Husband and Wife 2 Man Group Texas PPO Health Insurance

[russelltw]

That would be nice, but not possible here in NC. Our carriers don't want small groups and pay accordingly. Most group people I have talked to are charging a broker fee to make it worth their time.

 

[scagnt83]

Now if I could just figure out what to do with my single people to get them off the trainwreck.....

Let me know when you figure that one out. I looked into hiring my teenage daughter to form a group this year (gotta love lax child labor laws for family members). But the money saved was minimal because of my age, and the group option I wanted (level premium self-funded) wont take employees below age 17.

I could look into partnering with another agent here locally... but that creates a whole other set of issues/headaches/potential problems.

Fortunately, SC Blues is offering off-exchange plans that are around 30% cheaper than on-exchange.

 

[scagnt83]

That would be nice, but not possible here in NC. Our carriers don't want small groups and pay accordingly. Most group people I have talked to are charging a broker fee to make it worth their time.

Im not sure if National General is offering 2 man groups in that area, but they do in SC and comp starts around 5%. Its a Level Premium Self Funded product. Good for healthy people with low utilization. People who would normally do a HSA are perfect prospects for it.

 

[bill3173]

Im not sure if National General is offering 2 man groups in that area, but they do in SC and comp starts around 5%. Its a Level Premium Self Funded product. Good for healthy people with low utilization. People who would normally do a HSA are perfect prospects for it.

Just appointed with NG, and wish I had known about the 5%. I completed a two man group this month, for $50/month commission. Based on their premium, I would have gotten $165/mo...knowledge is power...lack of knowledge is poverty.

 

[kgmom219]

Im not sure if National General is offering 2 man groups in that area, but they do in SC and comp starts around 5%. Its a Level Premium Self Funded product. Good for healthy people with low utilization. People who would normally do a HSA are perfect prospects for it.

The guy keeps calling me, but it scares the crap out of me. You sell a $3K 100% HSA and limit them at $3K for OOP.

What's the OOP on the level funded plans? Is there enough savings to justify the risk?

 

[LostDollar]

Fortunately, SC Blues is offering off-exchange plans that are around 30% cheaper than on-exchange.

BCBSKS EPO approach to network concerned me-and here-no price difference between on and off exchange blue plans.

I could look into partnering with another agent here locally... but that creates a whole other set of issues/headaches/potential problems.

Because of my age, I am not sure we had any realistic options like that--but I think it gets to a point where recordkeeping, govt reporting and third party involvement in your affairs gets so complex that the possible health ins savings are not enough reward for the changes.

 

[scagnt83]

The guy keeps calling me, but it scares the crap out of me. You sell a $3K 100% HSA and limit them at $3K for OOP.

What's the OOP on the level funded plans? Is there enough savings to justify the risk?

Dont let it scare you. Think of it as an HSA for the entire Group.

Level Premiums for 12 months.

Claims are paid out of Premium Dollars up to a certain threshold.

Anything over that threshold is paid via the StopLoss Policy.
There is a Group Threshold and a separate Individual Threshold the StopLoss applies to.

At the end of 12 months, they review claims and issue the renewal rate for the group.

IF claims are below a certain level, the Employer/Group can receive a refund of up to 50% of premiums paid. The business can apply it to future premiums, or take it as cash.

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Your question about OOP depends. The plans are totally customizable, old school style.

You could design a HSA plan with a $3k deductible/$3k OOP.... or $2k/$3k ... or a Co-Pay Plan with your pick of Co-Pay levels... same for RX... same for ER.... etc etc. Its pretty much completely customizable.

So you can replicate the groups current plan, and in my exprience, they will save around 20%-35% in Premiums on average.

Or you can slightly undercut current Premiums, and provide a MUCH richer Plan.

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Obviously, its not right for certain situations. If you have a 2 person group prospect and they are on a ton of meds for multiple chronic conditions, then forget about it. If they are HSA owners and rarely go over their $10k deductible, then they would be great prospects for it.

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I realize there's the "what if" there is an extremely high claims situation... especially an ongoing one.

It could certainly cause premiums to increase significantly for a 2 man group. Same for a very small group. And they can technically deny a renewal if the group is just totally upside down.

BUT, as a business, you have safety nets for that.
- Switch to fully funded plan upon renewal
- Switch to ACA upon renewal if just a 2man group and fully funded isnt option


Talk to your guy and ask for the agent overview pdf they have. It makes a lot of sense for the right situation. And since its level premiums, there are no mid-year surprises.

 

[scagnt83]

Oh, and it's a bundled setup that is completely turn key.

The Stop Loss and TPA are bundled and integrated into the Plan.

So no having to "piece together" all 3 parts, and no having to shop around for SL or TPA.

 

[dorado]

I would Lic in every state that allowed husb/wife groups......I am writing the hell out of them here in tejas.......

In DC Metro Area (Northern VA, Southern MD) Kaiser lets you do a one person or one family Group. This is the only carrier I found in my area that allows it.