Celtic

[TXINSURANCE]

"If the goverment regulates us the price of cars will go crazy and no one will be able to afford them."

Hmmm....seems to me you can still buy many new cars for the $10,000 range.

What are you driving? For me a half way respectable , safe, reliable car starts $40k and up, except for my Audi A8 Quattro, that starts at $115k for the 12 cylinders. Seriously - have you seen the cars that are 10k? You want to talk about death traps.

"Design any plan you want but it can't have drug caps."

OK so now the costs go up higher, and even MORE people are uninsured due to cost. Plans with $3k or $5k drug caps sell ALL DAY LONG, the only people that have a problem with them are agents. The consumer could care less because "I am not on that much in drugs" and if they ARE on that amount of drugs - they won't qualify anyhow.

If they exceed their drug cap they can likely qualify for their states risk pool, if there is one - or a multitude of government and private programs.

And where does it stop? How about invitro fertilization? Does a 58 year old woman or a MAN need this coverage? What about mental health - should this be covered on an individual policy? What about maternity? Why is the creation of life avoided like the plague in individual insurance? What about hearing aids or glasses - shouldn't you be able to hear and have vision?

We can go on and on but before you know it we would have a BLANKET policy that "covers everything" for $2000 per month (individual). There is a clearly a "balance" - although I think the BEST solution MIGHT be to explore some basic standardization of A-Z so a consumer could at least tell what "level" of policy they are buying instead of relying on the "opinion" of their slime ball agent chasing commissions.

This would NOT be a mandate - but rather a universal GAUGE if policy had NO RX limit maybe it would be a E level policy, etc., etc., You get the point... Free markets still would rule however consumers would be able to have a basic gauge of what they are buying.

I would however support a mandate that a CELTIC thread should not exceed 3 pages...

 

[Crabcake Johnny]

Med supps are regulated and I don't see any issues there. Why can't we allow a company to shave a few benefits off "plan F" and lower the rate?

 

[GreenSky]

Med supps are regulated and I don't see any issues there. Why can't we allow a company to shave a few benefits off "plan F" and lower the rate?

Agreed, and they do have this in a high deductible Plan F.

But there is a load for emergency world-wide coverage. If I never go out the U.S., why do I need to pay for this? How about if I'm willing to take a $500 annual deductible for all services?

Can't do either of these things because of government regulations.

By the way, I have come to the conclusion that coverage for Rx for many people is not the best way to go. Yes, there are some $1,000 monthly meds but this is unusual. Is it better to offer a policy someone can afford or to force them to buy something they can possibly pay for? A $500 limit takes care of most anti-biotics.

Drugs from overseas pharmacies cost about the same as a copay. Isn't it govt. regulation that makes these illegal? What happened to personal freedom?

Come on John, let's meet in K.C. and "duke it out!"

Rick

 

[somarco]

Plans with $3k or $5k drug caps sell ALL DAY LONG, the only people that have a problem with them are agents. The consumer could care less because "I am not on that much in drugs" and if they ARE on that amount of drugs - they won't qualify anyhow.

Those plans, except in states where there are no other options, sell all day because consumers are ignorant.

You purchase insurance for things that can happen in the future, not for what has happened in the past.

You may be perfectly healthy today and in 6 months need a med that runs $2k+ per month.

Any guess what will happen when their health changes and the crap plan you sold (or allowed them to buy) doesn't cover their meds.

I have not had a single client go ahead and apply for a Saver plan (or anything similar) that has little or no Rx coverage once I explained the difference in the lesser price plan vs. the one I recommended.

I can assure you, clients have very short memories when they are suddenly faced with a situation where their policy won't cover something that is going on that will cost them dearly out of pocket. Guess who gets a letter from their attorney?

BLANKET policy that "covers everything" for $2000 per month (individual).

You can write a blanket policy that covers everything, usually for a lot less than $2k per month.

They are referred to in the industry as HDHP.

 

[TXINSURANCE]

I can assure you, clients have very short memories when they are suddenly faced with a situation where their policy won't cover something that is going on that will cost them dearly out of pocket. Guess who gets a letter from their attorney?

You are going to get a letter anyhow, anyone can sue anyone.

You can write a blanket policy that covers everything, usually for a lot less than $2k per month.

They are referred to in the industry as HDHP.

They are hardly blanket coverage, still look like swiss cheese.

Besides every time I sell a HDHP we get TONS of calls that little johnnies runny nose wasn't a "fixed co pay" or the RX wasn't covered until a super high deductible - despite spending hours explaining and educating them up and down...

People who have been on co pay plans for their whole life as soon as they use that HDHP that most agents "rave" about - the client says "this policy doesn't cover anything!!!"

HDHP's would make sense if the price break was there - but carriers refuse to price these correctly, we sell very few of them - since the pricing is not right and the retention was low, most never even funded the savings side.

Consumers are uneducated and ignorant - I agree. I can tell someone all day long about how Unicare has unlimited RX on most plans, but they will take BCBS with a $3000 cap or Aetna with a $5000 cap because they want physicals covered or similar. People buy for today - most carriers in most markets have RX caps, some have caps on outpatient surgeries (like the Assurant people rave about...) - even our BCBS of TX has a $300k cap on organ transplants - should I not sell it because of that? Is that sufficient?

Where does it end?

 

[Crabcake Johnny]

To me it's not insurance if I have a major event and have to file BK. If that was the case I would should get the most watered-down policy I can find - get slammed with $100,000 in medical bills? Bk. Done - solved.

The likelyhood of my house burning down? Pretty close to zero but if it burns I'd can't imagine my agent saying:

"Oh, you have our homeowners Saver policy. The Saver policy doesn't cover electrical fires like yours so no check for you."

Ask any homeowner who opted not to add flood insurance and lost their house if they would have paid the additional premium.

People are short-sighted. It's our job to make them think about consequences.

And it doesn't have to be $2,000 a month worth of meds. Just a $200 per month med could be a financial problem for a lot of people who could have had a $30 copay.

Drug discount plans? Anyone here even use them? I have. Go invest in $9.95 per month and grab a drug discount plan - then go into any Rite Aid and try to use it, then come back and report your results.

Does anyone here really know how those "Tiered" drug discount plans work? They only apply when all criteria is met. Example:

Tier 2 - $40 copay
So your client is on Cardizem and it's listed on Tier 2. So they have a $40 copay - right? Wrong. It's Cardizem 150 mgs 30 pills. That's it. If your client gets 20 mgs 60 pills it doesn't apply.

So even when they comply the pharmacy certainly takes it? Lol. Oh Lord - please get a card and try it like I did. Hand over that card to the pharmacist and watch is reaction and he starts searching his computer.

Not having drug coverage, above all other crappy benefits is the worst. Why? If you have a lacking hospital benefit you'll get the surgery, then get slammed with bills. Notice the "got the surgery" statement?

But get a prescription for a med you need (could be pain medication) and go the pharmacy to find out it's $280 and you don't have $280 you're leaving with nothing. Programs? Sure - go fill out all the paperwork to get on a program and after a few months I'm sure you'll find something.....while you're not getting the meds you need.

You can make arrangements with hospitals and providers if you're broke. I'm not sure you can walk into CVS and say "listen, here's my situation..."

 

[TXINSURANCE]

For 95% of the general public a $3000 to $5000 RX benefit is sufficient. The other 5% could potentially get screwed - you are correct.

Do you require 100% of people to buy unlimited RX for the 5% that might get screwed?

Besides lets not blame the agents here - we only give people options and the client receives a policy in the mail (which they don't read).

If you don't like those policies - scream at the carrier who is rolling these type of products out. Get used to more limited plans - MAJOR carriers are starting to design and roll out mini meds even, doesn't mean you have to sell them - but when you are selling a $600 blanket plan and the slimy agent down the road is selling a $200 limited plan from the same company , you are going to be swimming up stream to stay in business.

 

[somarco]

every time I sell a HDHP we get TONS of calls that little johnnies runny nose wasn't a "fixed co pay" or the RX wasn't covered until a super high deductible - despite spending hours explaining and educating them up and down...

Then one of us isn't doing this right.

Almost all of my clients on some form of high deductible plan with no copays. I get more complaints from the ones on copays than the ones with the HD plans.

"Why am I getting bills for lab work when I paid my doc copay?"

"This plans copay doesn't cover my Rx?"

"I had an endoscope and it was subject to my deductible. Why?"

It is much easier when they understand from the first that the carrier isn't paying for anything until they hit their deductible.

 

[Crabcake Johnny]

I'm in full agreement. It is what it is. There are 8 indie companies in MD and 6 limit medication. Does that mean I leave the field? No. Does it mean I'm blowing off a client if I can't sell Assurant or GR? Heck, even GR has plans now that limit meds and you cannot buy up the coverage. Maybe a trend for GR? Maybe in a year all GR plans will cap meds?

What is does mean is the two - GR, and Assurant - that don't limit meds are my go-to carriers. If GR and Assurant doesn't fit I drop to Aetna with the $5,000 cap. If they don't fit my last resort is BX.

 

[TXINSURANCE]

Since this is a CELTIC thread - lol... What is CELTIC's RX benefit on co pay plans?