- 9,744
It's excellent info, however the practical application of the concept is a little more difficult than Professor Pilzer (as he calls himself) lets on...
Any where to learn Group Health Insurance 101?
- Thread starter Phil C.
- Start date
It's excellent info, however the practical application of the concept is a little more difficult than Professor Pilzer (as he calls himself) lets on...
- 4,132
I googled Pilzer and read his information and like many before him and many after.. he's just another blind man on one side of the elephant... He's making alot of assumptions that don't really hold water across the board.
In WA state group is FAR superior to individual. Not the other way around. I sell both.
While under an employer sponsored plan it is correct you are at the mercy of the employer for your benefits selection. Most employees don't participate that heavily in the cost.
Those that do, do so for the most part on a tax favorable basis.
Anyway.... Healthcare is 49 states and Aloha.. 49 different sets of rules set up by each state's legislature and overseen by the OIC of each state. What one state allows, another doesn't.
What may work in WA, won't fly in FLA... and visa versa.
In WA state group is FAR superior to individual. Not the other way around. I sell both.
While under an employer sponsored plan it is correct you are at the mercy of the employer for your benefits selection. Most employees don't participate that heavily in the cost.
Those that do, do so for the most part on a tax favorable basis.
Anyway.... Healthcare is 49 states and Aloha.. 49 different sets of rules set up by each state's legislature and overseen by the OIC of each state. What one state allows, another doesn't.
What may work in WA, won't fly in FLA... and visa versa.
This book is a not a cure all and Pilzer is not correct in all of his assumption. However, it is a good way to familiarize oneself with a lot of the issues and nuisances of both group and individual coverage in a short period of time. Someone new to health insurance would be ahead of the game if they read this book.
- 4,096
I do not know if I would use the book for general selling purposes. It seems a lot of his statements about the indiviudal market may have some truth to them if your healthy and young. I don't think he does nearly enough to address people with on going health conditions that are in there 50's. Some of the advice he gives about small groups going to indiviudal plans I question. To take a small group and put indiviudals in place usually meets some people with declines. Now you have the issue if the employer is giving money to these indiviudal plans is this an employered sponsored plan? Some of his statments on renewals of indiviudal plans and rate increase I don't think are accurate.
So this is a good book for selling healthy indiviudals that are young.
Shoot I have had 6 declines this month on the individual sales.
- 4,132
I think the best place to learn about individual and group is the continuing ed classes for credit. While Pilzer has written a book, it's a book of opinion.. a newbie or anybody else needs to learn facts and function first. Then read, learn and experience to develope an opinon.
I don't ever think it's a good idea to copy someone else's opinion out of the gate... it leads to a closed mind and mistakes. Just ask the primerica people
or a captive agent just out of career school....
no?
I don't ever think it's a good idea to copy someone else's opinion out of the gate... it leads to a closed mind and mistakes. Just ask the primerica people
or a captive agent just out of career school.... no?
Like anything else, the only way to learn is to do. You can read, attend meetings, have coffee with reps but until you get your shoes dirty you haven't learned anything.
I have put group health plans together from start to finish including reinsurance, actuarial, issuing carrier and TPA. Self funded plans are nothing like fully credible insured plans and have very little in common with small, fully pooled group plans. When you shift over to individual it is almost like learning a new language.
Pilzer has some good ideas but they have limited application.
Unless you are dealing in self funded ERISA plans the rules do differ from state to state. And what applies to group does not always apply to individual and vice versa.
Group is not inherently superior to individual. Both have pluses and application. I have group clients and individual. Most of the group plans are small group and will stay where they are year after year. I placed them in a group because someone (usually the owner and/or their spouse) was uninsurable. They have no other place to go.
My individual clients usually stick but some will eventually migrate back to an employer plan.
CE classes are required but unless the material offered in other states is superior to what I have been through it is about like drinking near beer.
I have put group health plans together from start to finish including reinsurance, actuarial, issuing carrier and TPA. Self funded plans are nothing like fully credible insured plans and have very little in common with small, fully pooled group plans. When you shift over to individual it is almost like learning a new language.
Pilzer has some good ideas but they have limited application.
Unless you are dealing in self funded ERISA plans the rules do differ from state to state. And what applies to group does not always apply to individual and vice versa.
Group is not inherently superior to individual. Both have pluses and application. I have group clients and individual. Most of the group plans are small group and will stay where they are year after year. I placed them in a group because someone (usually the owner and/or their spouse) was uninsurable. They have no other place to go.
My individual clients usually stick but some will eventually migrate back to an employer plan.
CE classes are required but unless the material offered in other states is superior to what I have been through it is about like drinking near beer.
- 4,132
"CE classes are required but unless the material offered in other states is superior to what I have been through it is about like drinking near beer."
It certainly can be or it can be part of chfc type education.. a wide range. the reason I keep mentioning it for someone new is that usually there isn't a bais.. just explainations.
The trouble with some publications for newbies are simply reading someone post about an aspect of insurance makes their opinion "fact" if the newbie doesn't have a basic understanding of what the subject matter of the "fact" is they learn the opinion as fact rather than understanding it as an opinion. see what I mean?
It certainly can be or it can be part of chfc type education.. a wide range. the reason I keep mentioning it for someone new is that usually there isn't a bais.. just explainations.
The trouble with some publications for newbies are simply reading someone post about an aspect of insurance makes their opinion "fact" if the newbie doesn't have a basic understanding of what the subject matter of the "fact" is they learn the opinion as fact rather than understanding it as an opinion. see what I mean?
- 4,096
Sorry to jump off topic but why did you get out of the large group? Self funded plans are awesome. You have all the data you need to negoiate the best deal for the client.
I got tired of working large group plans after 20 years or so. The last 10 years was all self funded ERISA plans using MGU's for the xs cover and TPA's for admin.
Don't get me wrong. I made very good money but then the stop loss market became very unstable about 10 years ago and TPA's were merging or going out of business. It was a lot of work, dealing with politics of the decision makers and balancing against a fractured stop loss/TPA market.
Part of the problem (for me at least) was I had placed a majority of my business with an MGU I had known for years. They crashed and burned almost overnight and almost drug me into their shenannigans. That deal affected my reputation in the large case market.
Guilt by association.
And it cost me a lot of money. A lot . . .
So it was more that it left me more than I left it. After being away from it (and mostly from the industry except a few consulting deals) for a few years I reinvented myself and never looked back.
Carriers had no clue then how to properly underwrite and manage self funded plans and it is still true today. Regional TPA's are almost non-existent and the few that have survived are mostly hanging on out of greed. The stop loss market never recovered from the whiz-bang days of the late 80's and early 90's.
It is a different game today and one I don't care to revisit.
Been there, done that, got the tee shirt.
Don't get me wrong. I made very good money but then the stop loss market became very unstable about 10 years ago and TPA's were merging or going out of business. It was a lot of work, dealing with politics of the decision makers and balancing against a fractured stop loss/TPA market.
Part of the problem (for me at least) was I had placed a majority of my business with an MGU I had known for years. They crashed and burned almost overnight and almost drug me into their shenannigans. That deal affected my reputation in the large case market.
Guilt by association.
And it cost me a lot of money. A lot . . .
So it was more that it left me more than I left it. After being away from it (and mostly from the industry except a few consulting deals) for a few years I reinvented myself and never looked back.
Carriers had no clue then how to properly underwrite and manage self funded plans and it is still true today. Regional TPA's are almost non-existent and the few that have survived are mostly hanging on out of greed. The stop loss market never recovered from the whiz-bang days of the late 80's and early 90's.
It is a different game today and one I don't care to revisit.
Been there, done that, got the tee shirt.
- 4,096
That is horrible about the TPA going under with your block of biz. Most of the TPA's in my state have sold out and or shut their doors. They are really having a hard time competiting.
The self funded market is where I want to be. After almost 10 years of selling small groups and Indiviudals I want to be in that large group game. I have been involved on a few deals but I mainly sat the bench and just listened. They were ASO plans.
The self funded market is where I want to be. After almost 10 years of selling small groups and Indiviudals I want to be in that large group game. I have been involved on a few deals but I mainly sat the bench and just listened. They were ASO plans.
