Health Ins. for Diabetic?

Aug 4, 2007

  1. Macdaddy
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    Macdaddy Guest

    Need a little help.

    Got a life customer here in KY that needs Health coverage. Husband and wife are both 46 years old and he is type 2 diabetic on a couple of meds. Both are on blood pressure meds.

    Is there any company that I can take them through? I have checked my underwriting guidelines for GR, Humana, and Assurant and the Diabetes is a decline with all of them and I am not seeing a exclusion rider available.

    Is there any alternative type plan available for this family?
     
  2. K-Dub
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    K-Dub Super Genius

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    Small group plan or the state risk pool if KY has one!
     
    K-Dub, Aug 4, 2007
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  3. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    Wow, that sucks. Diabetes is pretty common. No company will accept them at all? WOW
     
  4. Macdaddy
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    Macdaddy Guest

    I assume you mean employee sponsored small group plan? I will check to see if KY has a state risk pool. Thanks, Kris.
     
  5. somarco
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    somarco That Medicare Guy

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    Aetna will take type II if there are no other factors such as tobacco use, overweight. In this case the HTN is a deal killer.
     
    somarco, Aug 4, 2007
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  6. TXINSURANCE
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    TXINSURANCE Guru

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    I don't think it is realistic to expect individual carriers to accept diabetes. The cost averaged out to consumers would be through the roof.

    Small group is usually an option, or all 50 states have HIPAA or RISK POOLS to fund and spread the cost of high risk cases. Mini meds are also available for catastrophic coverage.

    Forcing individual carriers to take everyone simply does not work, it has been tried before in a lot of states - all of the carriers leave the market and the rates shoot through the roof.

    Diabetes and Blood Pressure is a pretty sure thing for claims I don't know how any company could make a profit on that client - which is really what we are talking about here.


    There are OPTIONS for these clients through group , HIPAA, or RISK POOL - that is the system we have. I appreciate your willingness to HELP people instead of hanging up on them.
     
  7. Macdaddy
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    Macdaddy Guest

    Guys thanks for the info...very helpful. KY does have a risk pool, but it looks to be to expensive for these folks to handle.

    Can you explain how HIPAA could help?
     
  8. somarco
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    somarco That Medicare Guy

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    Of course it's expensive. You are asking carriers to take on risks they would not normally do.

    HIPAA allows people leaving a HIPAA eligible plan (group insurance in most states) to convert to an individual plan on a guaranteed issue basis. The policy must cover their pre-ex conditions. They must not have more than 63 days without coverage from when the HIPPA group plan terminates and their new coverage.

    HIPAA guidelines vary by state. Check with your state DOI for details. In some cases it means going to a conversion plan, a gtd issue plan, the risk pool, or an assigned carrier. How your state handles it may be different from other states.
     
    somarco, Aug 5, 2007
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  9. bluemarlin08
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    bluemarlin08 Guru

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    How does Aetna rate a clean type 2 DIABETIC, RATE UP, RIDER ETC?
     
  10. BKrocko
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    BKrocko Guru

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    In CO, clean type II - no rider or waiver (they do not issue these on anyone), rate tabel C = 50% rate up.
     
    BKrocko, Aug 5, 2007
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