UHC Says GI? Client Leaving Retirement Medicare Plan

[yorkriver1]

New to dealing with retirement Medicare benefits, normally I can't save them money, here I can, very much. Verizon retiree Medicare coverage getting out of hand ($125 deductible, $1,000 max OOP, forgot to ask cost sharing %), likes Plan N. Medicare is primary, like I said, I am new to this, had to ask. Checked, are there any ancillary benefits, no. Just MedSupp type coverage/PDP in one plan. Saving over $200/mo, and Plan N is likely to be lower OOP.

Age 78, issues too many for almost all Med/Supp (internal cancer, radiation, chemo in last 12 months), was going to do underwritten rates for UHC/AARP. Called them, oh, no, it's GI, due to leaving retirement coverage. Even on PDP? UHC swears this is how they consider leaving retirement Medicare plan. Check the "plan is ending" box on Med/Supp app.

Calling to double check on SEP for PDP. They say that, too. Not cancelling coverage or writing PDP until Med/Supp app is issued. No money with app.

A little disappointed about GI, due to commission, but that's not the primary motivation...

Next client T65, eligible for retiree benefits from our state. Any suggestions for finding out what benefits they offer for future reference--other than getting with client after he talks to benefits rep? I sold an on exchange/no subsidy health plan to the spouse, saves $ from retiree rates under 65. I consider working on this as my training for any future state retirees as prospects.

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SEP-LEC per Humana. OK if voluntary or involuntary. Learn something new daily. I swear the written material says if the plan ends/is discontinued.

Can someone comment on experience learning about employer retiree plans common in states where you sell? Maybe no best way, but thanks in advance for any suggestions.

 

[midwestbroker]

From my experience, every group plan will be different. It is up to the company what they want to offer their retired employees.

I have seen some get an allowance to get their own plans, subsidized premiums for Medicare supplements, full blown group benefits (like they never left), plans that pay nothing (there was a big company in KC that pulled this one...plan paid 80/20 just like Medicare, but cost $450 per month).

If they have their outline of coverage, I would take a peak at it, or call their benefits administrator to get plan details (most have them online).

 

[yogooglethis]

New to dealing with retirement Medicare benefits, normally I can't save them money, here I can, very much. Verizon retiree Medicare coverage getting out of hand ($125 deductible, $1,000 max OOP, forgot to ask cost sharing %), likes Plan N. Medicare is primary, like I said, I am new to this, had to ask. Checked, are there any ancillary benefits, no. Just MedSupp type coverage/PDP in one plan. Saving over $200/mo, and Plan N is likely to be lower OOP.

Age 78, issues too many for almost all Med/Supp (internal cancer, radiation, chemo in last 12 months), was going to do underwritten rates for UHC/AARP. Called them, oh, no, it's GI, due to leaving retirement coverage. Even on PDP? UHC swears this is how they consider leaving retirement Medicare plan. Check the "plan is ending" box on Med/Supp app.

Calling to double check on SEP for PDP. They say that, too. Not cancelling coverage or writing PDP until Med/Supp app is issued. No money with app.

A little disappointed about GI, due to commission, but that's not the primary motivation...

Next client T65, eligible for retiree benefits from our state. Any suggestions for finding out what benefits they offer for future reference--other than getting with client after he talks to benefits rep? I sold an on exchange/no subsidy health plan to the spouse, saves $ from retiree rates under 65. I consider working on this as my training for any future state retirees as prospects.

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SEP-LEC per Humana. OK if voluntary or involuntary. Learn something new daily. I swear the written material says if the plan ends/is discontinued.

Can someone comment on experience learning about employer retiree plans common in states where you sell? Maybe no best way, but thanks in advance for any suggestions.

In Fl anyway yes GI with AARP/UHC even if voluntary drop of EGHP but need letter of coverage termination before they issue policy GI and in your case that sounds like a problem.Whenever I write a Med supp when dropping EGHP I ask underwriting questions and if they pass then you don't need termination letter - also you still get full commission assuming they already have part b

 

[yorkriver1]

"In Fl anyway yes GI with AARP/UHC even if voluntary drop of EGHP but need letter of coverage termination before they issue policy GI and in your case that sounds like a problem.Whenever I write a Med supp when dropping EGHP I ask underwriting questions and if they pass then you don't need termination letter - also you still get full commission assuming they already have part b"

*smacks forehead* I had the underwriting issue reasonably set up with client's expectations to get an answer before dropping the EGHP. According to UHC they will underwrite for rate if client has doesn't have one of the conditions/situations that's a knockout question. There are only two simple knock out questions.

Now, will this be a Mexican standoff waiting for a letter of termination before issuing a policy? I told the client not to cancel prior coverage until the policy was issued.

The underwritten plan would have cost at least 1/3 more. It could have been the printed "underwritten" rate at best (a guideline, mostly, per UHC) or a higher one they determine. I have been Robin Hood to my own money here, not just UHC's, but it's the right thing to do. I was there by invitation to help a client's 78 YO mother get a better rate than the $366/mo retiree plan. Sometimes it's not a huge money maker, but I think they will stay on the books.

I am adding Med/Supp carriers as fast as possible, but have the feeling internal cancer above stage 1, radiation/chemo within 12 mo. would be a non-starter with almost all carriers except UHC.

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Thanks also MidWest Broker for your plan descriptions, very helpful!

 

[yogooglethis]

"In Fl anyway yes GI with AARP/UHC even if voluntary drop of EGHP but need letter of coverage termination before they issue policy GI and in your case that sounds like a problem.Whenever I write a Med supp when dropping EGHP I ask underwriting questions and if they pass then you don't need termination letter - also you still get full commission assuming they already have part b"

*smacks forehead* I had the underwriting issue reasonably set up with client's expectations to get an answer before dropping the EGHP. According to UHC they will underwrite for rate if client has doesn't have one of the conditions/situations that's a knockout question. There are only two simple knock out questions.

Now, will this be a Mexican standoff waiting for a letter of termination before issuing a policy? I told the client not to cancel prior coverage until the policy was issued.

The underwritten plan would have cost at least 1/3 more. It could have been the printed "underwritten" rate at best (a guideline, mostly, per UHC) or a higher one they determine. I have been Robin Hood to my own money here, not just UHC's, but it's the right thing to do. I was there by invitation to help a client's 78 YO mother get a better rate than the $366/mo retiree plan. Sometimes it's not a huge money maker, but I think they will stay on the books.

I am adding Med/Supp carriers as fast as possible, but have the feeling internal cancer above stage 1, radiation/chemo within 12 mo. would be a non-starter with almost all carriers except UHC.

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Thanks also MidWest Broker for your plan descriptions, very helpful!

Coverage will not be issued GI until termination of coverage letter is received by underwriting so yeah it's a stand off. Yes he will get approved but he has to initiate cancellation of current coverage to get letter of termination.That is sure to make for an awkward conversation with an unhealthy client.It's best to walk away from those IMHO.

Florida there is only one rate class for NT so we don't have to worry about higher premiums based on underwriting for someone who also has the GI option.

 

[kstein]

Does your state accept involuntary termination as GI for whatever reason? If so you can typically send a letter attesting to losing employer coverage and they issue the policy vs getting an actual letter, which involves actually dropping group. Mutual if Omaha, Stonebridge, and BCBS are easy to use in this situation. Aarp not so much.

 

[yogooglethis]

Does your state accept involuntary termination as GI for whatever reason? If so you can typically send a letter attesting to losing employer coverage and they issue the policy vs getting an actual letter, which involves actually dropping group. Mutual if Omaha, Stonebridge, and BCBS are easy to use in this situation. Aarp not so much.

I believe most carriers don't in Florida for voluntary termination but UHC/AARP does and they always have the best rates where I am located so I use them 100% of the time

They are looking for written documentation from the carrier or benefits admin. that, in the case of voluntary drop of coverage , a request has been made and has been acknowledged by the carrier , benefits admin . etc. for termination of coverage by xyz date.A letter from the prospect attesting to request will not suffice.

I once ran in to a situation where I mistakenly assumed prospect qualified based on underwriting but actually didn't because they were under 65 outside of their open enrollment and on the last day before effective date of new med supp I had to get prospects employer to fax a somewhat informal letter on company stationary stating that the employee had requested termination of coverage on that day to end the next day.Underwriting at UHC accepted this even though the request for termination had not technically been received and processed by the employees carrier.

 

[yorkriver1]

Good info. Helpful. I like to develop procedures to avoid problems. Will call my FMO and see what they say about the need for a letter from the plan (or client), and by what time.

If the policy gets issued near the effective date, the rule is, the client will have to have a need to use the insurance card before it arrives in the mail....

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Does your state accept involuntary termination as GI for whatever reason? If so you can typically send a letter attesting to losing employer coverage and they issue the policy vs getting an actual letter, which involves actually dropping group. Mutual if Omaha, Stonebridge, and BCBS are easy to use in this situation. Aarp not so much.

1. not sure about our state, but all the information I read from carriers and Medicare sounds like it should only be GI when involuntary. That's why I was caught off guard by UHC's GI offer. I now know that Humana when asked about PDP also considers voluntary to be a SEP-LEC (ok to write).

2. I am not sure how you mean that AARP is not so easy in the termination letter rules. No letter from client, only carrier?

 

[yogooglethis]

Good info. Helpful. I like to develop procedures to avoid problems. Will call my FMO and see what they say about the need for a letter from the plan (or client), and by what time.

If the policy gets issued near the effective date, the rule is, the client will have to have a need to use the insurance card before it arrives in the mail....

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1. not sure about our state, but all the information I read from carriers and Medicare sounds like it should only be GI when involuntary. That's why I was caught off guard by UHC's GI offer. I now know that Humana when asked about PDP also considers voluntary to be a SEP-LEC (ok to write).

2. I am not sure how you mean that AARP is not so easy in the termination letter rules. No letter from client, only carrier?

State insurance laws say carriers have to have to offer Med supp GI when it's involuntary loss of EGHP however it's the insurance carriers call whether they want to be " crazy generous " and offer GI even for involuntary loss of EGHP
I would call the carrier or read their producer handbook to get this type of information.This information is also contained in the " Choosing a Medigap Policy " booklet that state insurance laws say agents must give to all Med supp applicants upon completing all Med supp applications Medicare.gov - Publications - Results

Also this information is also contained in the Medicare Bible called " Medicare and You 2014 " that all seniors have a copy of in their homes and that i carry with me on all Medicare related appointments: Medicare.gov - Publications - Results

I wouldn't consider AARP/UHC requirements for proof of loss of coverage neither strict or lax.Insurance laws say that carriers must send policyholders a standard form referred to as a "Termination of Coverage Notice " This is what you want to try to submit to underwriting for GI purposes however i believe other written documentation that is generated by the carrier or employer that proves EGHP is ending at a specific date will suffice but a letter from the applicant stating their intention to cancel I don't imagine would work but who knows you could call the carrier and ask.

 

[cadylou]

State laws differ as to involuntary vs. voluntary loss of coverage, so some of that has to do with the state laws, and not necessarily the carrier's preferences. No matter, it has to be clear to the carrier that the loss of coverage will occur - the insurance doesn't have to be cancelled to have the policy issued. You just have to produce "intent" and the date coverage will be lost I've had no trouble producing that - it can take many forms - from a letter from the client to the carrier requesting termination, to the actual letter from the employers HR dept. Often the actual letter acknowledging loss of coverage isn't generated until it actually ends, so carriers will usually accept other things to show that it WILL end.