- Overlooking ancillary lines (dental, vision, life) because they're small individually.
Automate it with CommissionGuard
Health commissions change every month, which is exactly why manual review fails. CommissionGuard reads each carrier and aggregator statement, reconciles the commissioned member count and rate against what each group actually enrolled, and flags PMPM underpayments, missing groups, and unreconciled retro adjustments before they compound.
For the fundamentals, read the complete commission reconciliation guide or the step-by-step guide to auditing carrier commission statements. You can also estimate your own exposure with the free leakage calculator.
Reconciliation built for health brokers.
CommissionGuard reads every carrier statement with AI, reconciles it against what you were owed, and flags what's missing or underpaid. Start your 7-day free trial — no card required.
Start your free trialPrefer to run the numbers first? Try the free leakage calculator →