Customer Needs

[Bitnis]

My original question was how do you professionals evaluate a customers needs and find a major medical health plan to fit them. I'm guessing it's probably a combination of a quality prescreen of the customer and knowing the plans available.

What is the best resource for learning each carriers plans?

I just ran a search for plans for myself. I know what I would like in a plan and still haven't figured it out. I believe I came up with 92 different plans. Where do you start and what are the most important things you like to take into consideration when evaluating a plan for your customer?

Anyone who cares to provide help with this one...it is very much appreciated.

 

[Todd King]

When it comes down to it, you need to find products that are good for your area. For instance, you're in NC. Coventry One has one hell of a product there at great prices. There are actually products out there that you won't get by going through just any FMO also. Watch for pricing, co-pays, underwriting, deductables and the like. You have to question you client and find out their needs and WHY those are the needs. Alot of times a client doesn't really need what they think they need or they need something they don't even know about. I hope a lot of agents here reply to you on this because you've asked a very open ended question that requires many answers. Alot of 'what ifs' and 'howevers'. This is just the type post that could go on and on and give you many different answers and opinions.

 

[somarco]

In GA there are over 100 plans just from Aetna, BX, KP, Humana and Golden Rule.

Add Time in the mix and the figure jumps to more than 3000 plans and combinations.

What I do is eliminate plans that are either pure junk or do not fit my clients needs & budget.

I start by finding out what they have now, which benefits they use (and how often) and which ones they don't. That can quickly narrow the search to fewer than a dozen plans.

Next I put up some suggested plans beside a plan of their choice and point out how doing things like eliminating copay's and raising the deductible (while keeping the OOP virtually the same) reduces the premium by 30 - 40%.

Once we find a plan design and price that fit's their budget, I get into the nitty gritty of underwriting, illustrating what each carrier (from the winnowed field) will treat their situation.

Most of this can be covered in 20 - 30 minutes. Some medical conditions require more research (including a pre-screen).

This is what works for me. YMMV.

 

[Bitnis]

Thanks guys.

Do you guys sell plans that have a $2-$3k cap on prescription medications?? I'm having a hard time convincing myself that this is actually catastrophic coverage.

Without going into detail we had such an event in the family last year. The Wellpath plan that we have saved us from BK and limited exposure to the deductible. The plan served its purpose. But, we found out along the way about the $2k cap on prescribed medications.

Here's something else that blew me away. In my state the 800 pound gorilla is BCBS. I believe they have a very similar cap on prescribed medications. There are a lot of people exposed to these risks that like me, probably don't or didn't even know.

Your thoughts on prescribed medications and caps?

 

[somarco]

Do you guys sell plans that have a $2-$3k cap on prescription medications??

Never!

But I understand in some states you don't have an option for unlimited coverage.