PopRick
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Technically by definition no it is not major medical, no it is not compliant because it is not a guarantee issue you have to qualify for it and much more stable then an indemnity plan
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If the standard Premier Choice plan is, for example, either $400/600/700 per day for being in the hospital......how would that not be called an indemnity plan? Maybe you would care to talk about all the ancillary add ons that try to make up for the lack of base coverage in the plan.Technically by definition no it is not major medical, no it is not compliant because it is not a guarantee issue you have to qualify for it and much more stable then an indemnity plan
If the standard Premier Choice plan is, for example, either $400/600/700 per day for being in the hospital......how would that not be called an indemnity plan? Maybe you would care to talk about all the ancillary add ons that try to make up for the lack of base coverage in the plan.
so...to make sure I understand....a healthy, fully underwritten person who does not want to pay ACA prices buys your limited benefit indemnity plan and hopes nothing really bad happens. If something really bad happens, the plan is not strong enough to cover it.....but hopefully when he first applied, he checked off a rider box ($?) that says if he really needs major medical insurance, he can invoke the rider clause (you said "has the ability") that allows him to purchase "real" insurance at some possibly prior undisclosed rate, possibly with retroactive premiums to make sure that he is covered for claims already submitted over the last two months but were not covered by the $600/day plan, since he gambled and lost.....but since the "real" insurance is only a short term policy, he will not be renewed and forced to buy an ACA plan during the next open enrollment since he is now likely riddled with pre-existing conditions. Maybe at that time they will pull medical records to make sure he first did not lie/mis-speak on the application before they decide to honor the claim Is that the process you are describing? If so, its like having insurance options in case you need insurance to make up for the first plan you bought.see the difference is that the hospitalization room and board benefit come from the association not the the core policy itself. the different ancillary add-on's differ from accident protection, critical illness, disability, life, vision, dental. the plan itself is an accident and sickness/disease plan that has the ability to be like a platinum plan with uncapped unlimited coverage for a short term and can be extended but doesn't have to be. when those other health insurance plans require you to meet a large deductible before they cover anything except your basic dr visits or preventative.(which in fact is not free your paying for it with your overly high premiums)
so...to make sure I understand....a healthy, fully underwritten person who does not want to pay ACA prices buys your limited benefit indemnity plan and hopes nothing really bad happens. If something really bad happens, the plan is not strong enough to cover it.....but hopefully when he first applied, he checked off a rider box ($?) that says if he really needs major medical insurance, he can invoke the rider clause (you said "has the ability") that allows him to purchase "real" insurance at some possibly prior undisclosed rate, possibly with retroactive premiums to make sure that he is covered for claims already submitted over the last two months but were not covered by the $600/day plan, since he gambled and lost.....but since the "real" insurance is only a short term policy, he will not be renewed and forced to buy an ACA plan during the next open enrollment since he is now likely riddled with pre-existing conditions. Maybe at that time they will pull medical records to make sure he first did not lie/mis-speak on the application before they decide to honor the claim Is that the process you are describing? If so, its like having insurance options in case you need insurance to make up for the first plan you bought.
It is true that most people hardly use their insurance if they are healthy enough to qualify in the first place.....so most people would never find out how good/bad their coverage really is. I never really used mine for 62 years, and then out of the blue ran up about $250K of charges in 5 days...glad I had a $6000 deductible ACA plan at the time. Paid my $6K and never got another bill for the rest of the year with all the follow ups for rehab, etc. Maybe I have no idea how this really works, but I think this is what you said....and if so, it would likely work. I can't imagine explaining that to a potential client. Was I even close?![]()