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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"Tell me and I will forget. Show me and I will remember. Involve me and I will understand." Confucius
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 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.
Last edited by salpro22 : 05-25-2007 at 10:52 AM.
Reason: Clarification
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.
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 . . .
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.
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?
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.
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, you are exactly right. I told her I was sorry it was taking so long with Assurant and that she was making a wise decision to go with Highmark. I reminded her I will be able to help her with her Med Supp in a few years, and she promised to call. We'll see, but for sure I WILL call her.
Man when I was with Met Life 11 years ago and they got busted and fined for selling WL as a retirement plan and not telling the nurses it was life insurance I had 3 people dump in underwriting because of press releases.....
Time insurance is a joke, to date they have rescended 5 of my policy holders, and making me pay back the 12 month advance, what is worse is the 5 policy holders who cancelled thier old policy to go with Time
( Assurant ) that now have no coverage. every one was refunded, after they filed a clain, then it seems what Time does is go through the records with a fine toothed comb to first make the claim as denied saying it is pre- exisitng, if they cant do that, then they try to find something else in thier records to allow them to send a letter saying " we found out that you left of the application that you have this conditon or that you recived medical attention for this 5 years ago", such as one lady who went to the doctor , said she had chest pains, once the doctor deteremined it was acid from eating spicy foods ( they had just got back from New Orleons ) and presibied her to take soem ant-acids, yet since it was in her report that she had chest pains and had not gone to a cardiologist to get tested, that they would now rate her up , and for her to send $ 1700 in 10 days to cover all the back months being rated, , and if she didnt she would be re-csended, and refunded, wel not only did thye cancel her, they canceled her husband also, even though he was the applicant, and to this date I still cant get a straight answer on that one from Time. why he was refunded also.
I had a freind of mine who was selling for them also, I brought him to them, I tired to warn him about hat they wer doing and that he should stop writng for them, he would not take my wanring saying " they pay fast, and issue fast, I think your 5 cases were just a fuke, well within 6 months he had 2 policy holdres canceled and refunded as wel, he sent me an apology letter, saying he should have listened to me
I would not sell for Time aka Assurant aka Fortis even if they paid 100 % commisoin, but I am sure the guy's on here that like to promote Time ( thye make 5% of od bring guys under them wil probaly attack me, just rmember what is thier true motive.
For what it is worth I have been selling Insurance ful time for close to 18 years, so I have owrked for many a Insurance compnies, and to date none as bad as Time ( Assurant ) they are a joke
Time insurance is a joke, to date they have rescended 5 of my policy holders, and making me pay back the 12 month advance, what is worse is the 5 policy holders who cancelled thier old policy to go with Time
( Assurant ) that now have no coverage. every one was refunded, after they filed a clain, then it seems what Time does is go through the records with a fine toothed comb to first make the claim as denied saying it is pre- exisitng, if they cant do that, then they try to find something else in thier records to allow them to send a letter saying " we found out that you left of the application that you have this conditon or that you recived medical attention for this 5 years ago", such as one lady who went to the doctor , said she had chest pains, once the doctor deteremined it was acid from eating spicy foods ( they had just got back from New Orleons ) and presibied her to take soem ant-acids, yet since it was in her report that she had chest pains and had not gone to a cardiologist to get tested, that they would now rate her up , and for her to send $ 1700 in 10 days to cover all the back months being rated, , and if she didnt she would be re-csended, and refunded, wel not only did thye cancel her, they canceled her husband also, even though he was the applicant, and to this date I still cant get a straight answer on that one from Time. why he was refunded also.
I had a freind of mine who was selling for them also, I brought him to them, I tired to warn him about hat they wer doing and that he should stop writng for them, he would not take my wanring saying " they pay fast, and issue fast, I think your 5 cases were just a fuke, well within 6 months he had 2 policy holdres canceled and refunded as wel, he sent me an apology letter, saying he should have listened to me
I would not sell for Time aka Assurant aka Fortis even if they paid 100 % commisoin, but I am sure the guy's on here that like to promote Time ( thye make 5% of od bring guys under them wil probaly attack me, just rmember what is thier true motive.
For what it is worth I have been selling Insurance ful time for close to 18 years, so I have owrked for many a Insurance compnies, and to date none as bad as Time ( Assurant ) they are a joke
Thank you for the input Ozark. Since you have been selling insurance for a while I am curious about something. Since Time is out for you, what are your top carriers in order? thanks...
If it is an online sale, then I use a few companies , such as Blue Cross Blue Shield and Humana, neither are perfect yet, and (note :with Blue Cross they cant apply online, but they can print the app and fax it back to me ) to date I have not had one rescend ( refund ) yet in under a year I had 5 with Time.
If it is a person to person sale I also use a few others, that are not for online sales, although one is in the process now, one is American National (out of Galveston). they are not perfest either, yet in the entire time I have been sellling for them, not one rescend ( refund ) leaving the policy holder hanging with no coverage, and me hanging owing a year of commission back. And they also do a better job of underwrting.
My point is : If I go in a cafe, and in under a year I get sick 5 times from eating the food, the 2 things I can promise you is I wont ever go back to that cafe, and I wil tell everyone I know. I hope you are the same.
Last edited by Ozark : 05-25-2007 at 01:08 PM.
Reason: spelling
although one is in the process now, one is American National (out of Galveston). they are not perfest either, yet in the entire time I have been sellling for them, not one rescend.....
Stan Firebaugh, the owner of a national insurance agency in Dallas, says he took control of the Health Through Exercise group in 1987. At around that time its name was changed to the National Business Association. Mr. Firebaugh's insurance agency made a proposal to American National Insurance Co. of Galveston, Texas, on how to put the National Business Association to use, according to officials with the agency and the insurer. "The concept embodied in this proposal -- namely that of mass-marketing health insurance products via monthly bank authorizations to self-employed individuals through a captive, nonprofit association -- is a successful, well-established concept," the agency wrote. The NBA began endorsing American National as its insurer in 1989. Mr. Firebaugh's agency receives commissions on policy sales and a share of association dues.
He denies any involvement with the proposal to American National and says the National Business Association is completely independent. The association "was never set up to sell strictly health insurance," he says.
For a decade, Patrick Archibald served as president or a board member of the National Business Association and manager of Mr. Firebaugh's insurance agency. In effect, he was touting his agency's product to his association's members. He left the insurance agency in 1998 but stayed on at the association until April 2001. Mr. Archibald could not be reached.
"The association was portrayed as independent," says Betty Wendland, 61, a retired saleswoman who joined the NBA and bought its insurance in 1999. "You joined this group and then you buy this insurance. I never assumed they were one and the same." Mrs. Wendland's rates went up 61% over the course of eight months before she found a new policy from a different insurer last year. "At my age, it isn't easy to get insurance," she says.
Mrs. Wendland and some other policyholders learned about the cozy relationship from an agent after American National cut benefits and raised premiums in 1999.
She and others filed a class-action suit in 2000 in state court in Austin, Texas, claiming that the NBA, Mr. Firebaugh's agency and American National had marketed insurance "through a sham organization." The suit alleges that more than 60,000 customers were defrauded and that the NBA "exists primarily for the purpose of selling health insurance and making profits."
William Watson, American National's chief health actuary, said in a deposition last year that it didn't concern him that Mr. Archibald was running the association and the insurance agency. American National declined to comment because the litigation is pending. The defendants, including Mr. Archibald and Mr. Firebaugh, have denied the allegations in the suit.
I am not with this Nat. Bus asoc.you mentioned above, I am contracted directly through the moody group in Galveston. I am sure you can do the same. I have yet to this date, had one policy resecended ( refunded ) via Blue Coss, Humana, or American National and I am not on here trying to get you to come under me as an MGA, ( like some do on here ) I am just an ind. agent, yet with Time, 5 in under a year. leaving 5 of my policy holder with out insurance, and me owing back over $6100
You keep selling Time if you want , but dont say you wern't warned.
I am not with this Nat. Bus asoc.you mentioned above, I am contracted directly through the moody group in Galveston.
so your selling the NCAA association with your health plans.....point is all they sell is ass. plans and I do not sell ass. health plans.....you do not get a policy...you a certificate off of a group policy and the insurance company can do what ever they want to you.....BCBS is your better bet and I am waiting for Humana's new plans to come out to see what direction they are heading ....they have only been doing ind. health for a few years and seems to me are still working out some kinks... http://www.health--savings--accounts...20Brochure.pdf
"Note the 3 yr lookback.
My guess is this was a STM with a 5 yr lookback."
Bob, correct. The Time trouble in CT (my state) is all regarding short term medical plans and not IM products. The 2 year incontestability clause in the I contract would have led them to pay this guy's heart attack on the IM product I believe.
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