- Staff
- #11
ASSURANT AND WELLNESS
- Thread starter taterpeeler
- Start date
- Staff
- #12
- 14,809
Well - this is from the actual policy. I can't imagine in a thousand years an agent would sell a plan without actually reading the policy first. Assurant has specimen policies in the site.
For example, are you telling your clients that the MAX charge for a mammogram is $65? Not in any brochure - you actually have the read the policy.
Certain wellness benefits are not subject to any deductible and that includes in-office testing:
For example, are you telling your clients that the MAX charge for a mammogram is $65? Not in any brochure - you actually have the read the policy.
Certain wellness benefits are not subject to any deductible and that includes in-office testing:
- Staff
- #14
- 14,809
You're confusing me - what's not available in TX?
- Staff
- #16
- 14,809
This is why you have to read the policy from your state! Correct, in TX only child immunizations are not subject to the deductible. This all so state specific you simply cannot get proper answers unless you know your state mandates, which policy form your company is using (which dictates which mandates they follow) and by reading the policy from your state. The language in these policies are very different state to state.
- Staff
- #18
Crazy how state mandates affect a policy from state to state. In California paps and mammys are state mandated. Paps are once a year (applied to wellness benefit) and mammys are a little different depending on the clients age. Ages 35-39 only one exam is required by mandate, but once the client hits ages 40-49 then it is one exam every 2 years, and over 50 it's state mandated once a year.
Most of the plans I deal with will cover labs & x-rays up to the covered limit but must be "ordered" on the same day as the physical exam to be applied towards the wellness benefit, otherwise it's applied to the deductible.
Most of the plans I deal with will cover labs & x-rays up to the covered limit but must be "ordered" on the same day as the physical exam to be applied towards the wellness benefit, otherwise it's applied to the deductible.
- 14,809
For association plans it's very complicated. They can choose not to comply with the state manatates and are only required to follow all the mandates of the state the master certificate is filed in. So if the master certificate is filed in Illinois and you're writing in California they may or may not follow the CA mandates.
Golden Rule pulls this crap. In MD maternity is mandated. All carriers must offer at least one plan with full maternity coverage. But GR plans are not filed in MD so they choose to play the "association card" and not even offer it. When they had the copay 25 and 35 adult wellness was a one year wait which went against the MD mandates. Again, they pulled the association card out and say "tough crap." Assurant simply chooses to abide by the mandates even though they're not filed in MD. They do not have to.
The association rules are what allow companies like Mega to offer very limited plans and not offer hardly any mandated coverage. Since they're association group states cannot regulate the plans or benefits.
Golden Rule pulls this crap. In MD maternity is mandated. All carriers must offer at least one plan with full maternity coverage. But GR plans are not filed in MD so they choose to play the "association card" and not even offer it. When they had the copay 25 and 35 adult wellness was a one year wait which went against the MD mandates. Again, they pulled the association card out and say "tough crap." Assurant simply chooses to abide by the mandates even though they're not filed in MD. They do not have to.
The association rules are what allow companies like Mega to offer very limited plans and not offer hardly any mandated coverage. Since they're association group states cannot regulate the plans or benefits.
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