You had the same experience with them as I did, I won't have any part of them whatsoever.
Limited Benefit Plans After 10/1/13
- Thread starter Monti_Ray
- Start date
You had the same experience with them as I did, I won't have any part of them whatsoever.
- 2,128
Yep, I didn't care for his presentation at the time, would not answer a lot of questions.
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Guys I'm not going to disagree that there is more risk selling STM. However, in this hyper cost inflated Obamacare market, its going to sell itself and if the consumer wants it, I'm gonna sell it. Yes, obviously for the marginally sick and frail, its not a good option, but through the years I have sold plenty of it, and it has paid claims plenty of times....Not changing what I do one bit with short term. True story, I have a veteran health agent friend and only one time in over 25 years of selling ST health insurance (along with selling major med of course) has he had a company deny a big claim...ONCE in 25 years. And the person truly lied on their application, even after he told them that ST covered no pre ex... I'm not a ST health conspiracy theorist...sell it with disclaimers, and if it makes sense, give it to the consumer...If you don't sell it somebody else will.
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Btw Humana had told me on numerous occasions on recorded lines that hypertension doesnt mean that if someone has a heart attack they wont cover it on a short term plan. They do.
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Btw Humana had told me on numerous occasions on recorded lines that hypertension doesnt mean that if someone has a heart attack they wont cover it on a short term plan. They do.
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- 3,863
And in some states short term is capped at 6 months. In other states caps are placed on the number of re writes. In addition what if a short term expires and it is outside of AEP and you can not reapply for any reason including pre ex. Does a short term expiration trigger a SEP? If you say YES please provide supporting documentation.
A few years ago one of my existing clients dropped her major med (without my knowledge) and signed up for an STM using a link on my website. A few months later she called because her STM was ending and she wanted to get back on a major med.
Turns out she dropped the major med because she was getting married in a few months and would be going on her new husbands plan.
Shortly after going on STM she was in a very bad accident. STM paid as it should but in the interim the wedding was called off (didn't ask) so she needed a "real" major medical plan.
Problem was, she had ongoing expenses, therapy, pain meds, more surgery . . .
I told her no one would take her until she was released from a doctor's care.
That was when she started to cry.
I hate when that happens.
I doubt the "new" STM plans will cover pre-ex either.
The problem with STM is not the first go around as it is what happens when they need a new policy and are still in claim.
Turns out she dropped the major med because she was getting married in a few months and would be going on her new husbands plan.
Shortly after going on STM she was in a very bad accident. STM paid as it should but in the interim the wedding was called off (didn't ask) so she needed a "real" major medical plan.
Problem was, she had ongoing expenses, therapy, pain meds, more surgery . . .
I told her no one would take her until she was released from a doctor's care.
That was when she started to cry.
I hate when that happens.
I doubt the "new" STM plans will cover pre-ex either.
The problem with STM is not the first go around as it is what happens when they need a new policy and are still in claim.
You are correct, TXInsurance. STM is not ACA-compliant since it is HIPAA excepted. As such, losing your STM does not trigger an SEP. There are some STM's that claim they are HIPAA compliant and can issue a Certificate of Creditable Coverage. If so, then they must be ACA-compliant, meaning GI and Guaranteed Renewable, attendant with higher rates.
I think we will see lots of legitimate uses for STM when we are painted in a corner and have very little to offer. To me, those situations are when AEP is over and there is no open window for SEP. Examples are when people lose their insurance and don't realize it until SEP is over (or don't care), like a lapse, ugly marital separation, a parent dropped the kids' insurance and didn't tell the ex-spouse, the boss let the group plan lapse... You might get a person who didn't enroll during OEP or SEP, and comes to you later wanting insurance, understanding that it won't cover pre-ex. What are you going to offer except STM, fixed indemnity, etc. In these situations, I see no agent liability in offering SEP or a fixed indemnity plan if market provides a good one. In all those situations AEP and SEP are over.
However, a client who has an open window of opportunity during OE or SEP, but doesn't want to pay the premium is a case I'd rather not put into STM. There will be lots of them, but I'm a little leary of selling STM as a cost-effective alternative to a major medical plan. I'd almost rather see the person take a bronze HMO with a small network... (Did I just say that? Oh my, the choices are going to be ugly.)
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I agree with your analysis.
- 8,448
1-15-2014
Some new (and confusing to me) guidance from HHS on FIXED INDEMNITY plans..and several other ACA related issues.
See Q&A #11 at this link:
http://www.dol.gov/ebsa/faqs/faq-aca18.html
Anything new or newsworthy?
Some new (and confusing to me) guidance from HHS on FIXED INDEMNITY plans..and several other ACA related issues.
See Q&A #11 at this link:
http://www.dol.gov/ebsa/faqs/faq-aca18.html
Anything new or newsworthy?
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What does this mean "excepted benefits"? It says you must have a seperate mec plan in order for it to qualify as excepted benefits.
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