Cover Pregnacy?

Jan 22, 2007

  1. Golddoor
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    I had a client call me today and an employee of theirs whom just applied with me for an individual plan with Unicare, but hasn't yet been approved, thinks she is pregnate. She is already on an individual plan with another company and they told her they wouldn't cover maternity but would pay for any type of hospitialization due to complications or even if there was some type of emergency such as an emergency C section due to the pregnancy. Is all that possible? She said if I couldnt get Unicare to verify that they would do that she was going to keep her other policy until after the kid is born.
     
  2. Crabcake Johnny
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    First of all, if she conveys to you that she thinks she's pregnant and the deal is still pending you must call the company and postpone underwriting until it's confirmed whether or not she's pregnant.

    And yes, some companies will cover complications of pregnancy like a C-section even if they don't have a maternity benefit.
     
  3. Golddoor
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    If she hasn't even been to the Doctor yet to confirm and the carrier doesnt cover maternity any way why would it matter?

    Thanks for the help John!!
     
  4. Crabcake Johnny
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    If you're in possession of knowlege that could change underwriting you're duty-bound to Unicare to report it. You now know that she thinks she might be pregnant. If you don't call Unicare you could very well lose your appointment over it. How, might you ask?

    She gets approved then immediately after issue it turns out she's pregnant. But Unicare's guidelines are they don't accept anyone who's pregnant. So now some claim is filed and Unicare finds out that she's pregnant and also how far along she is, ie; proof that was was pregnant while applying.

    Unicare may want to rescind the policy and she rolls you under the bus:

    "BUT I TOLD MY AGENT I MIGHT BE PREGNANT AND HE SAID AS LONG AS I HAVEN'T SEEN A DOCTOR JUST LEAVE EVERYTHING ALONE."

    Then it comes out that she already had a policy and you took of off just to get a commission even after knowing that she might be pregnant.

    Well, there goes your appoitment - maybe your license if she sues or contacts the DOI. If it ever hit the DOI that you recommended she continue with Unicare and not stay with her current plan after you found out she might be pregnant count on losing your license.
     
  5. Crabcake Johnny
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    Imagine this scenario while a deal is pending:

    Client: "Hey, I think I might have something wrong with me."

    You: "Why do you say that?"

    Client: "I don't know. My head feels funny and all of a sudden I'm dizzy all the time. I'm having a hard time walking. Thank God I haven't seen a doctor yet. Am I approved yet?"

    Well.....you just lost a deal.
     
  6. Golddoor
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    That makes sense John but she applied before she "thinks" she is prego? If its approved this week and this week she didnt have her regular menstrual cycle, so that makes her "think" she is prego, then it hasn't been diagnosed by a doc yet, so technically she isn't pregnate yet is she?

    Also what happens if someone gets prego right after being issued a policy?
     
  7. somarco
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    somarco That Medicare Guy

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    Why not tell her to get tested before going forward.

    Unless you want a lawsuit that will result in you paying her maternity benefits.

    Which would you rather do? Postpone the application for a month or end up in a lot of trouble with the carrier and your clients attorney?

    Many states mandate coverage for preg complications. Your state may be one of them. FYI, a c-section is not always equal to a complicated delivery.

    So . . . you go ahead, hope this flies with Unicare, then she has a c-section. Unicare denies the claim and guess who pays?
     
  8. Crabcake Johnny
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    If you don't postpone this until she gets tested you could be looking at a lawsuit and loss of license.

    Your client "messed up" by telling you she might be pregnant. You now have no choice but to tell her that underwriting cannot continue until she's tested.

    If you don't do that, and if she cancels her current plan, and if she ends up pregnant you'll be in a wild world of shit. Unicare most likely will rescind the policy. Then she'll got nuts and you'll be on the hook.

    You need to call her, tell her she must get tested or at least take a home test before underwriting can continue. And you needed to call Unicare to stop that app hours ago.
     
  9. Crabcake Johnny
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    Let's make it simple - call Unicare and ask them what to do if a client who's pending states that they might be pregnant because they're late. Then do what they say.
     
  10. Airborne1
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    Good advice John,

    Also Probably a good idea to get anything the carrier tells you to do going forward in an email, and make sure you have the underwriter's full name in the body of the msg.
     
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