Thought She Had Major Medical but Was Sold an Indemnity Plan—Seeking PPO Options

[GOLIFEANDHEALTH]

Hey everyone, I recently spoke with a client who thought she had major medical insurance, but after reviewing her application, I realized it’s actually a fixed indemnity plan. She had been shopping for major medical two years ago but was sold an indemnity plan instead.

To make matters worse, she doesn’t have proper coverage documentation—just the application, without even a coverage brochure. Buried in the e-application was an "applicant statement" confirming it’s not major medical, but a fixed indemnity plan, which I pointed out to her. The agent never explained this, didn’t go over the coverage, and despite the application stating there would be follow-up, she never received any calls to clarify.

I’ve seen this happen with this company before, so I recognized the issue right away when I saw the company’s name.

Now, she’s self-employed and earns too much to qualify for premium tax credits, so she’s looking for real major medical options—specifically a PPO plan outside of the marketplace. Or does she still need to purchase through the marketplace?

Any suggestions or advice on where to explore reliable, self-employed PPO plans would be greatly appreciated!

Thanks in advance!

 

[Jim Wright]

This is unfortunately pretty common.

What state is she in? Most Blues will have an off exchange PPO available. She likely can't enroll earlier than 1/1 but there should be some options.

 

[GOLIFEANDHEALTH]

Florida. Thanks for your response!

 

[Jim Wright]

99% positive Fl Blue has national PPO.