Universal Health Care suspends MA PFFS plan in all states

[policy doctor]

Key Information

• Universal Health Care is financially strong and secure. Universal Health Care will continue to process and pay claims for members enrolled in the PFFS plan.

• Enrollment of new PFFS members has been temporarily postponed. Only PFFS enrollment has been postponed. Universal Health Care will continue to enroll new members in the Masterpiece and Masterpiece Plus plans in Florida.

• The postponement of new PFFS plans was a voluntary action by Universal Health Care as it works closely with the state insurance department.

• Universal Health Care has enrolled over 100,000 new members in 3 months. We are working with the state to meet the regulatory requirements accompanying this rapid growth. Both the state and Universal Health Care have the same goal: to deliver personal, professional and proactive health care to our members.

• Universal Health Care is a pioneer in PFFS plans. As with any innovative company, periods of adjustment are common. Universal Health Care is committed to senior citizens and will continue to provide exceptional service for its members and partners.


Operational Instructions

All sales seminars are to be postponed until further notice, at which time the postponed seminars can be rescheduled.

A hold has been placed on any PFFS application signed after February 14, 2007. Applications signed after February 14, 2007 will not be accepted until further notice. Please send all applications to Universal Health Care as soon as possible. Any PFFS applications received by Universal Health Care after Monday, February 19, 2007 will be reviewed and approved by Compliance before processing.


Media Contact

Please refer all media calls to Universal Health Care.

 

[honestagent]

As long as the agent has not told the member anything wrong, the agent has nothing to worry about.

If the plan does not perform as stated, then it is the fault of the company.

Worst thing that will happen is that they will pull out of the county, and you can go in and sell them a different product.

I disagree with you. We are the fuduciary 'agent' in the field disclosing things. Whether or not one comes after the agent can become a 'he' said 'she' said case unless verification was done - and even then it can become shady. I personally know a few agents who are going through state greivances presently with a MAJOR player in the field on MA plans. Do not DO NOT think for a moment that you or any of us may not be held liable.

And in fairness to you on ' it's the fault of the company,' that is true. Sure. And that can be better paper trailed then what the agent said in the home. Fine. But the company not delivering does not relief the agent - whatsoever. There are many reasons why we MUST be certified to conduct business in this market.

 

[policy doctor]

Don't know how this will play out but I talked with my mktg office Friday and got some interesting news.

First, they have had a large # of unqualified enrollees so chargebacks are slowing them down.

Also, they got an infusion of $120 mil capital to pump up their reserves. Which was the main concern of the Fla DOI. With that being resolved it is possible they may resume selling within 2 weeks.

This was primarily a re-insurance problem....where they had maxed out on their capital for liability reserves...now that has been resolved.

Checks will be cut, but may take another 2-3 weeks because of the unexpected confusion. In the meantime, employees haven't been paid either.

For sure, even if they come back quickly, unpaid agents will be leery of writing more apps until they see the green!

I've been thru receiverships with other companies but I did get paid. (anyone here remember Conseco and their BK)?

 

[midwestbroker]

Honest, we must be certifies and we must take accurate notes!

I always rec. that you should have a note sheet (I use my mapquest printout) to take notes on my appointments) to document any irregularities that my happen. Cover your a**. That is the key.

Like the old saying goes, if you haven't pissed anyone off, you are not doing your job. Not to say you should lie or be rude, but some people want it all for free, and that does not happen (unless they are on full medicaid, but then it cost them all their assets).

 

[honestagent]

Honest, we must be certifies and we must take accurate notes!

I always rec. that you should have a note sheet (I use my mapquest printout) to take notes on my appointments) to document any irregularities that my happen. Cover your a**. That is the key.

Like the old saying goes, if you haven't pissed anyone off, you are not doing your job. Not to say you should lie or be rude, but some people want it all for free, and that does not happen (unless they are on full medicaid, but then it cost them all their assets).

I agree. Also, after I heard from a very seasoned, talented agent, she suggested having a legal disclaimer that highlights the pros and especially the cons in our tool belts. That could only corroborate our case (should we have one) that a client can sign off and we can keep with our records. Not all MA companies have verification and even with that, we still should have a c.y.a. document. My question with this is: Does a lawyer need to draft this for it to be a 'legal' document or can we just draft one ourselves and it be deemed as 'credible,' in the eyes of the courts?

 

[Guest]

Honest, we must be certifies and we must take accurate notes!

I always rec. that you should have a note sheet (I use my mapquest printout) to take notes on my appointments) to document any irregularities that my happen. Cover your a**. That is the key.

Like the old saying goes, if you haven't pissed anyone off, you are not doing your job. Not to say you should lie or be rude, but some people want it all for free, and that does not happen (unless they are on full medicaid, but then it cost them all their assets).

I agree. Also, after I heard from a very seasoned, talented agent, she suggested having a legal disclaimer that highlights the pros and especially the cons in our tool belts. That could only corroborate our case (should we have one) that a client can sign off and we can keep with our records. Not all MA companies have verification and even with that, we still should have a c.y.a. document. My question with this is: Does a lawyer need to draft this for it to be a 'legal' document or can we just draft one ourselves and it be deemed as 'credible,' in the eyes of the courts?

A legal disclaimer is a bad idea--even if an attorney writes it up. Besides the fact that insurance companies will not allow you to have your own disclaimer associated with any of their products, a disclaimer letter does not help your case. A disclaimer for this purpose would say to a judge that you know you are putting your clients at risk.
Picture yourself in front of a Judge reading all the legal jargon where you had your 75 yr old client initial and the Judge turns to you and says. "you expected them to understand this?". A disclaimer letter will immediately put you on the defense. Leave the legal stuff to the insurance companies.

This is what E&O is for--to protect you.

 

[midwestbroker]

I agree with Kyle.

If you should have a claim and you have all your ducks in a row, along with a notebook or file of clients and notes on them all, you will look much better then an agent without.

I have a file for each month with my notesheets for each sale I had. If they were not a sale, I have an accordian file by last name I put the notes into. I also spreadsheet all my names for mailings, ref, etc. Nice and simple.

 

[policy doctor]

Has anyone here, besides me, sold Universal MA plans? If you have, and not been paid, I understand it may be another month before you do.

They met their money deadline for today, but another one is looming for next month. If they default, they will be liquidated.

Not a happy scenario. Wondering if this is the time to change seniors to another MA before end of March.

 

[midwestbroker]

If the company does liquidate, then they will have a SEP (special election period) to change plans. At that point I would be on the phone with them telling them what their options are.

 

[agent007]

Very interesting.