Matching the client with the right plan

[Crabcake Johnny]

You just have to know your state - and well. You have to read the policies you're selling cover to cover.

Assurant in MD in the policy:

Adult preventative - immediate benefit:
Pap smears with chlamydia screening
Mammography screening
Stool for occult blood testing
Flexible sigmoidoscopy and barium enema or colonoscopy
Prostate specific antigen screening
Fasting glucose testing
Lipid profile testing
Complete blood count testing
Urinalysis testing
Tuberculin skin testing
Other diagnostic services as recommended by the United States Preventative Task Force on the date service in incurred


Mammograms, pap tests and prostate specific antigen screening are not subject to the preventive services calendar year maximum benefit.

Wanna guess if GR has that language in MD policies? Again, I sell to value, not price.

 

[Crabcake Johnny]

I didn't mean to start a controversy herebut it sounds like(to me at least)that GR is trying to get back to the more traditional ways of what health insurance is;or should be. It is there to cover life's unexpected bumps in the road and more often than not maternity is something to be expected and insurance is like every other type company;they are in business to make a profit

I sell plans that offer the least amount of exposure. I'm not the amazing Keskin which means I can't stare at al client and let them know when they'll get diagnosed with something. I don't like this GR clause and I've called about it.

This is no coverage for reproductive organs in the first 6 months unless it's a life or death medical emergency. I don't think anyone wants the list of reproductive problems that would not be life or death if not treated in 24 hours. How 'bout an ovarian cyst? How 'bout stage 1 cervical cancer? What if the caner is benign? Uterine fibroids? Then it's definitely not life threatening.

This strikes personal for me. Without violating HIPAA lets just say that three females very close to me all had reproductive problems - all needed surgery, none were life or death. I couldn't imagine any of them calling me if they had the misfortune to have it diagnosed within the 1st six months. Go roll the dice on the craps table with your clients - not me. And if you think that clause isn't a big deal, then call GR and ask to remove it.

And if you don't think it's a big deal to your clients then please point out this clause to all female clients and see how many plans you sell. Any takers on people selling GR plans that go over this with female clients? What has their response been?

 

[somarco]

What am I missing?

The site says "every insurance policy that PROVIDES HOSPITALIZATION BENEFITS FOR NORMAL MATERNITY must also provide hospitalization benefits to the same extent as that for any covered illness".

This is not the same as saying every carrier must provide maternity cover.

Is there more?

 

[somarco]

No controversy. Just seeking opinions on how folks match up clients with coverage.

 

[Crabcake Johnny]

Second paragraph says all carriers must provide inpatient maternity benefits. 6 out of 7 offer it - only GR doesn't.

No controversy either. What has your experience been with telling females about the 6 month clause on no coverage for reproductive disorders? I've had bad luck with it.

 

[Crabcake Johnny]

You take a state like CT - got a very good broker friend there. State mandates that no riders allowed in the state. So no carrier - including Assurant issues riders. Assurant can't even issue CDS's there. It's rate-up or decline. Well....GR can't rate up. So they just issue riders against the state mandates. Can CT do anything about it? Nope....association protection. Could Assurant issue riders and say "scew it - we're association too?" Yep...but they don't.

Again, easy to offer cheap rates when you don't play by the same set of rules.

 

[somarco]

By second paragraph, I assume you refer to the well baby & recuperative care provisions. The one that says:

"Requires carriers to provide inpatient hospitalization coverage for mother and newborn for a minimum of 48 hours AFTER an uncomplicated delivery"

I still have not seen anything that requires maternity coverage.

 

[somarco]

For starters, I dont write business in CT, and I do not know what is available there, what isn't.

I do know from talking with a broker from CT that their GR policy is different from the ones offered here in GA.

As for association plans . . . look for a new thread.

 

[Crabcake Johnny]

I think it's neighter here nor there. All carriers in MD interperate that as having to offer maternity so all do.

Here's the matter at heart: Do you always offer the least expensive carrier? And it's a good debate. I've gotten into it before at broker meetins for offering ANY carrier except Blue Cross. An older broker in MD who I know thinks anyone who sells a GR or Assurant plan is unethical and commission driven since it's 20% to 25% versus Carefirst's $17.50 per app.

Our discussion was Carefirst's $500 drug cap versus the rate. He has a point and so do I.

Scenario: Husband and wife both 40 with 2 kids:

Carefirst Personal Comp: $2,500 deductible, 1 mill in coverage, $500 drug cap, $10 wellness copays, most meet deductible for sick visits. Cost - $291.

Assurant Max plan w/o copay (tough for apples to apples on this one, but Personal Comp has no copay for sick visits.) 8 mill in coverage, unlimited drugs and it's $386.

His debate is the price difference makes up for the $500 drug cap. I disagree. He's unwilling to listen to anything I say since he thinks I'm commission driven. Same with GR - they're more expensive then Personal Comp too.

So here's my philosophy:

As long as the price fits into my client's budget with a reasonable deductible I'm selling what I consider to be the plan that offers the least amount of liability. So if I have client at $750 a month and they'll move for $500 a month, and Assurant comes in at $500 a month I'm not even looking at anyone else.

That being said, you think I'm pricing up a 58 year old female smoker on Assurant? Nope. Price would never cut it.

What's unethical is to recommend a higher-priced plan that's not in your client's budget just for commission. And example would be someone saying they need $300 a month. Assurant comes in at $430 and GR comes in at $290. For me to recommend Assurant in that case is unethical barring no pre-ex conditions. But what if that same client was currently paying $600? Maybe she's trilled to death at $430. In that case it's Assurant since I feel they have the superior product in this state.

And Somarco - I'm not baiting you trust me, but how do you feel about the GR six month reproductive clause and do you go over it with female clients?

 

[J.R.]

Here is a spreadsheet I came across the other day that illustrates state mandates.