I'm not an agent. But I thought this might be a good place to ask this question.
Do insurers ever revisit a Med Supp application, regarding conditions, AFTER underwriting approval?
Reason I ask (in addition to curiosity):
I'm thinking of switching from N to G -- same insurer -- but only in the absence of any underwriting-based upcharge. (I have no interest in changing insurers, otherwise I would contact an agent/broker.) 32 months ago a specialist I saw produced a physical test result suggestive of the presence of condition X, but I never had the common followup procedure to confirm its presence and extent. I haven't seen that doc since then. I noticed that Condition X was never added to my record, although I have always guessed he was likely to say "probably" or "yes" if I directly asked him whether I had Condition X.
But I recently secure-mailed this doctor on MyChart, told him that I was considering making the switch, and asked, "if the application asks if I have Condition X, should I say Yes, No, or Not Certain." He replied that I should be "safe to answer No to that question since it was never proven."
But I'm a little uncomfortable about what might happen if a Condition X - related illness/event happens 6 months, a year, 10-15 years from now. Could the insurer go back and investigate my app looking for a non-truthful answer, and then deny payment of their 20% and/or cancel my supp?
Also, do the major Supp companies routinely do an underwriting phone interview if I answer "no" to all the conditions and don't have any red-flag meds?
Thanks in advance for any thoughts.
Do Med Supps ever revisit app re conditions AFTER approval?
- Thread starter Rick441
- Start date
The question from most carrier applications after your six month eligibility of turning 65 window will be:
Have you been diagnosed, treated, given medical advice, or prescribed medications for:
Atrial Fib
Artery or vein blockage
PVD
Cardiomyopathy
CHF
CAD
COPD
CKD
Diabetes
Cancer
Cirrhosis of liver
MS
Macular degeneration
MS
RA
SLE
and/or not completed surgery on joints, organs, cancer, back, spine or heart.
Declines or "rate up" depending upon state, carrier and u/w guidelines.
I've had clients also denied for multiple conditions including HBP, cholesterol and obesity cumulatively. I've had carriers write and approve a policy on multiple conditions where another carrier declined for the same thing.
Some underwriters on some carriers more lenient depending on the situation.
The only way to know is fill out an application with an agent; wait for the underwriters decisions and then you can decide to stay with Plan N or go with Plan G if approved. The reason why I say fill it out with an agent is that they will do some research behind the scenes to see if it's worth filling out the application in the beginning and then follow up with you quicker then waiting on the letter and also make a determination if you should try with another carrier. Why you would not go with another carrier if it's the same product and you can get approved at much better premium is strange to me but that's your right. I have clients felt the same way.
And Yes. If you do not disclose information on your application at the time written it can be rescinded.
Good luck.
Have you been diagnosed, treated, given medical advice, or prescribed medications for:
Atrial Fib
Artery or vein blockage
PVD
Cardiomyopathy
CHF
CAD
COPD
CKD
Diabetes
Cancer
Cirrhosis of liver
MS
Macular degeneration
MS
RA
SLE
and/or not completed surgery on joints, organs, cancer, back, spine or heart.
Declines or "rate up" depending upon state, carrier and u/w guidelines.
I've had clients also denied for multiple conditions including HBP, cholesterol and obesity cumulatively. I've had carriers write and approve a policy on multiple conditions where another carrier declined for the same thing.
Some underwriters on some carriers more lenient depending on the situation.
The only way to know is fill out an application with an agent; wait for the underwriters decisions and then you can decide to stay with Plan N or go with Plan G if approved. The reason why I say fill it out with an agent is that they will do some research behind the scenes to see if it's worth filling out the application in the beginning and then follow up with you quicker then waiting on the letter and also make a determination if you should try with another carrier. Why you would not go with another carrier if it's the same product and you can get approved at much better premium is strange to me but that's your right. I have clients felt the same way.
And Yes. If you do not disclose information on your application at the time written it can be rescinded.
Good luck.
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- Thread starter
- #13
- Thread starter
- #15
Is the post-claim underwriting review for supps a one-time event, or does it recur?
- Thread starter
- #16
Could you be a little more specific about what you mean in this context?
Don't ever try to slip one by an insurance carrier.
This is why it is extremely important for an agent or broker to get the client to answer all the questions on an application whether it be under or over 65 plan. And for the client to get a copy of the application to review otherwise if they skip one and it comes back that the member actually did take a medication some of it comes back on the agent or broker. I've seen in my 20 year career only one policy rescinded because the member did not disclose melanoma in the cancer portion and medical records revealing later they were treated for it with another doctor. And I remember the whole process quite well and it went as far as collections to get money back from the member. Real stinker but you don't forget those.
- Thread starter
- #19
I hear you, and it makes sense, but if the doc had answered "yes" or "probably" instead -- as I was expecting -- I wouldn't even be considering asking for the change from N to G. Same goes if there wasn't such a small difference in monthly premium (currently $10, although I know that can change...tho it's been that way for 3 years now). I also don't like the office-visit copay billing (I originally assumed I would just have to hand over a credit card for the $20 *at* each office visit -- as I did for years with employer insurance). But I guess that's not a big deal.
The insurer waits until a claim has been filed to obtain information and make underwriting decisions which should have been made when the application for insurance was made. System will pick up a CPT and/or Diagnosis code which is flagged based on dates or service of the claim. Medical records can be obtained from PCP or specialist regarding the claim or at time of original application. There's also something called the Medical information bureau much like the credit bureau which warehouses your information which they can use at their disposal since you signed on the application that they can use it.
