This "Im on my spouses plan" thing is getting real annoying

Golddoor · 06-27-2007, 03:16 PM

You would think that every single employer in the country covers the employee, spouse and children and it cost the employee nothing. I consistently get that from people. Even if I tell them that its rare these days for employers to cover the whole family they still say that theirs does. Are people just stupid and think they are getting it for free when their really not?

*STIBROKER@AUSTIN.RR.COM* · 06-27-2007, 04:20 PM

have you tried how much do they take out of your check each month.....

Golddoor · 06-27-2007, 04:25 PM

Quote:

Originally Posted by STIBROKER@AUSTIN.RR.COM

have you tried how much do they take out of your check each month.....

Oh yea and its either "nothing because my spouses company pays for it" or "I dont know if they do or not".

salpro22 · 06-27-2007, 04:49 PM

Quote:

Originally Posted by Golddoor

Oh yea and its either "nothing because my spouses company pays for it" or "I dont know if they do or not".

I'd say about 10% of my current clients have a spouse on a group plan and an individual/family plan with me. I get the "I don't know if they do or not" 90% of the time in which I say, "did you know that spouses who are are on group plans typically pay as much as 50% more vs. similar plans that are available on the market?" This opens the door to building value and ME, while also ascertaining the potential for a sale.

Simply schedule a time to discuss the group rates that they find out about from their respective HR rep and see if there is anything there worth salvaging.

somarco · 06-27-2007, 06:32 PM

Quote:

either "nothing because my spouses company pays for it" or "I dont know

Either way you do not have a prospect.

Move on . . .

headcoach · 06-27-2007, 07:31 PM

I agree with Somarco.....When a business owner starts telling me about his wife's group plan I move on to the next prospect

djs · 06-27-2007, 08:34 PM

I'm on my wife's group plan. Her job pays most of it. I'd be rated if I went out on my own, so, don't call me, I'll call you

Dan

BKrocko · 06-27-2007, 10:44 PM

Golddoor - I just posted a thread about a "Weird Group Clause". Seems that many if not most, group policies have a clause that will not cover on the job injuries. I don't know about TX law but CO does not require a business owner to carry Workman's Comp. (if they have employees, they must carry WC on the employees). So, if the owner gets hurt while working, and doesn't have WC, the group plan will not cover them and they are SOL.

Seems like a good rebuttal for you to use. On the other hand, it may be more beneficial for you to just move on to the next prospect. Saying "I'm covered on my spouse's plan" is just like us saying "I'm just looking" when we are approached by a sales person. It's an easy out.

Bob_The_Insurance_Guy · 06-27-2007, 11:04 PM

#2 agrees with #1.

David C · 06-27-2007, 11:59 PM

I'm in a somewhat rural area. (50,000 population in the county) I make it my business to know the insurance programs of the major employers. I know if they pay 0 for dependent, or 50% for dependents.

somarco · 06-28-2007, 08:46 AM

Quote:

I don't know about TX law but CO does not require a business owner to carry Workman's Comp.

All states have WC laws. The minimum number of employees will vary by state.

Here in GA it is 3.

You count W2 employees, not 1099.

Even if you do not carry WC that does not exclude the employer from liability. If I work for you and I am injured on the job I can still come after you for med payments, LOT and other issues.

If you meet the minimum threshold (3 employees for example) and do not have WC you must purchase a bond to cover your liability. Many large employers will either post a bond or pledge assets and purchase a cover (reinsurance) to take care of claims in excess of the bond.

healthagent · 06-28-2007, 09:43 AM

Maybe Sam or others can answer this, but is there any claims review involved regarding participation? If a company currently has a group plan with 10 employees and 6 blow off the plan are they going to get contacted by the carrier?

somarco · 06-28-2007, 10:31 AM

Group carriers review participation on small group on a regular basis if the number of employees drop. Not so much with larger groups.

This is an accounting function, not claims.

If a 10 life group suddenly drops to 6 someone in accounting will probably call them if enrollment does not pick back up within 90 days.

If a 5 life group drops to 2 they will most likely react much quicker. Some carriers will ignore the drop in enrollment until renewal before giving them the boot.

healthagent · 06-28-2007, 10:49 AM

Thanks - I feared that. This has always been a small issue when I contact a lead and it's a small employer with say 5 employees. Three are interested in looking at indie plans but I've always pulled away from that knowing it will harm the rest of the group.

I understand the theory behind participation and also employers contributing towards or paying for individual coverage for their employees. In reality that's a doomsday forecast by the state DOIs - that companies would cancel group, just offer money towards indie plans - the healthy make out fine, the sick get screwed.

The problem is a state like MD which is non-underwritten group with high rates. A small employer, say 3 employees, cannot afford group in most cases and also isn't allowed to pay for indie plans. I think the DOIs need special rules for micro-businesses - under 10 employees.

It doesn't need to be said that a lot of micro business owners say screw those rules and put extra money into employees checks anyway.

al3 · 06-28-2007, 11:05 AM

Most carriers have a waiver clause. According to CA law, from what I undersstand. valid waivers are those individuals who have other health care coverage through a spouse, parent or legal guardian, individual coverage, coverage through another employer of coverage provided through a government subsidized health care program.

djs · 06-28-2007, 11:35 AM

Quote:

Originally Posted by somarco

All states have WC laws. The minimum number of employees will vary by state.

Here in GA it is 3.

You count W2 employees, not 1099.

Even if you do not carry WC that does not exclude the employer from liability. If I work for you and I am injured on the job I can still come after you for med payments, LOT and other issues.

If you meet the minimum threshold (3 employees for example) and do not have WC you must purchase a bond to cover your liability. Many large employers will either post a bond or pledge assets and purchase a cover (reinsurance) to take care of claims in excess of the bond.

This varies a lot by state. For instance, in California, 1099 employees MAY have to be covered by workers comp. A good example is hair salons. Most hair dressers are 1099, not w-2. They have to be covered by workers comp. They are not eligible to 'make a group' for health insurance, but they can be covered under the group health plan, as long as the salon qualifies with the owner and a W-2 employee.

In most occupations, 1099 contractors do not have to be covered by workers comp. But, as usual, it's difficult to make a blanket statement.

Dan

djs · 06-28-2007, 11:39 AM

Quote:

Originally Posted by al3

Most carriers have a waiver clause. According to CA law, from what I undersstand. valid waivers are those individuals who have other health care coverage through a spouse, parent or legal guardian, individual coverage, coverage through another employer of coverage provided through a government subsidized health care program.

I always get this one wrong. In all of your examples above (except the government plan), they have to have group coverage to be waived, correct? I don't think you can waive 'Dad' when they are on 'Moms' IFP plan, he has to be on 'Moms' group plan.

Obviously, dependents don't count towards waivers. Maybe it's just me though, but in Silicon