I have a potential client in Nevada.She is looking for health insurance, she is self employed but waiting tables here and there since business is a little slow right now for her. I know a bit about the hospitals etc. because I used to live in her area but don't really know the carriers too well in Nevada because I don't sell there (yet). I have done some quotes and so far I like Aetna's plans the best. She is 46 years old, and smokes. She has a bit of a lengthy health history due to being some what of a hypochondriac as well as things that have happened.
-She had brain surgery about 9 years ago ( I don't know details yet)
-She is currently looking at Bankruptcy and wants to get health coverage before she files...(I don't know if this is the best thing or not) And much of this bankruptcy is due to previous hospital bills.
-She has had problems in the past with chemical dependencies pain pills, as well as alcohol, and has been in rehab several times the last time about 6 months ago, she had a relapse due to a family members death, divorce etc. and the rehab has been paid for by an insurance company 1 time I am not sure how long ago.
-She is currently sober but I am not sure if any carriers will even look at her mainly due to the rehabs etc.
I have a couple questions:
1. How much will the recent rehab affect her and should I wait to try to have her apply?
2. What Nevada carriers would you recommend for easier underwriting etc.?
3. Should she apply for coverage before filing bankruptcy or after and will it affect the underwriting?
Any other advice or things I should be careful of etc. is greatly appreciated.This is my first client with this complex of a history and I really don't want to do something wrong and ruin their chances for future coverage.
-One last thing to add. She is dating someone that is also self employed, it is serious, should I try to see if she can be an 'employee' of his and get group coverage. It worries me in case they were to split up... you get the drift.
I have a potential client in Nevada.She is looking for health insurance, she is self employed but waiting tables here and there since business is a little slow right now for her. I know a bit about the hospitals etc. because I used to live in her area but don't really know the carriers too well in Nevada because I don't sell there (yet). I have done some quotes and so far I like Aetna's plans the best. She is 46 years old, and smokes. She has a bit of a lengthy health history due to being some what of a hypochondriac as well as things that have happened.
-She had brain surgery about 9 years ago ( I don't know details yet)
-She is currently looking at Bankruptcy and wants to get health coverage before she files...(I don't know if this is the best thing or not) And much of this bankruptcy is due to previous hospital bills.
-She has had problems in the past with chemical dependencies pain pills, as well as alcohol, and has been in rehab several times the last time about 6 months ago, she had a relapse due to a family members death, divorce etc. and the rehab has been paid for by an insurance company 1 time I am not sure how long ago.
-She is currently sober but I am not sure if any carriers will even look at her mainly due to the rehabs etc.
I have a couple questions:
1. How much will the recent rehab affect her and should I wait to try to have her apply?
2. What Nevada carriers would you recommend for easier underwriting etc.?
3. Should she apply for coverage before filing bankruptcy or after and will it affect the underwriting?
Any other advice or things I should be careful of etc. is greatly appreciated.This is my first client with this complex of a history and I really don't want to do something wrong and ruin their chances for future coverage.
-One last thing to add. She is dating someone that is also self employed, it is serious, should I try to see if she can be an 'employee' of his and get group coverage. It worries me in case they were to split up... you get the drift.
We apparently have different perspectives on clients we accept.
How long has she been w/out coverage?
She will not be getting a major medical policy if she was in rehab 6 months ago.
Are you sure you want to sign up somebody in the middle of bankruptcy for not being able to pay her medical bills, but somehow she can pay an insurance premium? Time to walk away.
Who do you think she is going to blame when her insurance plan "doesn't cover anything" and she reverts back to pain killers, drinking and breaks up with her boyfriend?
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"Tell me and I will forget. Show me and I will remember. Involve me and I will understand." Confucius
If this person isn't a close friend or relative I would run far, far away!! That's the beauty of this business you don't have to work with people that might harm your business. It's nice to be able to help people but..........
There's ton's of red flags all over this one, no one mentioned the group angle. Your just as likely to get a decline on group with her on it. Underwriting isn't going to give you any breaks on group.
I work in individual and group health in Nevada, specifically in Reno. I agree with everyone here she'll be declined individual or group.
NV must have different rules on small group. Carriers are not allowed to deny coverage to anyone under a group plan in GA, even a 2 person group where both employees have AIDS.
Health insurance is like craps here in Nevada, with only slightly better odds.
I'm waiting for medical records on one employee and if it comes back bad, I can say goodbye to a group with 50 employees-it will be declined completely. So far they've been uprated 40%.
My fingers are crossed.
I wish I would have realized that better than 95% of people who work for car dealerships smoke, live and learn.
Nevada does have some "interesting" rules. I ran across a case not long ago while helping another agent were the client came off of group in NV and was looking at HIPAA in CA.
In NV, you are eligible for the state mini-COBRA program when you lose your employment, except when you voluntarily leave your job. So if you get fired you get mini-COBRA, if you quit, you don't.
Thx for the feedback, Dave, but it still doesn't explain how a group carrier can dodge HIPAA rules and exclude someone from coverage on a 50 life group. You can't even do that with an ERISA (self funded) plan which doesn't have to comply with any state rules.
It's likely state law, same in California. In CA, only groups 2-50 are guaranteed-issue groups. Anything over 50 is subject to full underwriting and can be declined if risk is too great. All it takes in CA for a 150 person group to be declined or seriously rated is on person in the group with cancer.
I worked for a group insurance company before I became an agent I really had no idea that guarantee issue was available in any state. I'd actually never heard of the term until this board.
Nevada is a very employer friendly state. I've actually never thought of researching the laws, now you've got me wondering.
I did have another larger car dealership with 100+ employees with a participation rate of less than 60% that 3 major health insurance companies declined due to industry. This group was uprated more than 50% in the last two years and the employers wouldn't pay more than $200 per employee per month, their employee only rates were close to $600 per employee per month. And just looking at their medical conditions it was going to hard to move them anywhere in the end they stayed where they were at. And I'm sure their participation rates continued to decline.
I had a hunch that I couldn't help her. I appreciate all the feedback good things to know. Salpro, believe me this is not the type of clients I try to find. No actually, she is a close family member of someone close to me and I was approached by her. As far as the comments on her not paying premiums that will not be a problem, although she is doing really well right now I almost wouldn't rule out another rehab. I don't know what to tell her other than to go work at starbucks where you can get bene's for only 18 hours of work a week or something like that.
One last question though, which I could probably go to underwriting, how long would it be until a carrier would look at her without an auto decline?
My Nevada Client...help
Re: My Nevada Client...help
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