New Health Agent in Need of Help...

[Mari]

Hello to everyone,

I am a new agent, who could use some help, recommendations, or possibly some insight.

I found this forum after speaking with a man from Pa.

The man is Over 50, Cobra soon to expire, and with a pre-existing condition that might(?) otherwise make him uninsurable.

I noticed that a BX has/had(?) an affordable compliant plan for up to $35,000. Small, but immediate...

This started me wondering,

Once a compliant plan is exhausted, can an individual transfer directly to another Blue GI, and if so, is the pre-existing then waived?


TIA of your replies..

 

[somarco]

What is the px condition?

 

[Mari]

Hello somarco,
Thank you for responding..

PX's are...

Heart Attack (11) yrs ago.
Peripheral Neuropathy
Catheterization (every 9 mos)
physician tear, leading to a vein graft. ( assume bi-pass regardless of the reason?)

 

[DS4]

I would say the prospects only hope is HIPAA GI.

To be HIPAA eligible, you must meet certain criteria

If you are HIPAA eligible in Pennsylvania you are guaranteed the right to buy individual health insurance policies and are exempted from pre-existing condition exclusion periods. To be HIPAA eligible, you must meet all of the following:

· You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.
· You also must have used up any COBRA or state continuation coverage for which you were eligible.
· You must not be eligible for Medicare, Medicaid or a group health plan.
· You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.)
· You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.

HIPAA eligibility ends when you enroll in individual coverage, because the last day of your continuous health coverage must have been in a group plan. You can become HIPAA eligible again by maintaining continuous coverage and rejoining a group health plan.

 

[Mari]

I don't have a Blue appointment, and wouldn't know where to begin.

The Blue plan I found, "might" "still" fit into his budget.

Can someone give me a rate in Franklin County?

If it works for the man I will refer him on...

Just curious,

Are the Blue plans similar throughout PA.?

and,

Does one appointment permit you to sell the whole of Pa.?

TIA..

 

[arnguy]

Capital Blue Cross covers Franklin County. You can obtain information from their website: www.capbluecross.com. In PA there are four different BXs, namely, Independence BX, Capital BX, BX of Northeastern PA, and Highmark (formerly BX of Western PA). Highmark also owns Blue Shield of PA which covers the entire state. IBC requires that brokers get appointed under certain Master Brokers. I would assume the same holds true for the other BXs. Each one is an independent licensee of the Blue Cross Association and coverage may differ. Highmark often encroaches into the territory of the other BXs to compete with them, with the exception of IBC. One appointment will not suffice. Hope this helps

 

[mmike160]

Capital Blue Cross covers Franklin County. You can obtain information from their website: www.capbluecross.com. In PA there are four different BXs, namely, Independence BX, Capital BX, BX of Northeastern PA, and Highmark (formerly BX of Western PA). Highmark also owns Blue Shield of PA which covers the entire state. IBC requires that brokers get appointed under certain Master Brokers. I would assume the same holds true for the other BXs. Each one is an independent licensee of the Blue Cross Association and coverage may differ. Highmark often encroaches into the territory of the other BXs to compete with them, with the exception of IBC. One appointment will not suffice. Hope this helps

URL Financial has one of the GA contracts for Capital Blue Cross. They are based out of Harrisburg..

 

[arnguy]

URL Financial is an excellent FMO. Good advice, Mike.

 

[mmike160]

URL Financial is an excellent FMO. Good advice, Mike.

Yeah, URL has been great to work with and they have some pretty cool trips for their producers...

 

[Mari]

Capital Blue Cross covers Franklin County. You can obtain information from their website: In PA there are four different BXs, namely, Independence BX, Capital BX, BX of Northeastern PA, and Highmark (formerly BX of Western PA). Highmark also owns Blue Shield of PA which covers the entire state. IBC requires that brokers get appointed under certain Master Brokers. I would assume the same holds true for the other BXs. Each one is an independent licensee of the Blue Cross Association and coverage may differ. Highmark often encroaches into the territory of the other BXs to compete with them, with the exception of IBC. One appointment will not suffice. Hope this helps

Now that is a study unto itself...

Thank you.. You have been most kind..
- - - - - - - - - - - - - - - - - -

I would say the prospects only hope is HIPAA GI.

To be HIPAA eligible, you must meet certain criteria

If you are HIPAA eligible in Pennsylvania you are guaranteed the right to buy individual health insurance policies and are exempted from pre-existing condition exclusion periods. To be HIPAA eligible, you must meet all of the following:

· You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.
· You also must have used up any COBRA or state continuation coverage for which you were eligible.
· You must not be eligible for Medicare, Medicaid or a group health plan.
· You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.)
· You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.

HIPAA eligibility ends when you enroll in individual coverage, because the last day of your continuous health coverage must have been in a group plan. You can become HIPAA eligible again by maintaining continuous coverage and rejoining a group health plan.

This is where I'm still a bit confused..

If creditable group coverage leads you to Cobra,

And Cobra is still considered "group"...

On a carrier site, there are 2 categories listed with plans that "appear" to be similar but with different rates..

HIPAA Compliant Comprehensive
*If applicable, you have exhausted COBRA coverage provided to you after leaving active group employee coverage.

and

GI.. Comprehensive..
*There is a px condition limitation, unless prior creditable coverage applies from your last insurer(s).

Does the Cobra count as creditable coverage in the GI Comprehensive?

and if so, I'm having difficulty accounting for the difference in rate..

I must be missing something... I'm just not sure what it is..