Need Expertise of NC Broker/agent, Please

[insagt]

Hello and thank you for reading.

I have a client who is 63 and covered in NJ by an Oxford HMO Individual HC plan. She is thinking of moving to NC in 2011. Since the NJ HMO won't respond out-of-state, she'll have to get a replacement policy in NC. She will pick up Medicare A, B & D w/a supplement when she turns 65.

The client has diabetes II, high cholesterol, mitral valve prolapse and high BP. Has been on meds for Cholesterol for years but it remains in the low 300's. BP seems to be stable and under control. Also may need hip replacement. Since I understand that NC isn't a GI state like NJ is I would imagine these ailments would have an impact on the premium.

Could you tell me
1. would NC impose a PreX clause on these ailments
2. if so, how long would that be in place or does it depend on the client's medical history
3. what kind of impact are we looking at as far as an increase in base premium if a company will take this on

Client is currently paying $600+/month for HMO w/50% Rx.

Thanks so much for any input you could give me.

 

[bill3173]

Hello and thank you for reading.

I have a client who is 63 and covered in NJ by an Oxford HMO Individual HC plan. She is thinking of moving to NC in 2011. Since the NJ HMO won't respond out-of-state, she'll have to get a replacement policy in NC. She will pick up Medicare A, B & D w/a supplement when she turns 65.

The client has diabetes II, high cholesterol, mitral valve prolapse and high BP. Has been on meds for Cholesterol for years but it remains in the low 300's. BP seems to be stable and under control. Also may need hip replacement. Since I understand that NC isn't a GI state like NJ is I would imagine these ailments would have an impact on the premium.

Could you tell me
1. would NC impose a PreX clause on these ailments
2. if so, how long would that be in place or does it depend on the client's medical history
3. what kind of impact are we looking at as far as an increase in base premium if a company will take this on

Client is currently paying $600+/month for HMO w/50% Rx.

Thanks so much for any input you could give me.

She would be declined by any carrier and offered a hippa plan which is a joke.

She will be eligible for the State Plan once she applies to, and is declined by a private carrier. The cost is about the same as what she's paying now, depending on the plan that she chooses.

She can contact the DOI, once she moves here, and obtains a residence. They will guide her in the right direction. If she wants to have an agent assist her in the County that she resides, they will give her a list of agents to contact.

I have no less than 2 of these cases sitting on my desk per week. It takes a little effort to get approved, but is well worth it to those that can afford it.

 

[insagt]

Thank you for your reply.

Could you tell me if the State plan imposes PreX conditions?

Is it detrimental from the State's U/W stand-point for the client to decline the HIPAA plan and apply for the State plan?

The time-frame of the underwriting process is a concern. Are we talking days, weeks or months to get a declination from the private carrier and then approval from the State? Since she'd be loosing her NJ HMO coverage when she moves down to NC, she'll be without coverage from the day she gets there until U/W decides what it's going to do. I understand that the U/W review time-frame also depends on how fast the docs get the med history to the companies. I know there are not guarantees, just looking for a time-frame. Thanks again for your time.

 

[bill3173]

Thank you for your reply.

Could you tell me if the State plan imposes PreX conditions?

Is it detrimental from the State's U/W stand-point for the client to decline the HIPAA plan and apply for the State plan?

The time-frame of the underwriting process is a concern. Are we talking days, weeks or months to get a declination from the private carrier and then approval from the State? Since she'd be loosing her NJ HMO coverage when she moves down to NC, she'll be without coverage from the day she gets there until U/W decides what it's going to do. I understand that the U/W review time-frame also depends on how fast the docs get the med history to the companies. I know there are not guarantees, just looking for a time-frame. Thanks again for your time.

1. The State does impose pre-ex, but not if continuous coverage has been maintained.

2. No, turning down a hippa plan will not keep you from getting the State Plan.

3. Rather than give you a long answer, the easiest way to meet the enrollment criteria is to be turned down by a private carrier. With the conditions that you listed, she could apply at 8:00 AM and be declined by 10:00 AM the same day with Humana.

Once you're able to pm send me one, and I'll give you my contact info. if you would like for me to assist this lady.

We don't get paid a lot for it, but it's part of the job for those of us listed on the site, and like most State Plans, only NC agents can be of assistance. You can view the info. for the NC state plan at www.inclusivehealth.org.

Agents are not fighting over that business, trust me. I know that it's important to help, but I generally have to take 2-3 ibuprofen when I start this process with a new client.

 

[insagt]

Thanks so much for taking the time to explain the system in NC. I've passed it on to my client. Just to show you how much people need cost effective health care, she's decided to put off her move until she's eligible for Medicare. Now we're talking supplements. Thanks again and all the best.