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pre-screen and individual health insurance 101

Crabcake Johnny

5000 Post Club
I get a lot of emails from new agents regarding underwriting so I figured I'd give a quick "101" on it.

First of all, it's all about a thorough pre-screen. Here's the medical info you need to collect before you recommend any company or product.

*How many times did you see a doctor last year?

*What's your height and weight?

*Have you taken any prescription medication in the past 5 years? (If yes you need dosage, frequency and how long they've been on the med.)

*Do do have any medical conditions that have been diagnosed by a doctor? (wait for answer, then ask) - any asthma, allergies, acne, migraines or anxiety/depression?

*Any trips to the ER or hospital in the last 5 years including accident, in and outpatient surgery?

*Do you have any pending doctor visits or testing? Are you waiting for the results on any testing you just had done?

*Do you plan on seeing a doctor for any condition that has not yet been diagnosed?

Basically, you don't want any surprises during underwriting. You also want to explain to clients how claims review works. A small percentage of clients have no plans on disclosing their pre-exisiting conditions to you under the false assumption that they can't get "caught" and they'll get a policy.

They need to know that if they use the plan to get anything treated that was not disclosed on the application the company will perform a claims review which will include reviewing all medical records and any medications they've taken.
I agree with everything you've said. I tell them, up front, that I know they aren't comfortable divulging personal information to me. That's why I do the following:

1. I encourage them to apply on-line. This allows them the anonymity, the time they need to gather medical information and physician's information, and the ability to work at their own pace. This also keeps me OUT of the loop. They can't tell the insurance company that I wrote something in, or anything like that. (I like that - no E&O claim)

2. I tell them that the insurance company contacts the MIB. This is NOT the Men In Black. It is a small company, in Boston, MA that has a record of EVERY time they have been in a physician's office.

When it comes to pre-screening: Once it is done, and I present a quote, I still let them know that this is subject to change. All we did in the pre-screen is narrow the scope of what to expect. It is still up to underwriting.

I tell them that insurance companies do not think logically, nor emotionally. They think financially.

I let the prospect/client vent, and tell me that their Osteo or High Cholesterol, or Depression is in check, and there is nothing to worry about. All they need is someone to yell at, and, if they are signing the app and handing over the check, I'll let them.

I have found that the prospects that have vented, and got close to what we asked for usually stay on the books the longest. Once they calm down, they realize what I have done, and what value that has for them. I've even had a few thank me for it, and tell me that other agents sent them Preferred Rating quotes, then disappeared when the pre-ex came up.

I also let them know that different companies react to different conditions differently. What is a claims problem for BCBS may not be for Assurant or Celtic.
insurebob said:
MA that has a record of EVERY time they have been in a physician's office.

thats not right...but they do have a record of every time a person has applied with a company that buys thier service and if they have been declined....
I disagree stongly that clients should fill out their own app. I should fill out the app since I know exactly what kind of information is needed. I have no E&O liability since after the app if filled out the client must review it and E-sign it. Aside from that Assurant takes an extra step and has the client review the printed application in the policy and sign an offer to accept/attest and fax it back. My butt is completely covered.


High blood pressure diagnosed in 2001. Taking Cardizem.


High blood pressure diagnosed in 2/15/2001 during routine physical with an initial reading of 165/90. Doctor recommend a weight loss of 20 pounds and Cardizem 100 mgs once daily. Second readings conducted on 6/20/2001 140/85. Last readings on 7/02/2006 of 120/90. Client lost the 20 pounds and medication changed to 20mgs once daily. High blood pressure is well controlled with medication, no ER visits or hospitalizations.
I usually find the opposite happens. Whenever I fill out the app, they become closed mouthed. When I tell them to complete the app on-line, I instruct them to include all the information, including when the nurse came in, and asked if you had to go to the bathroom.

I tell them about HIPAA, and PHI, and that they need full disclosure to increase their odds of getting coverage.

I tried yanking teeth for the first year in business. Then, when I left them to fill out the apps, both on line and on paper (before the on line app was available), I found less declines, less of increase in premium, and more business retention.

Getting back to pre-screening, I do demand that they be up-front with me, and that if there is anything, I mean anything, that comes up in underwriting that I don't know about, I can't help them. I present it as: Give me all the information, so that I can do a thorough pre-screen for you, and get you a more realistic quote. Then, when it comes time to fill out the application, YOU can fill it out, with all the detail you gave me, without me around, at your own pace (keeping in mind the 3-4 wk underwriting time), and you still have the dignity of filling it out yourself. People still need to feel like they are in control of SOME aspect of this process, and letting them fill out the app without me there is that way of giving it to them.

That way, they already have the Dr.'s info, the appointment info. All they have to do is duplicate it on the paper (online) app. It's like preparing a speech. The first draft is more difficult than the second.

That's just been my experience.
they do have a record of every time a person has applied with a company that buys thier service and if they have been declined....

This is not correct either.

Aetna for one does not report to MIB if a person is declined or rated. There are probably others as well.

Most of what MIB tracks is claims filed with carriers. If you don't file a claim, the information will not be in MIB. Even then, the information they keep is limited. They only have around 300 codes in a proprietary system for tracking data. Only carriers that subscribe to MIB have access to the information and the code.

And I also fill out, or at the least review, every client app before it goes to HO for underwriting. I have had clients queer the deal in the past by being trigger happy and filling out direct. More often than not, when the client does it themselves they end up costing themselves more money or receive more waivers than if they had let me assist.
Dead on correct. MIB is a strange animal and only certain conditions are logged and just by code. There are no details ever given on a MIB.

And if anyone wants to take a look at one, just get your own for free at http://www.mib.com You call a toll free number and you'll have the report in about a week.

Both my wife and I have pre-ex conditions and have nothing noted on the MIB.
As I stated earlier, I stand corrected on MIB. However, I find that if clients apply on line or fill out the app themselves, after we have done the pre-screen, they already have the information, and it's just a matter of copying it on to the paper or online app.

As I stated earlier (I notice you guys quote when I'm wrong, but never when I make sense), if there is anything they do not divulge, or if they misrepresent what we've already covered, I can't help them.

I usually find that people feel at the mercy of the insurance industry, in this process, and this gives them a bit of dignity and power.

Listen, we all do things differently. What works for me (obviously) doesn't work for others. I got tired of people expecting me to fill out THEIR apps. I had one lady who filled in her name and address, and told me to fill out the rest.

That was my epiphany. She expected me to fill out the app, while she did laundry, and talked on the phone to her friend.

If you do what others do, then they won't value you for what you do.

Now, if anyone else would like to highlight my MIB statement, which I've already said, twice, was incorrect, I'll be more than happy to admit it for a third time.

As for pre-screening, which is what this post is all about, I believe it is vital to a smooth application process, and it is something that both you and the prospect/client should be involved in.

P.S. If the app is in my handwriting, the client/prospect can always claim that I put it there without their knowledge. My GA at Berkshire told me to NEVER NEVER have an app in your handwriting. Best advice I've received. That's why I've never had even a hint of an E & O Claim.