If a beneficiary disenrolls within 3 months of enrollment due to finding out the plan doesn't cover providers, what happens to the agent's compensation?

• A. The agent keeps the full commission
• B. The agent's entire compensation must be recouped
• C. The plan refunds only the first month
• D. The agent pays a penalty to the plan

Answer: (B)

When a beneficiary disenrolls within a short window after enrollment, the agent’s compensation is typically recouped (a clawback). In this scenario, because the member left within three months after discovering the plan doesn’t cover their providers, the plan requires the agent to return the full commission. This policy protects the client from paying for a plan that doesn’t meet their needs and keeps incentives aligned so agents verify network adequacy before enrolling someone. The idea is that if the sale isn’t sustained beyond the short probationary period, the compensation isn’t earned, so the entire amount is recouped.