Waivers from GR, what to do?

[trvlnut]

Hi all:
I have a client that just received restrictive riders from GR. 1) 14 day waiting period deleted (don't even know what this is). 2) Cholesterol outpatient (indefinite duration). 3) Increased PCS DED +$900 (Indefinite Duration).

Not sure what to do at this point. She has 20 day free look, but I don't think I can get her through underwriting with another carrier quickly enough. Is this common? Also, what should I get in writing from GR?

She doesn't have any coverage presently. Should I just have her keep the policy and look for another? I think I should have her fill out an Aetna app since she has Credible Prior Coverage. No other carrier will waive without prior coverage.

Lastly, she does qualify for a portability plan now, but if she accepts this coverage and Aetna doesn't take her, then she's stuck in this plan.

Any other thoughts would be great too.

 

[somarco]

Depends on what is available in AZ.

The 14 day waiting period is an illness only waiver GR applies to new policy holders. It is waived if they currently have coverage.

If the cholesterol rider is tight then accepting it might be advantageous. Other carriers will rate up for cholesterol (or also place a waiver that may be more restrictive). Depends on how the rider is worded, how much her meds cost, and what other carriers (such as Aetna) will rate up to cover the cholesterol.

I have no idea what an increased PCS deductible is. Explain.

If her condition is such that she cannot get a fair shake from other carriers, then a HIPAA plan might be her best option. Of course most of the HIPAA plans I have seen are lousy & extremely pricey.

 

[Crabcake Johnny]

Don't think for your client - let your client think for themselves. Present all options, explain all options and let them choose. Do they want to pay an extra premium to be covered on Aetna? Let them choose.

I'd run it through Blue Cross, Aetna, and possibly Assurant's pre-screens to get the likely decision. Then present the rates including the Aetna and Assurant rate up's and let her pick. Aetna, Assurant and Blue Cross will not rider cholesterol.

When I have my client's choose between any rider and a rate up about 95% choose the rate up.

 

[J.R.]

Did you check with the other carriers (e.g., Time, Aetna, BCBS, AMS, etc.) to find out other offers? If I can get a client covered with a higher rate or CSD I do not prefer riders, however, to each their own.

Here is the HIPAA plan information for AZ. Plans are so so and the rates are double what a normal IFP would be. http://www.bcbsaz.com/healthplans/under65/portability.asp?market=broker


-J.R.

 

[Crabcake Johnny]

Riders are an absolute last resort. If your client can't afford a 25% rate up to get an very important condition covered I'd make sure my E&O was up to date. There is a lot of potential liability attatched to having clients sign riders for on-going medical conditions. Nothing I'd want to go to sleep at night thinking about. You'd better at least have presented all options. The jury will want to hear that during the trial.

 

[trvlnut]

I did run her past other carriers. I need to see what they said again. Also I will have to go back and check what she wrote on her app. I don't think she listed any cholesteral problems on the app. She takes meds for HBP. They may have found something on the HBP form from the doc.

BTW John. Thanks for the suggestion to just put the ball in her court. Sometimes I feel like I can do more for my clients than what I really can.

 

[trvlnut]

If the cholesterol rider is tight then accepting it might be advantageous. Other carriers will rate up for cholesterol (or also place a waiver that may be more restrictive). Depends on how the rider is worded, how much her meds cost, and what other carriers (such as Aetna) will rate up to cover the cholesterol.

I have no idea what an increased PCS deductible is. Explain.

The PCS Deductible for GR is $250 for all RX but generic. Looks like they just increased it to $900.

As far as the cholesterol rider, I will call and ask them about it. Does Aetna always rate up? I think I remember that they said +25% for her HBP. I guess HBP and Cholesterol are related in this case?

 

[somarco]

The higher deductible for Rx isn't bad. I would take that over a rate up any day.

Ask them to send you a copy of the cholesterol rider.

Aetna always rates up (as far as I know, YMMV). In GA and at least some other states you get 4 choices with them. Standard, +25%, +50%, decline.

HBP & cholesterol are rated separately with Aetna.

 

[Crabcake Johnny]

Anytime you get an adverse underwriting decision it is indeed important to present the client with likely decisions of other carriers. It's not only the ethical thing to do but we live in a very letigious society. Anyone I deal with pre-ex conditions I email a:

Company A will do "this" and the rate is "X"
Company B will do "this" and the rate is "X"
Company C will do "this" and the rate is "X"

I've had many case where I think a rider is a non-issue; maybe it's only for a year on a fully recovered small surgery. Yet when presented with options they'll go against my advice and take another company with a rate-up. That's their choice and their level of comfort, not mine.

 

[trvlnut]

Thanks for the replies. I called GR and they won't send me the rider. So, I asked that the UW call me and I should hear back within 48 hrs. I think I should be able to get a copy of the rider from him/her.

I contacted BXBS and they stated that there isn't a rate up and they won't put riders on. It's either decline or accept. It sounds like they will accept her since my client stated that her Blood pressure readings are normal and controlled with meds. Of course, after having GR put a rider on for Cholesterol, I'm wondering what else is happening with this client.

I am going to call my client with the news and then follow-up with an email like John's.