Anybody Selling IAC?

[GNSBRG]

what a passionate bunch of insurance agents!! It's been great reading thru all the comments.

I personally don't see the problem with offering a customizable plan that can save a client money should they choose not to purchase the optional benefit. You have a core plan on top of which you can layer benefits, such as office visit copay, Rx copays, accident. Offer the client all the choices and let them make up their own mind. You can always offer your recommendation.

I also don't see an issue with the daily deductible. This is the first time I have seen it, but with annual deductibles now commonly at 2,500 and 5,000 or more, plus the coinsurance, daily deductibles make sense, especially with the stop loss.

Arthoscopic surgery at an ambulatory center typically runs $10,000-$15,000. would you rather pay $500 or several thousand dollars?

 

[TXINSURANCE]

There is nothing wrong with daily deductible if the annual aggregate cap is reasonable.

 

[Josh]

what a passionate bunch of insurance agents!! It's been great reading thru all the comments.

With over 100 posts and over 750 views in less than two days, passionate indeed!

 

[IndividualHealthGuy]

The BX name seems "franchise-like." Carefirst BX here in MD is a regional player and has nothing to do with any other BX.

It's not like BX and Coventry are one large corporation like Aetna or UHC.

This is very true, however even though about half BX plans exist entirely on their own, or are regional in size, they still have strict performance requirements sent down by the BX Association. There are guidelines for claims reserves, customer service, claims speed and accuracy, etc. They are called the MTM (Member Touchpoint Measures) and they have a tremendous impact on the way the plan is viewed.

While Anthem/Wellpoint is a large portion of the BX plans, they are actually not the best performing. So the fact that a BX plan by itself is tiny compared to UHC or Aetna, it can actually be much more financially stable.

Do need to ammend this, as claims reserves are not a part of MTM, but there are requirements set forth by the Association still. These are stricter than those set in place by the majority of the state insurance commissions.

 

[somarco]

I personally don't see the problem with offering a customizable plan that can save a client money should they choose not to purchase the optional benefit. You have a core plan on top of which you can layer benefits, such as office visit copay, Rx copays, accident. Offer the client all the choices and let them make up their own mind.

These kind of plans are very expensive to administer. When folks are given two options, one with Rx the other without, invariably they will pick the one without Rx especially if they are on generics or do not take any meds. Consumers are not bright enough to make responsible choices. When they do something stupid they complain, get an attorney and an "investigative reporter" from the 6 o'clock news and eventually get their claim paid.

daily deductible. This is the first time I have seen it

Years ago Mass Mutual offered that on small group. Someone else in the individual major med market offered one as well. Provident American or Republic American maybe? Never was a big seller.

strict performance requirements sent down by the BX Association. There are guidelines for claims reserves, customer service, claims speed and accuracy, etc. They are called the MTM (Member Touchpoint Measures) and they have a tremendous impact on the way the plan is viewed.

Doesn't seem to be working here.

They have the worst customer service of any carrier, except for Coventry and have been fined by the DOI twice in the last 5 years for failure to comply with state mandates on renewal communication and slow pay of claims.

 

[IndividualHealthGuy]

Doesn't seem to be working here.

They have the worst customer service of any carrier, except for Coventry and have been fined by the DOI twice in the last 5 years for failure to comply with state mandates on renewal communication and slow pay of claims.

It doesn't work everywhere. There are some plans that are always high achievers, and some that prefer to wallow. The plan here in Kansas City is outstanding, and is always among the top 5 or 6 plans in the country. Some of the larger plans, which you would expect more of, are terrible.

The only point I was making by that is while the Blues are not a single company, they are stronger than most of the "national" carriers.

 

[IAC.Ryan]

1. 3X is common. Our Blue in TX is 3X, it is seldom an issue statistically.

2. Outpatient therapy is poor on most ind policies, particularly chiropractic care - can you say ACCIDENT PLAN supplement?

3. Complex answer I'll let Ryan touch that one

4. DME is similar on other policies, my response on #2

5. NON EMERGENCY ambulance $1000? So if it is not an emergency why are you taking an ambulance? Other plans in my state have $1500 ish after ded for ambulance, not uncommon.

6. Maternity, everyone I know gets free maternity from the state.

7. Being drunk and / or cracked out is excluded from a lot of policies, generally defined as legally intoxicated.



Thats better than 75% of the polices on the market.

This response works for me - other than the answer to #3 which is in a reply from last night. Thanks TX for saving me the time as I have enough voicemails to answer now that I'm back in the home office.

Thank you to all of those that have objectively participated in either side of this debate - regardless of stance, debates like this allow the agent to decide if the product makes sense for their clients or not

______

GAHealth - you are not missing a thing. That is strong example of how the Daily Deductible plan limits a clients out of pocket exposure

 

[STIBROKER]

You hit the nail on the head....the agent decides what makes sense for the clients....not the clients.....then you put advance commissions and free leads in the mix the client gets a skewed view of all their options....

...debates like this allow the agent to decide if the product makes sense for their clients or not..

 

[IndividualHealthGuy]

then you put advance commissions and free leads in the mix the client gets a skewed view of all their options....

This happens with the big carriers, too. Perhaps not as much on individual as in group, but carriers like UHC give leads for apps. An agent's integrity is always under attack by carrier reps/programs/bonuses.

 

[IAC.Ryan]

You hit the nail on the head....the agent decides what makes sense for the clients....not the clients.....then you put advance commissions and free leads in the mix the client gets a skewed view of all their options....

I still feel that the client is the one that ultimately makes the decision - I was referring to the agent deciding if it makes sense to present as an option.

As far as the rest of the comment - I can at least see where you were aiming but this sounds more to me like you're calling out the integrity of agents, not the carrier.