Health INS Question ???

Jun 2, 2008

  1. Agent4Life
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    Agent4Life Expert

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    Hi Everybody,

    I have a Life Client who has asked me if I can help her to get some Health Insurance. Let me start off by saying that I have been away from the Health Insurance arena for a couple of years...(I used to sell MEGA a few years back - which was a terrible experience - and after I escaped from them, I decided to go independent and concentrate on Life & Annuities)......however, I did try to do a little checking around and the underwriting depts. of both Anthem/BCBS and Aetna said that if she applied, she would probably be declined b/c of her weight.

    She is 44 years old; she weighs 307; she is 5'9, and she has sleep apnea. She has no other health conditions and takes no meds. A paramed, APS and EKG was done for the Life application, and everything came back fine. The sleep apena is treated with a CPAP machine. She lives in Virginia.

    Do any of you Health Agents have any suggestions as to what I can recommend that she do about Health Insurance ??? I was actually able to get her approved for a Life policy (rated up of course) with about 3 different carriers; so I was thinking that "maybe" there are some Health companies out there that would approve her as well.

    Any recommendations or suggestions would be greatly appreciated.

    (P.S....I've already given her one good suggestion: loose weight soon !)
     
  2. The Rabbi
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    The Rabbi Guru

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    Sounds like a candidate for one person group.
     
  3. tryan326
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    tryan326 Super Genius

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    Is this a joke???:err:

    5'9 307lbs and sleep apnea. Her best option with her current health is a Group plan from her employer, State Risk Pool which isn't offered here in VA or a prayer. She'll have to lose weight before any individual health carrier will even consider her sleep apnea.
     
  4. somarco
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    somarco That Medicare Guy

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    She needs to drop at least 100#, then maybe Aetna or H1 will consider her.

    Figure she is 2 yrs away from being seriously considered for individual health.
     
    somarco, Jun 2, 2008
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  5. moonlightandmargaritas
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    moonlightandmargaritas Guru

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    And it sounds like one person large group as well!
     
  6. theinuranceguy
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    theinuranceguy Guru

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    Lol, I dont think Medicaid would even underwrite her.
     
  7. LGilmore
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    LGilmore Guru

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    I'm 6'7" and weigh the same and I have a BMI of 35. You have a life company that will write her? wow. She's gotta have a BMI of 45+ (actually 45.3) That impressive that she can even entertain a life policy.

    It sounds like you have no state pool which is too bad. I don't think outside of being in a group plan you'll have much luck.

    She is a time bomb health wise, give her a few more years at that weight... what life company did you use.
     
  8. Duaine
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    Ok, here is one idea for you. Although she would be declined by almost all carriers, (I do have one carrier who would go to 296 lbs at her height), there is a plan on the market she would qualify for:

    AIM Health Plans - HIPPA compliant guaranteed issue health insurance for all 50 states

    This plan asks NO health questions. It is a HIPPA compliant plan and does have limited benefits.

    This plan would NOT pay for any pre-existing for (12) months unless she had a Certificate of Credible Coverage from a qualified group. HOWEVER it would issue her a CCC after she had been on the plan for (12) month which could be a boon for her.

    If you are interested in this plan and would like to have it in your portfolio you can go here:
    https://aimhealthplans.com:1445/index.php?fuseaction=home.acontract_app&agentid=DO4534

    I hope that this may help you and your client.

    Best regards,

    Duaine :yes:
     
    Duaine, Jun 3, 2008
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  9. TXINSURANCE
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    TXINSURANCE Guru

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    I don't see why she could not get a HIPPA plan from Anthem in VA? I believe the differential is 400%.

    This person has VERY SERIOUS medical condition of obesity and sleep apnea, that is nothing to mess around with. Even at 400% rate up, the carrier is likely still subsidizing her risk level.

    Unless she is not HIPPA compliant then we go back to the issue of personal responsibility - she allowed herself to have a gap in coverage for whatever reason.

    You failed to leave out when was the last time this person had creditable coverage? I can take a wild guess here - but I might be wrong.
     
  10. somarco
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    somarco That Medicare Guy

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    Duaine -

    AIM is junk.

    Already covered on this forum.

    And no, it is NOT HIPAA compliant nor does it qualify as creditable coverage.

    Or credible coverage either . . . (to use your terms).
     
    somarco, Jun 3, 2008
    #10
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