Matching the client with the right plan

somarco · 03-29-2007, 08:43 AM

This is mostly directed at health agents, but anyone can chime in and the rest can learn something about life, DI, LTCi, MA, etc.

When I am talking with a prospect, I ask a lot of questions. Health history is a biggy because I can usually rule out certain carriers or plans depending on what has happened in the past and is going on now.

I also ask how many times they go to the doc, how often (if at all) the take meds, and how much the meds cost.

Most of my clients end up with a plan lacking copays . . . especially those who listen to my advice. Some, like a lady who bought last month, insisted on buying a copay plan. Proving that she did not listen, she called to complain about the fact her meds were not covered by the plan.

I explained the situation (again) and told her I would be happy to show her a plan that would cover her meds for an extra $380 per month.

I also reminded her that the plan I suggested was $280/month (no copays) vs the plan she picked (with copays) for $500/month.

Essentially I recommend a plan I would buy if I were the client. Of course I recognize (and tell them) this is their plan, and their money, and they can buy any plan they like.

I dont really have a favorite carrier, but some are easier to work with than others. I do have some plans I really like and some I dont care for at all.

In reading posts from others, I find it interesting to discover some of the plans suggested to their clients. It makes me wonder just how much the agent knows about the plan and the potential traps.

The ideal plan for most of my clients is a deductible in the $2000 - $3000 range, no copays, 100% coverage above the deductible and no inside plan limits. Ideally the plan will be HSA qualified but some folks are just not ready to pull the trigger (especially on family coverage) with a deductible north of $5,000. Most pre-ex conditions are manageable out of pocket, so riders are not usually an issue. If the condition can lead someon to the ER or have contingent complications, I will suggest paying extra to get a policy with loads vs. riders.

I avoid plans that impose annual limits on certain treatment and plans with copays + a percentage of the remaining balance of the charge.

My preferred plan design are those like the Plan 100 (Golden Rule) and any HSA 100. World has plans that are similar to Plan 100 and I will use them from time to time.

Thats my list. What is yours?

CHUMPS FROM OXFORD · 03-29-2007, 08:50 AM

In Ohio...Blue Cross has a nice plan similar to GR's Plan 100. But meds are covered without having to meet the deductible. Rate is good.

Your strategy, for the most part makes sense. Over the years, I have found that one spouse usually likes the concept and the other has some reservations.

healthagent · 03-29-2007, 08:55 AM

HSAs are hands down my favorite plans. I really wish more of my clients would wrap their brains around it.

Regarding "favorite" carriers - I don't like riders. Period. I go with the carrier who will take the pre-ex conditions at day one. In the MD market it's a lot of "damned if you do" since 5 out of 7 carriers have low drug caps.

Most of my clients are on meds - probably 85% of them. Because of that I need carriers who will cover the meds day one - that's Assurant and Aetna and the list ends there.

I do indeed like Golden Rule and they are fantastic for very health people. I do not like their riders or loss of drug coverage if they're on meds. I also don't like the lack of options at renewal.

Sometimes we can get into an ethics war. 72% of everyone on an individual plan in MD has Blue Cross' Personal Comp with a $500 drug cap and 100% out of pocket for doctor visits for illness until the deductible is reached. It's a 1 mill policy with almost no outpatient benefits aside from lab testing.

So what's better - Personal Comp with a $500 limitation on meds for Coremed? Kaiser with a $1,750 cap on meds or CoreMed? Optimum Choice (owned by UHC) with a $3,000 cap on meds or CoreMed? Or Golden Rule ridering out the drug plan for people on meds or CoreMed?

I think you see where I'm going. You have to play the hand you're dealt. So when I'm talking to someone income challanged you'd better bet I'm going for $5,000 deductible CoreMed over Personal Comp with a $500 cap.

Other states might not have this nasty of a choice.

I really am not against GR at all. In fact I was shovelling business into them two years ago like there was no tomorrow. Then I found out why the rates are so cheap. If I seem biased remember that GR advances me a full 12 month commish just like Assurant at the same level.

***Melmunch3*** · 03-29-2007, 09:15 AM

Bob, in your area, are there no HSA plans with a family deductible lower than $5,000?

healthagent · 03-29-2007, 09:31 AM

I disagree about clients signing riders. You cannot pull out your magic 8 ball and decide what future liability exists with any pre-ex condition. And in fact when a rider is issued that insurance company is basically stating that so much liability exisits that they cannot cover it at the rates being offered.

I don't think any agent should recommend any rider be signed until all avenues have been exhaused.

somarco · 03-29-2007, 10:16 AM

Sure, but they get expensive.

Just ran rates for a couple, mid 40's + 2 kids.

$5650/100 = $405
$3800/100 = $498
$2200/100 = $758

The $2200 deductible is outrageous. Moving up to the $3800 plan saves $3120 in premiums against $1600 additional liability. That is a logical move.

Going from $3800 to $5650 saves $1116 per year for an additional $1850 in risk transfer. Not as strong an argument but still should be a no brainer. Higher deductibles diminish the argument even more but some folks are willing to go there.

somarco · 03-29-2007, 10:20 AM

I have been selling plans with riders for over 20 years and never had a problem. I know when to recommend the rider, when to move on. It all depends on how the rider is worded and how much another carrier will charge to cover the risk.

Some agents can sell riders, some can't.

I can go either way depending on the needs of my client. This is why I started this thread . . . to show ways to match the need with the client.

healthagent · 03-29-2007, 10:21 AM

Well it all goes a lot deeper than just rates. I do a lot of maternity - it's a Maryland mandate that every carrier must offer plans with maternity. Out of 7 carriers in MD only one doesn't offer it. Take a guess.

somarco · 03-29-2007, 10:29 AM

That is called matching the need with the client . . .

healthagent · 03-29-2007, 10:32 AM

This same mystery company that's the only one not to offer maternity is the same company that until recently didn't have a single plan that offered an immediate preventative benefit for adults. Yes.....they are indeed cheap.

johnrocks · 03-29-2007, 10:34 AM

Originally Posted by john_petrowski

Well it all goes a lot deeper than just rates. I do a lot of maternity - it's a Maryland mandate that every carrier must offer plans with maternity. Out of 7 carriers in MD only one doesn't offer it. Take a guess.

I'm confused,you said it's a mandate. If that's the case how can that one carrier "not" offer it?

healthagent · 03-29-2007, 10:40 AM

If you're association-based you don't have to comply with a single mandate. That's how companies like Mega are allowed to be in literally every state. It's up to the company if they're association-based to decide if they're going to comply.

In MD there's two "biggies" I feel need to be followed - maternity and wellness. In the past the only company who pulled out the "get out of jail free card" was Golden Rule. All other companies complied even though they didn't have to. Assurant has always had maternity and at least one plan with immediate preventative. Golden Rule doesn't offer it and until recently never followed the preventative mandates. So I'll stick with companies that are more client-focused and less focused on profit.

johnrocks · 03-29-2007, 10:46 AM

Thank you John, I honestly did not know that

somarco · 03-29-2007, 11:00 AM

If you're association-based you don't have to comply with a single mandate

That's highly unusual. MD must be the only state where that occurs.

healthagent · 03-29-2007, 11:05 AM

Everyone has to realize that my posts are Maryland-based. It's very hard to discuss generalities when everything is so state specific. In MD Golden Rule chooses not to follow the mandates while other carriers do. So until GR decides to be a better citizen I won't be offering them anymore. I don't care if they're offering $100 a month coverage with a free bowl of soup. It's easy to low-ball the rates when your coverage doesn't match up. Can we discuss that GR doesn't cover any reproductive organs/disorders for the 1st six months?

Ya know, when you don't offer maternity, don't follow the mandates, rider pre-ex conditions and yank away drug coverage for anyone meds it's pretty easy to beat everyone in rates.

healthagent · 03-29-2007, 11:12 AM

Originally Posted by somarco

That's highly unusual. MD must be the only state where that occurs.

Must be. Maternity is clearly a mandate in MD and they clearly don't offer it.

somarco · 03-29-2007, 11:25 AM

This is not all inclusive, but I see nothing about mandate maternity benefits here

http://www.statehealthfacts.org/cgi-...rance+Benefits

johnrocks · 03-29-2007, 11:25 AM

I didn't mean to start a controversy here

but it sounds like(to me at least)that GR is trying to get back to the more traditional ways of what health insurance is;or should be. It is there to cover life's unexpected bumps in the road and more often than not maternity is something to be expected and insurance is like every other type company;they are in business to make a profit

healthagent · 03-29-2007, 11:42 AM

Originally Posted by somarco

This is not all inclusive, but I see nothing about mandate maternity benefits here

http://www.statehealthfacts.org/cgi-...rance+Benefits

From the DOI website:

salpro22 · 03-29-2007, 11:45 AM

Most of my clients end up with a plan lacking copays . . . especially those who listen to my advice. Some, like a lady who bought last month, insisted on buying a copay plan. Proving that she did not listen, she called to complain about the fact her meds were not covered by the plan.

I explained the situation (again) and told her I would be happy to show her a plan that would cover her meds for an extra $380 per month.

I also reminded her that the plan I suggested was $280/month (no copays) vs the plan she picked (with copays) for $500/month.

I don't follow you here. Are you saying that you signed her up for a plan @ $500 a month that did not cover her meds and that she would need to pay another $380 a month for you to put her in a plan that covered her meds and had a copay feature? thanks.

Essentially I recommend a plan I would buy if I were the client. Of course I recognize (and tell them) this is their plan, and their money, and they can buy any plan they like.

How many plans do you normally discuss with clients?

-J.R.