Product lines & commission rates

Different insurance products earn commission in fundamentally different ways, so CommissionSight models a product line dimension with a config-driven engine per line. Nothing is hardcoded — rates and schedules are configuration, not code.

The three lines supported

• Major medical — percentage-of-premium or flat-per-member expectation vs. what the carrier paid (the default model). The rate can also vary by state — ACA / marketplace comp is typically a per-state PMPM, so you can set one rate per state (the most specific match — plan + state, then plan, then state, then a carrier default — wins). Beyond a single rate, it supports graded schedules: premium-banded tiers (graded comp / PMPM that steps by PEPM), a first-year-vs-renewal split, and a production-bonus override — the way real group/individual health comp is actually paid. Medicare Supplement (Medigap) also uses this model — it pays a level percent of premium, not CMS rates (see the note below).
• Medicare Advantage (MA / MAPD / PDP) — CMS-style compensation that’s advanced and earned over the year, with chargebacks on early disenrollment. Set the schedule’s payment cadence to match the carrier — lump (annual upfront) or monthly installments — so owed isn’t overstated for installment-paid renewals.
• Ancillary (Medicare Supplement, hospital indemnity, critical illness, DVH, final expense, …) — premium-based commission with policy-year rate bands and advanced-vs-as-earned handling. Rates can vary by state × issue-age (under-65 / 65+) × product — the way Med Supp and most supplemental products are actually paid — set as a rate matrix; policy year is derived from each policy’s effective date.

A carrier’s product line is set on its config and confirmed at onboarding. Each line is compared against your configured rate schedule to compute commission owed — expected vs. actual. A Medicare Advantage / ancillary carrier needs a matching rate schedule, or owed isn’t computed.

Medicare Advantage ≠ Medicare Supplement

They’re different product lines and must be separate carriers. Medicare Advantage uses the CMS engine (rate tables). Medicare Supplement (Medigap) pays a level percent of premium and uses the major-medical model — so a single rate (or the day-one estimate) reconciles it. A carrier like UHC may have all three (Medicare Advantage, Medicare Supplement, and commercial); set up one carrier per product line so each statement scores with the right engine. CommissionSight detects the shape automatically and warns if a statement’s product line disagrees with the carrier it’s filed under.

Configuring rates

Set your rate schedules in App → Rates (structured forms per product line, scoped by workspace + carrier), or the CommissionSight team can set them up with you.

For Medicare Advantage / Part D, you don’t have to start from scratch: the published CMS broker-compensation maximums (by plan year and region) are pre-loaded, so owed computes day-one even before you enter a contracted rate. Those figures are the CMS maximums (inferred from public CMS guidance, refreshed each plan year), so owed from them is an estimate — set your contracted rate to make it exact, since a carrier may pay below the cap. CommissionSight also flags any commission paid above the CMS maximum as a compliance/recoupment exposure.

Every statement is health-checked after scoring — if a file’s shape disagrees with the carrier’s configured product line, or a Medicare/ancillary carrier scores zero owed-coverage, the job is flagged so a mis-configured carrier can’t silently mis-score.

Integration & engine docs

The exact commission math per line — CMS proration & rapid-disenrollment clawbacks, ancillary advance/earned formulas and policy-year bands, the rate-schedule JSON shapes, and how “owed” is computed — lives in the in-app Integration docs. Sign in at app.commissionsight.com/docs.