Assurant on CBS news tonight

[J.R.]

Individual health is a great product for the right person. Many people can't even get group coverage through other means. Here in PA, I don't believe we have a state risk pool, but Highmark has guaranteed issue plans.

You are correct about Highmark, but don't forget about the HIPAA plans w/ the Capital, as well as CHIP, AdultBasic, etc. for children and low income families. The rates in PA for GI individual plans are horrendous, at least compared to the MD rates. Having said that, if something is important enough, I assume that people will scrimp, save, work harder, cut down on expenses,etc. to ensure that they limit their exposure.

That being said, there are only two areas where individual plans are better than group: price and ability to customize. Although the price and customization are significant, individual health actually sucks in every other aspect.

Would you be kind enough to explain how the majority if individual health plans suck? Are you referencing some specific limitations or something else?

Yet, if partners Billy Bob and Jed want to get coverage for them and their families, there is no question they would be save money with two individual policies rather than forming a group plan. People have different ways of thinking too. Some want the high deductibles and others don't like the idea of paying out of pocket, preferring low deductibles. Most individual health plans have many options available and are good in that regard. Although, I must say, I've never worked for an employer that didn't offer at least 3 or 4 different options, including both traditional and HMO plans.

MD clients have 7 companies, PA has about 10 or so (A rated companies), VA has along the same lines, so the fact is that people have plenty of options to choose from and all of them have their pros/cons.

None of that even begins to address the underwriting issues, which are a huge problem with individual plans. It varies by company, obviously, but some plans are so ridiculous in their underwriting requirements, as was featured on CBS news the previous night. I mean, companies asking if a person has EVER had a headache...that should never be allowed.

Agreed. Only a handful of carriers go that far.

Individual health is a good product, but it has to be used for the right market and definitely need some regulatory oversight added in some areas.

MD has 60 mandated benefits, while the winner is MN w/ 63. How far can we go? Low-income people are taken care of via state/federal programs. Children are covered in many states via CHIP programs and other avenues. Seniors have medicare and state/federal assistance. The affluent have money and can buy insurance if they want. The middle class also have the ability to purchase insurance (excluding pre-exisiting conditions). This leaves people born with disorders and ailments, and people who have come off group coverage and need STM or MM insurance via an individual/family policy. Sure, I am not a fan of having to tell a client that insurance companies in the area are afraid of depression/anxiety and can expect a rider, rate or decline, but I am also not a big fan of taking medications to solve minor psychological issues. Situational depression isn't an issue. They are more concerned with a manic, depressed man who has anxiety and ODD and believes he is King Henry.

I got off the phone with a very smart man yesterday. He is currently taking medication for HBP and it is regulated at normal levels. He also had HC in the past, but said that he didn't take medication for it. This quickly alarmed me and I asked him what he decided to do instead. "I changed my diet, started exercising and got a green light from my doctor for the past X years via check-ups 1-2x times a year. GREAT, that is a man who takes responsibility for his actions.

I Like Al's approach of trying to mitigate the insurance industry. Great way to look at things by serving both the client and insurance company. We are trying to protect both.
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[wilkin]

I just had a pending applicant call and tell me to withdraw her application with Assurant due to the CBS news report. Assurant has been jerking us around for almost 6 weeks. She called Highmark this morning and signed up for their guaranteed issue plan - coverage will start next week. She applied for a $3500 ded CoreMed at 288 per month. The Highmark plan has a 750 ded for 292! No medical questions asked. She is 61. No commission available to agents on that plan. Can you blame her?

 

[J.R.]

I just had a pending applicant call and tell me to withdraw her application with Assurant due to the CBS news report. Assurant has been jerking us around for almost 6 weeks. She called Highmark this morning and signed up for their guaranteed issue plan - coverage will start next week. She applied for a $3500 ded CoreMed at 288 per month. The Highmark plan has a 750 ded for 292! No medical questions asked. She is 61. No commission available to agents on that plan. Can you blame her?

I take it you are talking about the Classic Plan. IF so, her liability is a lot higher than that and you might be able to salvage the deal.

 

[somarco]

Insurance companies are supposed to use the MIB to determine such matters as pre-existing conditions

MIB does not have records on everything, only those situations where a claim was filed. If someone pays cash and does not file a claim, it is not reported to MIB.

And, not all carriers use MIB.

 

[somarco]

if they have a persons medical records and previous insurance applications what can possibly be an excuse for something major slipping through. If the insurance company has the records and something slips through, that should be on them.

You have a lot to learn about the way this business works . . .

 

[wilkin]

I take it you are talking about the Classic Plan. IF so, her liability is a lot higher than that and you might be able to salvage the deal.

Classic plan ded 750 plus 2,000 coinsurance, total 2,750 out of pocket. CoreMed 3,500 ded plus 3,500 coinsurance, total 7,000 out of pocket. Not even close. However, even if it was AND I could save her money, from the sound of her voice after seeing the news, she didn't want to have ANYTHING to do with Assurant.

 

[somarco]

One Deductible is their HSA qualified product.

Max is so-so, but the Rx benefit is a draw back.

 

[somarco]

She applied for a $3500 ded CoreMed at 288 per month. The Highmark plan has a 750 ded for 292! No medical questions asked. She is 61. No commission available to agents on that plan. Can you blame her?

Not at all.

 

[somarco]

after seeing the news, she didn't want to have ANYTHING to do with Assurant.

Carriers get bad press all the time. Deal with it.

The more you know about the situation, the more you understand the industry (AND the press) the better you will be at handling & diffusing the issues.

I placed $500,000 of qualified plan money with Mutual Ben a few days before they hit the iceberg. That was fun . . . NOT.

Kept the client.

Kept the money with Mu Ben.

You just gotta know how to handle it.

 

[arnguy]

PA does not have a stae risk pool for the uninsurable, but by state law all of the BX's in PA must have a guaranteed issue plan available. That means, Independence BX, Capital BX, Highmark BX, Northeastern BX, and Highmark BS must have a GI product. In PA the Blues are considered the insurance carrier of last resort.

Scott, who are you quoting with that piece that starts with the writer haveing been in the health benefits for 20 years? Where is it published? I know it can't be our John P. He is not that old and has not been in this business that long.