Aetna, BCBS, American Community, HumanaOne, GR, GTL, Assurant

emptyeternity · 02-18-2009, 06:04 PM

Hello Everyone,

I wanted to ask everyone who does health, a question about the above carriers.
1. Is there a particular underwriting niche that distinguishes one carrier from the rest? i.e. diabetes, cancer etc.

2. Would the particular underwriting niches vary from state to state?

I appreciate any input.

Peelerinsurance.com · 02-18-2009, 06:49 PM

Aetna used to be very liberal... not so much now however they do not do exclusions and with prior coverage in texas no pre x cigna the same way ... but again, i noticed underwriting clamped down in the last 30 days

Humana... underwriting very lberal and u can barder with them... i like that... so humana is the eaisest and u can get approval in 1 hour on so apps... even with health conditions

Blue cross tx... easy underwriting on most cases and they only do a 25% rt up in worst case unlike aetna and cigna with 50%

Assurant... who knows... they cost more than dope here in texas

Gr... i cant recall, they just have not been a big player in the last year

KCinsuranceguy · 02-18-2009, 07:09 PM

Someone correct me if its different elsewhere, but here it seem GR will rider just about everything. At least that's my experience so far.

somarco · 02-18-2009, 08:50 PM

Riders can be your friend if you understand them.

Most agents don't.

Charlie you are right. I have noticed a tightening of underwriting at Aetna as well. At first I thought it was just a bad string of apps but I am beginning to see a pattern.

Dave020 · 02-18-2009, 09:39 PM

Best thing to do in download each carrier's individual underwriting guideline for agents and study the more common things that come up like diabetes, hbp, cholesterol, gerd and so on. The more you write the more familiar you will be with the conditions people have.

In CA, each carrier has certain areas that they are more flexible in not necessarily in direct regard to overall underwriting. Also, we have no rider/waiver in CA, so it's pass, rate up or fail on overall health, no exclusions to rider out.

Example:

Blue Shield CA is tough on underwriting compared to Anthem BC and Aetna. However, when it comes to something like infertility treatments, BSC sets the bar at 2 years since last treatment, whereas the others are 5 years (or in the case of Health Net, PCare and Kaiser, lifetime decline).

Fibromyalgia - BSC declines as does Health Net and Kaiser, Anthem is possible depending on some things but always rated up at least 75%, Aetna most liberal for that condition (can get C rating with multiple pain meds and current treatment).

So, while I know CA market in terms of who is more flexible in general underwriting (Anthem BC and Aetna), sometimes the condition may fall with another carrier best.

Those guidelines are wonderful imho, at least to get you and your prospect looking in the right direction. I keep the PDF on my laptop for each carrier and when I am talking to someone I can pop up the guidelines and see what each says.

emptyeternity · 02-18-2009, 11:21 PM

THANK YOU everyone!!
My last question is for those that have insurint, which has underwriting guidelines markups, has anyone used this? and know of its precision?

somarco · 02-19-2009, 07:44 AM

Insurint links direct to the carrier info for rates and underwriting, so the results rely on the agents ability to understand and apply the guidelines. Keep in mind that underwriting guides usually do not give specific loads on anything other than tobacco use and build. Everything else is subjective.

bill3173 · 02-19-2009, 07:58 AM

Originally Posted by Dave020

Best thing to do in download each carrier's individual underwriting guideline for agents and study the more common things that come up like diabetes, hbp, cholesterol, gerd and so on. The more you write the more familiar you will be with the conditions people have.

In CA, each carrier has certain areas that they are more flexible in not necessarily in direct regard to overall underwriting. Also, we have no rider/waiver in CA, so it's pass, rate up or fail on overall health, no exclusions to rider out.

Example:

Blue Shield CA is tough on underwriting compared to Anthem BC and Aetna. However, when it comes to something like infertility treatments, BSC sets the bar at 2 years since last treatment, whereas the others are 5 years (or in the case of Health Net, PCare and Kaiser, lifetime decline).

Fibromyalgia - BSC declines as does Health Net and Kaiser, Anthem is possible depending on some things but always rated up at least 75%, Aetna most liberal for that condition (can get C rating with multiple pain meds and current treatment).

So, while I know CA market in terms of who is more flexible in general underwriting (Anthem BC and Aetna), sometimes the condition may fall with another carrier best.

Those guidelines are wonderful imho, at least to get you and your prospect looking in the right direction. I keep the PDF on my laptop for each carrier and when I am talking to someone I can pop up the guidelines and see what each says.

Seems like common sense doesn't it? So many agents don't do this, and it puts you at a distinct advantage.

I had a lady a six weeks ago call to get a price on her health insurance. I gave her my best estimate with the carrier most suited to her age, health, meds etc. She told me that I was an asshole and another agent was giving her preferred pricing on another carrier plan.

She called me back last week apologizing and we've started the application process.

It's not tree surgery.

somarco · 02-19-2009, 08:40 AM

I keep the PDF on my laptop for each carrier

Same here.

Whenever I talk to a prospective client I take a complete medical history including meds, the condition treated and how long they have taken the med. Also ask about hospitalizations in the last 5 years.

This, combined with a good working knowledge of what each carrier will and will not do give me a leg up.

I also pre-screen any time I am in doubt. Most of the time the response is as expected, but sometimes I get tripped up.

And I ALWAYS pre-screen via the online form or email. I NEVER call for a pre-screen.

That has saved my butt a few times. Recently did a pre-screen and got a favorable response from United HealthOne. We sent in the app and he was declined.

I went back and asked them to review the pre-screen against the app. Nothing had changed, all the info in the pre-screen was on the app.

They agreed to re-open the file and sent an offer letter to the client.

Then last week the client calls, said he did not have his policy and underwriting was calling to ask about his meds, etc.

I got back on the phone with UH1.

This thing went all the way to the top in underwriting with a sidebar in legal. They had two choices. Write a letter retracting the initial risk letter, or issue the policy.

Today I got a notice from eStore that the policy is being issued on a PREFERRED basis.

It pays to know your stuff, have everything documented in writing and have contacts in high places.

I had a lady a six weeks ago call to get a price on her health insurance. I gave her my best estimate with the carrier most suited to her age, health, meds etc. She told me that I was an asshole and another agent was giving her preferred pricing on another carrier plan.

She called me back last week apologizing and we've started the application process.

It's not tree surgery.

Reminds me of A Few Good Men.

"You can't handle the truth"

KCinsuranceguy · 02-19-2009, 06:36 PM

Originally Posted by somarco

Riders can be your friend if you understand them.

Somarco,

Can you please elaborate on this? Thanks

somarco · 02-19-2009, 07:59 PM

Most riders eliminate coverage for the specific illness AND anything related. Not so with GR/UHC.

They eliminate outpatient coverage for only the named condition.

No big deal for most illness. Better than a rate up in many situations.

KCinsuranceguy · 02-19-2009, 11:10 PM

Originally Posted by somarco

Most riders eliminate coverage for the specific illness AND anything related. Not so with GR/UHC.

They eliminate outpatient coverage for only the named condition.

No big deal for most illness. Better than a rate up in many situations.

Very interesting, every time I have done a prescreen with them they say the condition would be ridered.

I noticed you mentioned in another thread about sending in your prescreens by email which I've started doing recently, so thanks for the tip. But when I would call in a prescreen they would always say it would be ridered. I had the most simple case, a guy no other health issues other than he was taking 10mg HBP medicine (sorry can't remember what kind).

It was the lowest dose of that medicine though, but anyways they said his HBP would be ridered or an increased prescription deductible; she couldn't say for sure. Now Goldenrule's rates are pretty competetive here as far as I have noticed especially on younger people, but its hard to sell when you don't know what the outcome will be especially when its only HBP we're talking about. Will they tell you more about what type of rider will be placed on the policy when you email the prescreen?

Sorry, I'm getting off on a rant here. I need to learn more about riders with GR for sure.

emptyeternity · 02-19-2009, 11:56 PM

These are great questions. I would also like to know how you can get them to hold to the agreement of prescreening.

somarco · 02-20-2009, 08:30 AM

GR mails the policies to me for delivery, so I get a chance to read the rider language. Compare a few GR riders with those from other carriers . . . there is a world of difference.

HTN, especially if controlled with 1 or 2 meds (even better if generic) is an easy sale with a rider. However, some carriers, such as H1, will often issue at std or a slight rate up. You need to compare final offers (or estimated final offers based on pre-screen) to determine which to recommend.

Pre-screens and applications are like computers. GIGO (garbage in, garbage out). The key to getting good results is knowing what underwriters are looking for and giving them a reason to say yes rather than no.

The info that appears in my pre-screens is identical to what is on the app. The only time I get surprised on final offers is when something comes up on MIB, Intelliscripts or the phone interview that was not disclosed earlier.

H1 and UHC/GR are the most reasonable on appeal. Aetna is almost impossible but I have had some decisions modified or reversed. BX can be workable . . . sometimes and Coventry has no clue. Time is the most inflexible but they are overpriced so who cares?

emptyeternity · 02-20-2009, 08:49 AM

I recently sent away for my own MIB and there was no records, which they told me indicated I was clean. What is intelliscripts?

somarco · 02-20-2009, 09:47 AM

Millimen Intelliscript

KCinsuranceguy · 02-20-2009, 10:49 AM

Thanks again Somarco, this is great to know!

Well this probably explains the rate up I got on an app I wrote a couple weeks ago with Aetna.

I wonder if GR will send out generic riders? I'd like to know which conditions the riders would make sense on. I find it hard explaining and understanding a rider that I have not seen.

somarco · 02-20-2009, 11:35 AM

I doubt you will get riders from anyone. I probably could, but I am special . . .

You should have a specimen policy from all carrier on hand, and copies of every rider or amendment that is issued. One copy in your client file, the other in your reading file.

Compare, study, learn.

emptyeternity · 02-20-2009, 12:13 PM

Whats a specimen policy?

healthagent · 02-20-2009, 12:56 PM

It's when a portion of the policy is submitted for testing