Need Help for Hep C Client

[retread]

Yeah, I already talked to him about the kids. He didn't know he could get a policy just for them.

I feel sorry for him... he is looking at some very big Rx costs, my guess is first year about $20K. After that it should taper off.

I am weak in this area.... my expertise has been Medicare. I have only started studying the IFP and Group regs/policies for about a year. However, IFP is out of the question because Hep C is an auto decline. He says if he has to go to the state high risk pool, he will just do without.quote]

Your client is a fool if he goes with out. Tell your client that the state risk pool would give him a degree of asset protection.

Already discussed this.... I'm not completely brain dead!

 

[ABC]

Already discussed this.... I'm not completely brain dead!

My bad

 

[warrenins]

His condition will run up the tab for his employees. The insurance company cannot "discriminate" against any one employee so the entire group gets the rate up.
If he wasn't divorced I would have said make his wife an employee and write the group by excluding the 1099. Of course there might be tax consequences but that's better than a 20k rx bill. If he has one true employee (w-2) he might be able to get around it by saying the rest of his employees are 1099. Other than that it's the high risk pool

 

[TXINSURANCE]

I am sorry I seem to be missing one critical piece of information. Why does he not have coverage in place NOW?

 

[IAC.Ryan]

If he wasn't divorced I would have said make his wife an employee and write the group by excluding the 1099.

With the exception of a few states - generally a husband and a wife can not constitute a small group. In order to qualify, you would need an additional full time employee.

Kind of a moot point since their divorced - but I figured I'd chime in.

 

[retread]

I am sorry I seem to be missing one critical piece of information. Why does he not have coverage in place NOW?

I think that's a question you would have to ask all uninsureds. I think it comes down to at least two groups: 1) those who can't afford the premiums and 2) those who don't want to pay the premiums.

In his case, I think he had insurance through his former wife's group, but now recently divorced and with pre-ex he is faced with high monthly costs he hasn't had to deal with before. It appears he is too stubborn to recognize that he has been walking on thin ice, and thinks that even now with this recent proposition of high drug costs due to his dx, thinks that he can somehow find the means to self-insure.

He seems to be a prime candidate for a HSA, but in a group context, not IFP. At least that is the approach I am taking at this time. You can't always lead a mule to water, and you certainly can't make him drink. I like this guy, he is a friend.... he is just very difficult to educate.

This is common to many independent contractors, not just him. These guys should be commended on their ability to succeed in business without relying on some company to provide them a living. However, this independent spirit can get in the way sometimes. Sound familiar?
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With the exception of a few states - generally a husband and a wife can not constitute a small group. In order to qualify, you would need an additional full time employee.

Kind of a moot point since their divorced - but I figured I'd chime in.

I think he has several men on W-2 status and several others on 1099s. I would like to try to recruit as many total as I can to get the group size up. No telling what other pre-exs I will find....

 

[somarco]

These guys should be commended on their ability to succeed in business without relying on some company to provide them a living. However, this independent spirit can get in the way sometimes. Sound familiar?

Obama's inauguration address?

 

[TXINSURANCE]

In his case, I think he had insurance through his former wife's group, but now recently divorced and with pre-ex he is faced with high monthly costs he hasn't had to deal with before.

I thought when you get divorced there is some COBRA provision?

Can some group expert chime in if I am incorrect for my own knowledge?

 

[ABC]

I thought when you get divorced there is some COBRA provision?

Can some group expert chime in if I am incorrect for my own knowledge?

20 total employee's qualifies the group for Cobra and yes this guy would have been able to elect Cobra.

My experience with this industry is these people don't care about health insurance. You can write a policy on them and they will drop it 3 months latter. Now if you do have a prospect that has employees and is really trying to grow their business then a group health plan can be an easy sell.
Its getting through underwriting that can be the hard part.

 

[TXINSURANCE]

20 total employee's qualifies the group for Cobra and yes this guy would have been able to elect Cobra.

What about state continuation? I believe in Texas there is a 6 month state continuation? Is this a Texas thing only? Any ideas?

My experience with this industry is these people don't care about health insurance. You can write a policy on them and they will drop it 3 months latter.

Agreed.