Rejected by Kaiser

[Dave020]

Hi Al,

I think it's not a bad deal mainly because just a couple of years ago you got absolutely nothing. It at least gives us a chance to place those Kaiser folks that we used to have to turn away. MRMIP pays $50 one time, I enroll them too as well as AIM. Not my favorite business, but it's income and those people do like the help and refer others to me. Win-win!

Yes, 3% is not great, but in my world it is ok. Kaiser pays flat per member on small group business about that rate or just slightly higher ($13.75 I think). On HIPAA, which I write more probably than any 5 agents in CA, Shield gives me 2.75% while Cross gives 5%. Net, PCare all pay 20/10 on the adjusted premium for the standard underwritten rate for the same plan non-HIPAA.

So you can see it is all over the map. 20/10 is the best, or 10 on small group (which does drop given premium over the plan year) but of course underwriting for IFP becomes a big issue.

I write a lot of high risk because that represents the majority market share of the uninsured CA population. If they could pass underwriting they would have coverage on Tonik or something else low cost. Many agents cherry pick only those who can pass underwriting while others (like ehealth) shotgun thousands of apps a month in large volume. I'm one guy and cherry picking makes it hard to build a client base and also I prefer to advocate and help someone obtain coverage instead of turning them away. Each of us will have a different approach to this business and we do what works best for our clients.

Truth is Kaiser is never ever going to allow full agent servicing in CA on the IFP portfolio. This is a close as we are ever going to get and at least we can get compensated for our time and effort instead of referring them back to Kaiser and getting nothing.


Dave

www.davefluker.com

 

[Guest]

Hi Al,

I think it's not a bad deal mainly because just a couple of years ago you got absolutely nothing. It at least gives us a chance to place those Kaiser folks that we used to have to turn away. MRMIP pays $50 one time, I enroll them too as well as AIM. Not my favorite business, but it's income and those people do like the help and refer others to me. Win-win

Well, yes I agree it is a win-win in that you might get a referal for business that you can use to feed your family. But no matter what, 3% is NOT a good deal. What it IS is the ONLY deal. I would write it but Kaiser HAS to be the BEST choice for the client or what the client ABSOLUTELY wants... and I do my best to convince the client that they are better off with a PPO and not the over-priced Kaiser HMO. Why? Because in my heart of hearts I honestly belive that to be true. YMMV... and you (or anyone) are welcome to disagree.

Yes, 3% is not great, but in my world it is ok. Kaiser pays flat per member on small group business about that rate or just slightly higher ($13.75 I think).

When you consider that group usually pays 7% the Kaiser $13.75 equates to a premium of about 197 (.07x197=13.75). But we know that you can't put your cat on Kaiser for $197 a month. My attitude is that if Kaiser does not want to use independent agents, well fine. Thus I don't go out of my way to recommend their plan... and again having lived in Kaiser-land (Sacramento and San Francisco) for 30 years, I KNOW all the horror stories about their medical care, seen them first hand. Yes, they DO have some good doctors, but no matter how you slice and dice it, the incentive in an HMO is to keep you healthy... and that is wonderful. But g-d help you if you get sick because their incentive is NOT to treat you. That cost money.

On HIPAA, which I write more probably than any 5 agents in CA, Shield gives me 2.75% while Cross gives 5%. Net, PCare all pay 20/10 on the adjusted premium for the standard underwritten rate for the same plan non-HIPAA.

You have to look at HIPAA as a 'loss leader' in that you do a good service and hope to come out of it with a good referral. Nice thing about HIPAA is that it is not a lot of work since it is G.I.

I'm one guy and cherry picking makes it hard to build a client base and also I prefer to advocate and help someone obtain coverage instead of turning them away. Each of us will have a different approach to this business and we do what works best for our clients.

I think your approach is excellent. I do the same thing. But I know that I can't AFFORD to be in the health sector if ALL my cases are 2% and 3% ... or even 10% on IFP.

Truth is Kaiser is never ever going to allow full agent servicing in CA on the IFP portfolio. This is a close as we are ever going to get and at least we can get compensated for our time and effort instead of referring them back to Kaiser and getting nothing.

This is true. My hope is that the Blues give Kaiser a real run for the money and that HSAs catch on and that Kaiser's business goes in the toilet such that maybe they will see that using agents and compensating them for the business they bring is a GOOD thing.

On the other hand, when we get Hillary-Care, we're all going to be out of this business and selling LTC.

Al
http://www.insurancesolutions123.com