STM and GAP Plans Discussion.

Prospective or retrospective?

Its a 12 month look back.

So if you had a high blood pressure pill in March of 2016, but not after 3/31, my answer is "Nothing to do with the heart will be covered until 4/1/17"

Of course, the last time I said that, the woman started yelling that I had to sell her the policy, its the one her doctor recommended. That ended well. ;)

(Don't confuse the people who look at these later, Bob!)
 
Just seeking clarification and you provided it.

That being said I would not have offered as much as you did. Had it been me I would have told her to call me back in April and we will look at it again.

I do that a lot. Twice in the last 2 weeks in fact.

But that's just me.
 
UHC has 2 apps for STM. I called and was told that the long form is not necessary unless the applicant "wants to explain more". I find that strange. People generally answer questions as asked and SOP is to only answer those questions asked.

Keeping a copy of the app is even more necessary than keeping a copy of your med records. The records can be obtained on request in TN usually without cost when they are for your own information and not at the request of a carrier. Still, underwriting and the necessity of fighting with the carrier when claims are denied complicates the decision process.

I hope the criminals in Congress go a direction other than reinstating pre-ex. There are other ways to fix the situation.
 
Can't see any meaningful reform if you can't underwrite. Read that subsidy cost was 600 billion. Wonder what that works out to for each person qualifying



QUOTE=junkman;1153264]UHC has 2 apps for STM. I called and was told that the long form is not necessary unless the applicant "wants to explain more". I find that strange. People generally answer questions as asked and SOP is to only answer those questions asked.

Keeping a copy of the app is even more necessary than keeping a copy of your med records. The records can be obtained on request in TN usually without cost when they are for your own information and not at the request of a carrier. Still, underwriting and the necessity of fighting with the carrier when claims are denied complicates the decision process.

I hope the criminals in Congress go a direction other than reinstating pre-ex. There are other ways to fix the situation.[/QUOTE]
 
Just seeking clarification and you provided it.

That being said I would not have offered as much as you did. Had it been me I would have told her to call me back in April and we will look at it again.

I do that a lot. Twice in the last 2 weeks in fact.

But that's just me.

I offered her an ACA plan. That's when she started yelling at me about I HAD to sell her what her doc told her to get.

"I'm sorry, I don't let me people speak to me that way. If you would like to calm down, I would be more than happy to explain it to you."

CLICK. Good Riddance.
 
I hope the criminals in Congress go a direction other than reinstating pre-ex. There are other ways to fix the situation.

Such as?
Can't see any meaningful reform if you can't underwrite.

Truth.

Read that subsidy cost was 600 billion.

Per year or 3 yr total?

Wonder what that works out to for each person qualifying

A lot.

Also need to factor in not only lives but months covered. Very few stay for the full 12 months.
 
Greetings all,

I'm currently writing all IHC Health Solutions Short Term Medical plans, but with that company's premiums continuing to escalate, I want to add a lower-priced, quality carrier to the portfolio.

Today, I was solicited to write this particular plan from Peterson International Underwriters.

Link to Brochure: https://www.piu.org/wp-content/uploads/2016/12/Short-Term-Major-Medical-01-01-2017.pdf

Does anyone have experience with this plan and/or company? The premium is extremely low, compared to what IHC Health Solutions is charging.

I'm mostly concerned about the overall quality of the company, PPO Network, Customer Service, Claims payment, etc., from a customer's perspective.

----------------------

ALSO, have any new GAP/Deductible-Payer plans been unveiled by any carrier for 2017?

Specifically, are there any that will reimburse an individual's deductible for any medical care that is covered by the insured's Major Medical health plan?

I've attempted to accomplish this with Critical Illness and Injury plans, but there are a huge number of people who go to the hospital E.R., or a neighborhood medical center, for Non-Injuries and Non-Critical Illnesses.

A general medical plan with a $7500 coverage limit, and a $250 or $500 deductible would be PERFECT. Does one exist?

Thanks for any constructive feedback! :yes:

-Allen in Chicago




Hey Allen, I believe I read that you use GAC, so you probably got the e-mail that I just got. I don't sell STM, but this looks interesting. Covers prescriptions...underwritten by Lloyds of London.

https://onedrive.live.com/?authkey=...74C&id=36F4142FD5DB74C!148&parId=root&o=OneUp
 
Can't see any meaningful reform if you can't underwrite. Read that subsidy cost was 600 billion. Wonder what that works out to for each person qualifying

You must be young. When you underwrite, you exclude. Underwritten individual health contracts used to be almost impossible to have issued with out exclusions. When only the healthy have access to coverage, we don't have insurance. When only the wealthy have access to healthcare, we don't have healthcare and decline to a 3rd world position.

We "could" for example pay for healthcare with insurance and have everyone pay for insurance with tax dollars. Taxes could be a flat tax similar to medicare. Plan design could be based on income. Carriers could come up with supplements that integrate with the core plan. Everyone has to be included and everyone has to pay something.

Regulating procedure prices would lead to fewer providers and less access but if we want to rely on "market forces", we need the market to apply at the provider level. Our current system only makes us care about OOP and not procedure cost. I'm looking at an EOB where the lab company (Quest) billed $273.05. The carrier (BCBST) discounted it to $25.55. WTF?? Healthcare prices have turned into funny money. We could eliminate the carrier overhead if the lab would simply bill $25.55.

I favor HDHP plans and every benefits agency I know of went to them. I had an HSA the 1st year they were available. HSAs don't work for those with no money and I expect that paying for their healthcare would be cheaper if given incentives for having good as in healthy lifestyles.

People with diet preventable illnesses could be stuck with the higher OOP plans. I don't mind paying for an old person that exercises and has controlled blood pressure but don't want to pay for an obese diabetic smoker that continues to smoke and eat donuts. I've watched church friends eat Hunny Buns hot out of the microwave then complain about the cost of insulin ($175/month). Of course, that points to 2 problems. Hunny Buns shouldn't be scarfed by fat diabetics and there is no reason for insulin to be that expensive.

Drug companies make minor changes to keep a patent in place and don't make the cheap generic version. They also sell drugs at more in the US making us pay for development costs while selling overseas so long as the price is above production costs. Congress gives lip service to "market forces" while taking payments from the drug companies and allowing the drug manufacturers to rape or at least pillage.
 
Last edited:
Back
Top