HBP Waivers

Jun 1, 2007

  1. Golddoor
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    If an insurance company issues a waiver on high blood pressure any thing that is a result of HBP is also not covered? Doesn't that make the coverage basically an accident plan? There are a lot of conditions that are a result of HBP. And companies will find a way to make an illness a HBP issue if the can find a way to get out of paying I'm sure. I had a client that we submitted with Unicare and they issued a Hypertension waiver and he said forget it when we read the waiver. It listed dozens of conditions that wouldn't be covered because they all came back to the HBP. I then submitted him with Aetna and got him covered with a slight rate up. He was happy with it, but like he said why would some one take a plan with a Hypertension waiver?
     
  2. STIBROKER
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    STIBROKER Like My post and enter the DRAWING,,,, Moderator

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    you really do not want your client having a HBP waiver.......heart attack....your screwed.....look to aetna or john alden....maybe even humana....after reading your post I guess you did....I know not to send HBP down the unicare trail......although did have a borderline wait it out a year and got unicare to remove the waiver....it blew me away....tryed to get him to do app's with other co's but never went the distance......
     
    Last edited: Jun 1, 2007
  3. Golddoor
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    Scott,

    I just submitted an app with Unicare today and the client has Hypertension. When I checked out the underwriting guidelines he checked out as accepted. He's not over weight, doesn't smoke, takes single med and has normal labs. So I'm hoping that every thing works out with this guy with Unicare seeing that his premium is about $170.00 a month less than Aetna's. They are on Assurant now and paying like $1300.00 a month and I wrote him and his wife on a little over $900.00 a month policy and the Unicare comm advance is going to be really nice if it gets approved!!

    :biggrin: :biggrin:
     
  4. somarco
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    somarco GA Medicare Expert

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    It depends on how the waiver is worded.

    Some carriers are quite specific in their wording and I have no problem offering such plans.
     
    somarco, Jun 1, 2007
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  5. STIBROKER
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    STIBROKER Like My post and enter the DRAWING,,,, Moderator

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    not uniscare......it reads like a installation manual.....

     
  6. somarco
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    somarco GA Medicare Expert

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    Scott, I was not referring to Unicare.

    Only carrier I have seen with a clean waiver is GR. They rider the condition and nothing else when it comes to HBP or cholesterol.

    Every other carrier wants to tie in everything from heart attack to E.D. and refuse to pay.
     
    somarco, Jun 1, 2007
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  7. Crabcake Johnny
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    Never have a client sign a rider for any condition when you can go to another company that won't rider it. A rider should always be the absolute last resort.
     
  8. newmindfashion
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    Bob,
    That GR rider in your state is very interesting in how narrow it is. GR really just seems to want to eliminate paying for care related stictly to the HiBP
     
  9. Crabcake Johnny
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    States and language must be different. In MD I called about the HBP GR riders. I asked a pointed question that if my client has a heart attack directly related to HBP if that claim would be paid. 1st warning sign? They had to transfer me. The other person I spoke with would not answer it directly and just reiterated "anything directly related to HBP will be excluded however a heart attack should be covered."

    I said "should?" Then I wanted a document from GR in writing stating that a heart attack directly related to HBP would be a covered event. They would not send me such a document. No dice.

    Again, language might vary by state. But why put your client in that kind of situation when you don't have to. What if the medication they're on increases? What if well-controlled HBP turns into uncontrolled? I don't have a crystal ball - health insurance is for unexpected events. Never sign a rider if it can be avoided. Period.

    I can't imagine any situation where an agent would recommend that their client sign a rider for HBP. I'd certainly hope he has good E&O and an attorney in place.
     
  10. somarco
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    somarco GA Medicare Expert

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    Jesse -

    That is true. The rider says they will not pay for treatment of hypertension. Wording is the same for most other situations.

    When the meds are reasonable, and most HBP meds are (usually less than $30) it makes no sense whatsoever to pay another carrier an extra 20 - 30% in premium to cover the meds. This is especially true with a HDHP.

    Some of the carriers that want to bump the premium 30% on a $5800 SIR just so the meds can accumulate toward the deductible are smoking something illegal.

    Some of the cholesterol meds can get pricey but this can usually be handled by stepping back to a tier 2 med or sometimes generic.

    You just have to run the numbers then let the client decide.

    They almost always opt for the lower premium and pay for the meds out of pocket.

    I have sold riders for years on some very large (self funded) groups so this is second nature. Once you explain the economics of the situation, the carriers who surcharge look like idiots and I look like a genius.
     
    somarco, Jun 1, 2007
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