Medicare Supplement Policy Rescission

somarco

GA Medicare Expert
5000 Post Club
36,704
Atlanta
Have you ever had a Medigap carrier rescind a policy? One agent claims to have been involved in 3 rescission's. One personal, two more via sub-agents.

I haven't been involved in the Medicare business that long but have over 40 years experience with underwritten health insurance policies. To the best of my knowledge during all that time and literally thousands of applications, only one rescission. In that case the applicant lied to me and on the app. Policy was justifiably rescinded just a few months after it was issued.

How do you handle underwritten applications? Do you go over the health questions and collect Rx info? Do you check the medical conditions and Rx against the carrier underwriting guide? Do you tell your client to be completely honest on the app and in the underwriting interview?

I do all of those. Every time.

The one rescission was a major medical policy about 10 years ago. In all the years of writing underwritten business, major med and Medigap, I can probably count on both hands the number of applicants who have been denied a policy.

Carriers have to meet specific standards before rescinding a policy. They must have concrete evidence of fraud or misrepresentation. Unless Medigap is different, the carrier has 2 years from the effective date of the policy to complete their investigation and pull the plug.

I would really like to see feedback on this.
 
Never, not once.

Of course, using the birthday rule in CA and OR I rarely even bother with underwriting.

Underwriting is for chumps. (And not the one from Oxford).

Rick
 
Have you ever had a Medigap carrier rescind a policy? One agent claims to have been involved in 3 rescission's. One personal, two more via sub-agents.

I haven't been involved in the Medicare business that long but have over 40 years experience with underwritten health insurance policies. To the best of my knowledge during all that time and literally thousands of applications, only one rescission. In that case the applicant lied to me and on the app. Policy was justifiably rescinded just a few months after it was issued.

How do you handle underwritten applications? Do you go over the health questions and collect Rx info? Do you check the medical conditions and Rx against the carrier underwriting guide? Do you tell your client to be completely honest on the app and in the underwriting interview?

I do all of those. Every time.

The one rescission was a major medical policy about 10 years ago. In all the years of writing underwritten business, major med and Medigap, I can probably count on both hands the number of applicants who have been denied a policy.

Carriers have to meet specific standards before rescinding a policy. They must have concrete evidence of fraud or misrepresentation. Unless Medigap is different, the carrier has 2 years from the effective date of the policy to complete their investigation and pull the plug.

I would really like to see feedback on this.

We write a lot of fully underwritten. We target ages 65 on up not the 64.5 crowd. And our book is 80% Med Sup 20% Med Advantage.

Of all those cases, zero recisions. Never an issue.

We've had quite a few where the health changed drastically after approval but before the effective date. When that happens you just call the company with the client and explain it in detail. Let them make the call. And document it on the delivery receipt.
 
I have had one in all my years. The guy was looking to save money, he answered all questions NO, then when issued he went to start treatment for cancer that was diagnosed before he even contacted my office. He had a UA sup that was over $300/month and wanted his sister's company I put her with at less than 50% of the cost.

Of course they jerked the policy back and sent him a full refund. Problem is that now it is more than 30 days beyond the termination of UA and he couldn't get it back.

Glad I had everything documented.

His anniversary was three months after that when he could have moved without any question. Of course I would have told him to dance with the one that brought him since moving a new cancer case to a new company is bad business.
 
health changed drastically after approval but before the effective date. When that happens you just call the company with the client and explain it in detail. Let them make the call.

Had one like that a few months ago. After submitting app, and approval, client had eye exam and told she needed cataract surgery.

I told her to call the carrier and explain. No way I was getting in the middle of that. Carrier said no problem.

Glad to see responses from the non-CA agents. Rescission's are tough but if the client lied, what's the problem? The carrier was within their right to rescind the policy.

An agent that blames the carrier is one who either doesn't know what they are doing or is just lazy.
 
Back
Top