Insurance Agent Forum

[MIBizInsurance]

MI independant health agent with following questions regarding Assurant-

What type of services are covered with the office visit copay option with the MaxPlan or CoreMed?

In the brochure it states evaluation,diagnosis,and management of illness or injury and allergy shots. What actually does diagnosis mean? Bloodwork? Xrays?

[salpro22]

Originally Posted by MIBizInsurance

MI independant health agent with following questions regarding Assurant-

What type of services are covered with the office visit copay option with the MaxPlan or CoreMed?

In the brochure it states evaluation,diagnosis,and management of illness or injury and allergy shots. What actually does diagnosis mean? Bloodwork? Xrays?

Look in the back of the product brochure at page 10 under the Office Visit Copay section. All visits for injury, preventive or illness are covered at either the copay (if selected) or at the network rate w/out a copay. State mandated benefits are covered via the requirements of your respective state. Lab work and imagery services (MRI, CAT scans, etc.) are @ the deductible /coinsurance level + copay (if applicable).

[newmindfashion]

MIBiz,
Our resident Assurant expert John Petrowski is on vacation. Myself and Somarco do a decent amount with Time Insurance but mainly their higher deductible HSAs. I personally find that Assurant plans are not competitive on the copay arena. However, here is what I do know. The CoreMed and MaxPlan line up of plans do not cover lab and X-rays associated with the visit. Usually, only the HMOs in my market cover testing upfront as part of a visit. The PPOs such as Assurant, Celtic, Golden Rule, Aetna, Humana and many others will bill testing towards the deductible unless the tests were coded as part of preventative care which some carriers will cover up to certain point. If the testing was due to symptom, its going to deductible. The older line-up of Assurant plans used to cover the first $100 of lab/x-ray associated with the visit but no longer.

Basically, the copay is going to cover the physician's fee and maybe some minor in office services. Defintely not tests (see above) or surgery. If you want to sell a plan that has office copays and low testing copays, look towards an HMO.

In my opinion, Assurant has priced their plans is a way that encourages people not to select a copay option. A MaxPlan might work for you if your up against a group of 1 business owner that is overpaying and healthy enough to get into a MaxPlan and still save a lot of money.

[MIBizInsurance]

More questions for MI independant health Ins agent on Assurant-

Re: MaxPlan

Would an EKG would be covered under the new state variation (labs-xrays-mris-catscans...100% covered with MaxPlan). I am getting conflicting info and now just want to get a general census.

[salpro22]

Originally Posted by MIBizInsurance

More questions for MI independant health Ins agent on Assurant-

Re: MaxPlan

Would an EKG would be covered under the new state variation (labs-xrays-mris-catscans...100% covered with MaxPlan). I am getting conflicting info and now just want to get a general census.

What type of information are you getting?

[MIBizInsurance]

My general agent said the stress test is different and would be deductible first while the ekg is a simple test and would fall under the copay option.

I am wondering if depending how the doctor codes it, it might be covered.

I called American Community and they said it fell under radiology and if coded right, the copay would cover it. Assurant said no. Sometimes I wonder if they even know.

[salpro22]

I don't see how EKG's would be covered at the copay since it is a test and can or cannot be completed off-site of physicians office. The company you mentioned is only in a few states and has a B+ rating so they apparently do things differently.

Just out of curiosity, what prompts these questions. Are you trying to get up to speed on the plans or do you have a current client with an issue?

The best way to go with Assurant is to talk w/ their Claims department vs. the normal agent services.

[MIBizInsurance]

Both. I am a new agent and trying to submit my first app. I understand the plans fairly well, but of course this question didn't fall under a clear cut answer.

[newmindfashion]

MIB,
Unless MI has a mandate that makes Assurant cover preventative care upfront, then when they say 100% covered they mean towards the deductible without being subject to their normal $500 per person per year benefit cap on preventative care.

What some carriers allow as preventative and don't allow varies greatly. In my experience w/ Assurant, I'll be shocked if the EKG is upfront covered unless its mandated by the state.

[newmindfashion]

By the way MIB,
Questions on what is covered as upfront preventative and what is not with carriers that claim to cover it upfront (Humana, the Blues etc) is a constant grey area I've found.

[salpro22]

Originally Posted by newmindfashion

MIB,
Unless MI has a mandate that makes Assurant cover preventative care upfront, then when they say 100% covered they mean towards the deductible without being subject to their normal $500 per person per year benefit cap on preventative care.

What some carriers allow as preventative and don't allow varies greatly. In my experience w/ Assurant, I'll be shocked if the EKG is upfront covered unless its mandated by the state.

Did the preventative benefits not get increased in CT like they did down here?

[TheSalesWolf]

The Max plans cover preventative care including lab and x-ray work with the copay from day 1.
The Cored Med Plans you must wait 12 months for preventative services to be covered.

Other services such as blood work or x-rays for sick visits the customer would pay the Assurant discoutned rate and that would go towards their deductible.

Assurant is extremely competive in certains states and Michigan is defintiely a good one.

[salpro22]

Originally Posted by TheSalesWolf

The Max plans cover preventative care including lab and x-ray work with the copay from day 1.
The Cored Med Plans you must wait 12 months for preventative services to be covered.

Other services such as blood work or x-rays for sick visits the customer would pay the Assurant discoutned rate and that would go towards their deductible.

Assurant is extremely competive in certains states and Michigan is defintiely a good one.

The waiting period has changed from 12 months to 6 months on the CoreMed plan.