Sell health & cross sell life - could a nightmare happen?

[Crabcake Johnny]

Everytime I try to talk myself into cross-selling more life with my health clients I try to figure out what would happen in this "worst case scenario."

You're sitting with a client and sell him health. You also talk about life and write up an life app - schedule the paramed.

The health app is clean, no pre-ex conditions and it gets approved in a few days. Policy issued. The paramed pops by a few days later and about a week later results are in - extremely high cholesterol. Whether or not the the client accepts the table rating for life is irravelent.

Client receives his health insurance packet on Monday and Tuesday it's off to the doctor because of his high cholesterol.

Any takers on what happens to his health coverage?

 

[J.R.]

Denied and rescinded.

 

[MrStan]

Hmmmm... I am new at this - but I can guess.... it would be a NO GO. Recind???

Here's a question John, Couldn't you get him his health policy, then when you check in with him - talk about life/cross-sell? I mean - at that point, the heatlh policy is issued, he didn't know he had High Cholset., so he wouldn't have been lying. Would would happen in this situation.

 

[natem2112]

I would always wait at least a month or so, unless they had NO coverage at all and were in need of life coverage.

I've heard of this happening many times John, people applying for both life and health at the same time, finding something out in the paramed and getting declined or rated up extra for it.

No thanks to that.

 

[Crabcake Johnny]

If a life app is filled out first the health insurance company could request a copy of the paramed results. This is happened to me before without me even knowing about it. It's quite rate, but I've put an app in for health insurance then I get an open requirement. I call and it popped on the MIB that the client recently applied for life and now they want all the results of the exam.

 

[Guest]

Denied and rescinded.

Why? Client did not know he had a problem when he applied for health insurance. It might have been a pre-exist... but it was not known.

Let me ask this. You buy a health policy and 60 days later you go to the doc and he says "Too bad, you have CA (or diabetes, or whatever). Will the insurance company come back and say "Hey, you obviously had this before you got the policy so we won't cover you and we are cancelling your coverage? I've never heard of this happening in Calif. Hell two years later you could go to the doctor and they could say you have cancer and have had it for the past 5... just didn't know it. What is the 'limitation' on pre-exists when you change policies. What happened to the "credible coverage" provision... or is that a CA only thing?

Al

 

[J.R.]

Why? Client did not know he had a problem when he applied for health insurance. It might have been a pre-exist... but it was not known.

John did not say if the hypothetical client did not know he had HC. He asked for the worse case scenario, in which my thought entailed a client who "did" know that he had HC but did not disclose the conditionon the application. With the example listed above, if he saw the physician for treatment of HC and submitted a claim so quickly, the insurance company would perform a claims review and search his background. If it came up he lied, bye-bye policy (worse case), however, if he had no prior diagnosis, I take it that the insurance company would cover the condition.

Let me ask this. You buy a health policy and 60 days later you go to the doc and he says "Too bad, you have CA (or diabetes, or whatever). Will the insurance company come back and say "Hey, you obviously had this before you got the policy so we won't cover you and we are cancelling your coverage?

They may or may not deny the claim based on the aforementioned thoughts.

I've never heard of this happening in Calif. Hell two years later you could go to the doctor and they could say you have cancer and have had it for the past 5... just didn't know it. What is the 'limitation' on pre-exists when you change policies. What happened to the "credible coverage" provision... or is that a CA only thing?

12 months that may be reduced by prior credible coverage.

 

[Crabcake Johnny]

It would be in court. If you honestly didn't know you had high cholesterol yet saw a doctor for it literally days after your policy went active after receiving parament results you're getting that policy yanked.

If you honestly didn't know you had stage 4 cancer when you filled out the app but a month later just started to notice symptoms you're getting it yanked. Another "see you in court" from the insurance company.

 

[Guest]

If you honestly didn't know you had stage 4 cancer when you filled out the app but a month later just started to notice symptoms you're getting it yanked. Another "see you in court" from the insurance company.

Even if you had credible coverage for the past 15 years with another carrier?

Al

 

[somarco]

Creditable (not credible) coverage is a state by state & carrier thing. In GA only 2 carriers (that I know of) make allowances for creditable coverage.

Aetna & Consumers Life.