Trouble....???

[TonyC]

thanks Health....

BTW....i know who assurant is....buut who is GR?

AND....what about this?

....Why not give them (the insured) a choice?

With and without meds....wouldn't that serve them better?

OR...is it too difficult to get 2 quotes?

 

[Crabcake Johnny]

GR = Golden Rule. And if you give a client a pure choice between meds or no meds most clients who are not currently no medication will choose no meds.

And how is a client served by having a plan with no drug coverage? Because they're not on meds now? That's like saying you don't need fire protection for your house because it's not on fire right now or you don't need theft on your car because it's in the garage right now.

I'd love to see other insurance sold the way health is sold:

Agent: "John, is your house flooded now?"

Client: "What do you mean?"

Agent: "I mean right now - is your house currently flooded?"

Client: "Ummm, no."

Agent: "Then I see no reason for flood protection on your policy."

 

[GreenSky]

And how is a client served by having a plan with no drug coverage? Because they're not on meds now? That's like saying you don't need fire protection for your house because it's not on fire right now or you don't need theft on your car because it's in the garage right now.

John, while I tend to agree with you on this, I have one concern. First of all, 90%+ of my business is HSA so coverage for Rx after deductible is no problem. Your comment about not needing fire protection is invalid. Not having Rx is similar to having a higher deductible on a homeowner's policy. My house is not on fire now so I'm willing to have a $5,000 deductible. How is that different than going without Rx? What % of people take more than $3,000 in prescriptions without winding up on Medicare?

Additionally, how long does a person keep their individual plan? If the client is a 30 yr old male, what is the likelihood he needs Rx coverage in the next 5 years? And what are the chances he keeps his policy for 5 years without looking at alternatives?

Is it worth paying $1200-1800 a year for Rx coverage, or take the risk? Most medications can be purchased from foreign pharmacies at little more than a copay anyway. Is it really worth insuring, or is it better (assuming premium dollars are limited) to protect a client from a catastrophe like hospitalization?

My problem with this entire discussion of good vs. bad insurance is that in 5-10 years, no matter what plan a person has it winds up becoming a closed plan and the prices increase so high no one can afford it.

This is basically the same issue I have with LTC. Looks good today, but what about 10 years from now?

Are we becoming "insurance snobs" and suggesting that if a person does not have coverage for all conditions they are not insured?

Rick

 

[Crabcake Johnny]

My first recommendation will always be plans with drug coverage. A lot of it has to do with how you prospect. I'm deal with small biz owners who currently have "it's all covered" plans. It's near impossible to sell them plans that offer less benefits.

I'll easily recommend a plan with a higher deductible with med coverage and if they can't afford that, chances are they're broke and won't be on the books long anyway.

GR Copay Select $5,000 deductible male 40, female 40, 2 kids in 21113 zip:

$329 per month

If that family can't afford $329 for coverage I don't have to worry about them calling me back - I won't be calling them back.

 

[djs]

I'd love to see other insurance sold the way health is sold:

Actually, I'm the opposite. I'd like to see health sold the way homeowners or auto is sold. Much cleaner, fewer loopholes.

Client walks in the office, casual small talk, then get down to business, quoting a health plan...

How many people in the family? (similar to how many drivers)
Have any had any medical incidents lately? (tickets and accidents discussion)
Okay, I don't care about the cough/cold doctor visit (same as a ticket for not wearing a seatbelt), but I see here you had a visit to a dermatologist (I'm not looking at their medical insurance history, online, for claims paid). Tell me about that.... oh, skin cancer, okay, thats a major (similar to a DUI).
You're wife had the flu, that gets rated as a minor for 3 years (little speeding ticket).

Now, what deductible would you like (just like an auto or house deductible)? $500, okay, but with the major, I would recommend looking at a $1000 deductible on your plan.

At the end, a price spits out, and that is the price. Good enough. Issue it on the spot, print out insurance cards, move on to the next. Get all the rating factors on the table, and the agents write it. Each carrier can determine when it has to go to an underwriter due to strange things. Same as auto insurance, I can bind it, but the carrier has 60 days to decline it afterwards due to undisclosed info.

While I understand medical history is considered 'private', agents handle it anyway, it's part of our job, so providing access similar to how I get your DMV report and CLUE report isn't anything different.

Let the agents do the job!!!! Make it much more like P&C. Rate it on the fly, and issue it. I know we are getting better with computer issued insurance nowadays, but there is still a long way to go.

Dan

 

[HomeService]

I see a lot of folks selling limited benefit plans, yet implying that they are major medical. { old school major med: don't hear that term too much these days} or, flat out lies about coverage, not implying, but flat out lies.

 

[somarco]

in 5-10 years, no matter what plan a person has it winds up becoming a closed plan and the prices increase

That logic does not track with high deductible, no copay plans. I have several clients who have had such a design for years. One client has used the same carrier for 10 years.

"insurance snobs" and suggesting that if a person does not have coverage for all conditions they are not insured

Pretty much.

Agents sell, and clients want to buy phantom insurance. Pure waste of money.

Let the agents do the job!!!! Make it much more like P&C. Rate it on the fly, and issue it.

I don't see that happening any time soon. Most health agents are lazy & stupid. Can't see the carriers giving up control to a bunch of buffoons.

P&C underwriting factors (DMV reports, credit, etc) is not the same as PHI which is protected by federal laws. Unless HIPAA is repealed or amended, you are not going to see the kind of information available to agents that is required to underwrite & issue a policy.

Besides, agents are idiots. They think everything should be covered and every application approved.

Health underwriting is much more complex vs. auto or HO coverage.

 

[Crabcake Johnny]

Who are underwriters anyway - as in what's the criteria for the job. Could I apply to be an underwriter and simply go through some training program or are they looking for people with experience in the medical field.

How's an underwriter supposed to read and dissect an APS written in medical Klingon? I'd have client fax over their medical records to me many times. In most cases I can't make out 50% of the doctor's notes and it's obviously all written in medical language.

 

[TonyC]

Thanks guys....

now...how do you cover yourself for dis-closures?

Do you have clients sign a Disclosure stating that they are aware of policies limitations?

 

[Crabcake Johnny]

No - it's called the 10 day free look. For what it's worth if I sell online I email everyone a copy of the brochure and require a "I got it" reply which I save - just in case anyone would say "I never saw the plan benefits." For in-person I always leave a brochure.

But remember it's not our job to go over all the plan's limitations and exclusions. If we did the presentation would be 2 hours. Raise your hand and tell me the last time you told a client about the skilled nursing limitation. Does that mean if they need skilled nursing past the defined benefit they can sue? Ummmm, nope.

I go over what I consider "important" limitations which would be medications. I simply don't sell limited benefits plans that limit things like outpatient treatment.