Guaranteed Issue - Health Insurance Innovation?

[AllenChicago]

Sounds like your GA is still wet behind the ears..



Wait a minute, you have no issue selling some mickey mouse STM plan for 25% commission, yet have qualms about their limited benefit plan?

STM plans have their place. The few that I write are for recent college grads, people who are in between jobs, or older people with medical condtions that can't/won't pay big bucks for an ICHIP or PCIP policy.

But the Limited Benefit plan from HII Quote is horrible. Their $10,000 limit for surgery would be OK in 1965, but not today. My rule of thumb is that if I wouldn't put a close relative on a plan, I don't sell it. Period.

 

[Suis]

checked this site out and it found that it uses the
Beechstreet PPO network - same as Health Essentials (Hiiquote).

My GA was offered 15% by some GA in Indiana 2 months ago, and almost took it. But a wise/experienced agent in our office quickly intervened and advised him to try and go direct. It worked and now he's at 25%. I might license with this company for the 25% Short-Term Medical, but their Limited Benefit plan gives me the creeps. It's one of the worst I've seen... Link:

Health Essential

TeamCorp's limited benefit plan is now paying for surgeries at 100% of the Medicare Reimbursement Rate, instead of that rediculously skimpy surgery schedule they've used over the past 10 years. This is a huge benefit improvement, since the sky's the limit for what a major surgery can cost. If I were in a situation where I needed to write a Limited Benefit Medical plan, TeamCorp would be my choice. Hopefully they still advance 6 months commission, because if you don't write one policy per quarter, they cancel your contract. Maybe all the agent commissions they get to keep is why TeamCorp can now pay for surgeries at 100% of the Medicare rate?
REF: http://www.usateamcorp.com/PageView.aspx?state=il
-Allen

I

 

[somarco]

TeamCorp's limited benefit plan is now paying for surgeries at 100% of the Medicare Reimbursement Rate,

So?

Just because they pay more for surgery than other mini meds does not mean you can get a doc to agree to do a knee replacement for that rate. The surgeon's bill is only a small portion of the total.

There is the hospital, gas passer, cost of the device, follow up PT, pain meds . . . all of which are going to leave a LOT of OOP.

I am not a fan of mini meds. Better than nothing but most folks would be better off buying a $30 plan from Careington and pocketing the difference.

 

[YouGotMyMoney]

I think we all can agree that every single limited benefit plan out there sucks, and it's just about contracting with a plan that you feel somewhat comfortable with.

We can nit pick every plan and we can all find something wrong with every plan out there.

In my opinion the best limited benefit plan in the market right now is Assurant's "Affordable Health Access".

It's not perfect, but has the strongest core benefits of any mini-med out there. Keep in Assurant's AHA plan is not a true GI mini med, they will decline you if you answer yes to a series of medical questions.

* MultiPlan PPO Network. This trumps Beechstreet ANY day of the week. This IS the MOST IMPORTANT facet of any mini med plan.

More doctors are on MultiPlan than Beechstreet and the network discounts are better. This is especially important on a mini-med because most plans don't cover pre-ex(indemnity ins reimbursements...ppo disc are from day 1) for 12 months, even though with HII the 12 pre-ex wait only applies to (Mb Coremed too) hospital semi-private room, Hospital ICU/CCU, Surgery and Anesthesia Benefits.

* Absurd Application Fees. I don't sell plans with higher than a $25 app fee, so TeamCorp w/ it's $100 app is ridiculous. It's just there so we can make more money. Actually, I don't know about TeamCorp but I know every single mini med that has a $100 app fee, that indy agents can sell most of that fee goes to the marketing company. If anything, most of it should go to the agent NOT them.


Re: Surgery Schedule:

The surgery benefit with HII, leaves something to be desired.

They cover 1 surgery per year at a 10k max benefit, on top of network repricing.

So, take a gallbladder surgery for example....

HII would pay a $5k scheduled benefit for the removal of the gallbladder.

For the room & board, they would pay $500-$1500 per day....so I was in the hospital for 5 day for my gallbladder surgery....so I would see $2500-$7500

Thus far it's a total of $5k for surgery plus 2500-7500 for the hospital stay, that's $7500 to $12.5k. Add the network repricing, and that should cover 50% of the total bill at least, maybe more.

It's not perfect, cause it's not designed to be, that's not it's purpose....but for people who can't get major med or afford high risk pool, it's better than nothing.

 

[Crabcake Johnny]

I've said this many times but I'll say it again: I cannot help everyone. No one can regardless of their professional no matter how bad they feel about the situation.

They can be fully underwritten, jump back into group coverage, or qualify for the risk pool. Outside of that there are people who fall between the cracks that I cannot help.

This is far too litigious of a society for me to risk someone getting "amnesia" if they get whacked with bills they can't pay.

At a bare minimum if I sold one of these plans it would be a recorded conversation, with consent, go over every facet of the policy.

One of my biggest issues with most of these mini meds is they don't cover pre-ex but don't have a health history questionnaire. If there's no health history on the application, how do they know what is and isn't pre-ex?

 

[medx]

MY GA wants me to sign on to sell to uninsurable.
website is:
HIIQUOTE
Anyone signed up with them?
"Insured Benefits Provided By:
United States Fire Insurance Company , Rated “A” by A.M. Best Reports"
Website states it's approved in my state.
Offers short term and GI
Free leads
I welcome all advice, suggestions, thoughts, opinions, etc.
Thanks!
Sue

Tell him "no thanks"
Medicare Supplement Insurance

 

[arnguy]

I looked at that website of TeamCorp. What I find strange is that doctor's visits and wellness benefits specifically astate no waiting period and no pre-ex clause; however, when I clicked exclusion there is no mention of pre-existing conditions anywhere. Am I missing something?


My bad. I see that the pre-ex is 12/12.

 

[Suis]

But more and more we are seeing prospects who are uninsurable. I don't like HII's surgery benefit either but what happens to uninsurables if they have no coverage - bankruptcy?

And to get almost free coverage, you've got to be on medicaid. How can we just tell them "sorry"? Hipaa is extremely high priced from what I've seen.

I'm not trying to convince you experienced and wise Guru's but I am giving some feedback and hope for some more answers.

It seems that we should help these uninsurables to get SOME coverage and then when the "change" happens in 2014 get them a regular health ins. policy per health reform guidelines (whatever they are)
good idea??
Sue

I am contracted with HII, don't sell much of any limited benefit stuff, but it's a good option to have for anyone who can't qualify for major med or PCIP.

Also, you can get 25+% direct from HII....so don't get suckered into a crappy contract through a GA.

The question is, do YOU want to offer a limited benefit plan and deal with the headaches associated with it?

I would avoid stuff like this.

MY GA wants me to sign on to sell to uninsurable.
website is:
HIIQUOTE
Anyone signed up with them?
"Insured Benefits Provided By:
United States Fire Insurance Company , Rated “A” by A.M. Best Reports"
Website states it's approved in my state.
Offers short term and GI
Free leads
I welcome all advice, suggestions, thoughts, opinions, etc.
Thanks!
Sue

- - - - - - - - - - - - - - - - - -
So what happens if you need two surgeries per year? Bankruptcy again?
Sue
PS Can I write to you privately to ask you a bit more about Hii? [email protected]
Thanks either way


Re: Surgery Schedule:

The surgery benefit with HII, leaves something to be desired.

They cover 1 surgery per year at a 10k max benefit, on top of network repricing.

So, take a gallbladder surgery for example....

HII would pay a $5k scheduled benefit for the removal of the gallbladder.

For the room & board, they would pay $500-$1500 per day....so I was in the hospital for 5 day for my gallbladder surgery....so I would see $2500-$7500

Thus far it's a total of $5k for surgery plus 2500-7500 for the hospital stay, that's $7500 to $12.5k. Add the network repricing, and that should cover 50% of the total bill at least, maybe more.

It's not perfect, cause it's not designed to be, that's not it's purpose....but for people who can't get major med or afford high risk pool, it's better than nothing.[/quote]

 

[YouGotMyMoney]

So what happens if you need two surgeries per year? Bankruptcy again?
Sue
PS Can I write to you privately to ask you a bit more about Hii? [email protected]
Thanks either way

Sure. Just PM or email through the forum.

 

[Crabcake Johnny]

You're assuming the surgery is for an emergency where the client deals with the bill later.

If it's a scheduled procedure it doesn't make it through pre-authorization. Gall bladder surgery? The call from the hospital to the patient goes like this:

"We just got off the phone with your insurance company and only $2,000 of this $12,000 procedure is going to be covered. How will you be paying the balance?"