Cap on Meds

[dgoldenz]

And most people have no clue how much meds can run.

It is your job as a professional agent to educate your client rather than taking orders.

Would you sell a plan with a $5,000 cap on surgery or hospital admission?

Same thing except more folks take meds than have surgery or end up in the hospital.

I love to come behind agents who sell plans with caps. Makes my job so much easier.

I try to educate - my job is to lay out all of the options and let the client decide what is best for them based on what they want from the coverage as well as what they can afford. Often BCBS will come in substantially less expensive than other carriers who would put an exclusion rider on a condition.

The client has to decide whether they want to have an exclusion rider with no cap on Rx, or no exclusion rider with a cap on Rx. I would be happy to sell them either policy, but there is no "perfect" policy out there. A client may also be unwilling to switch doctors if their current PCP is not in the network of the program you are pushing. They may be looking for a lower doctor copay, need a maternity benefit, or have a condition that would be a total decline with other carriers. You get the idea.

 

[somarco]

Never said there was a perfect policy, but you have to match the client needs with policies that offer the broadest coverage.

Rx claims are roughly 17% of claims paid by carriers by dollar amount, not volume. Hospital claims are just under 50%.

When you find a plan that adequately addresses almost two thirds of the claim dollars and still fits your clients needs and budget you have done a good job.

Given what I know about Rx claims, I never suggest a plan that lacks Rx cover or imposes a dollar limit (or ridiculous coinsurance payment).

Never.

If someone wants such a plan, they don't buy it from me.

 

[ABC]

When it comes to these type of plans there is a market for them. People that are price shopping and care about nothing else because they have never experienced claims.

I have sold a handful of these type of plans to single people that were young(under 35) that were web shopping for the lowest premium. These people wanted an office visit co pay plan but did not want high premiums. From the handful of clients that went with these plans they all had the same attitude that they could fill generic drugs over at wallmart for $4 a script.

When I do sell these plans I go into to worse case scenario when it comes to brand name drugs and make notes of it in their file.

 

[schoolofhardknocks2]

No response in 5 days regarding availability of plans without caps. Guess I have my answer . . .

And what would that answer be? Perhaps I could be given the benefit of the doubt here without assuming I don't have the intention of replying to your question.

Yes, there are carriers that offer unlimited.
Aetna -only on the HSA
Golden Rule - with option rider
Humana - Good luck selling this in rural areas...where I happen to be
Assurant

Why do I offer it? Because I believe the other choices to be inferior to BCBSNC in a majority of circumstances. I've heard horror stories of other state's BCBS, but BCBSNC is a GREAT company that has been known to go above and beyond for it's members. As I mentioned, I have never heard of one of my clients reaching the cap. I'm not saying I like it...I'm simply saying when weighing all the pros and cons, they stand head and shoulders above everyone else. There DOI customer complaint ration has been minuscule for years. Simply put, my personal retention ratio and book of renewals tell me all that I need to know. BTW, four years ago, there was no Golden Rule, Aetna, or Humana in NC. Therefore I can't do a fair apples to apples retention comparison. But I will say, so far I believe Golden Rule to be the closest competitor, at least in eastern NC.

I don't have the faintest clue about GA, and it doesn't sound like you know a lot about NC. If you feel that I don't serve my clients properly, you are certainly entitled to your opinion. At the end of the day, my clients are the judge. Thankfully, I am blessed with loyal customers who seek my advise every year when their policy renews. From a pure financial point of view, I wish I could roll my customers every year and make first year commissions. However, that rarely happens. Why? Because it's not in their best interests.