Underwriting HBP & High Cholesterol

headcoach · 01-26-2009, 10:47 AM

When an individual in their 50's has HBP & High Cholesterol controlled with medication I can get Assurant to issue without an exclusion or waiting period on these. United Health Care wants to rider it. Is anyone having any luck with any other companies that will not rider these conditions?

dgoldenz · 01-26-2009, 10:53 AM

Anthem BC/BS in VA may issue at a Level 3 depending on height/weight profile and other factors. Everything covered from day 1 with prior creditable coverage. Not sure about BC/BS in other states.

indmedins · 01-26-2009, 10:59 AM

Humana in FL is a double rate-up (no exclusionary riders), % dependent on cost of medication. Add a ratable build or tobacco use, applicant is declined.

moonlightandmargaritas · 01-26-2009, 11:11 AM

Originally Posted by indmedins

Humana in FL is a double rate-up (no exclusionary riders), % dependent on cost of medication. Add a ratable build or tobacco use, applicant is declined.

There's actually more to it than this...

HumanaOne will also consider the deductible level applied for.

Just had a 55 year old male (ht/wt ok, non-tob) with meds for both cholesterol and hypertension issued standard on a 10k family deductible.

indmedins · 01-26-2009, 11:34 AM

Originally Posted by moonlightandmargaritas

There's actually more to it than this...

HumanaOne will also consider the deductible level applied for.

Just had a 55 year old male (ht/wt ok, non-tob) with meds for both cholesterol and hypertension issued standard on a 10k family deductible.

True, the deductible does make a difference. I kinda answered quick.

Next time sell your clients the integrated Rx. LOL. Just kidding.

somarco · 01-26-2009, 02:15 PM

Aetna is a possibility.

Sometimes the rider makes sense. I have quite a few folks who opted for the rider, and lower premium, vs paying the rate up + the Rx deductible + the copay.

SportsNut · 01-26-2009, 03:53 PM

Originally Posted by somarco

Aetna is a possibility.

Sometimes the rider makes sense. I have quite a few folks who opted for the rider, and lower premium, vs paying the rate up + the Rx deductible + the copay.

Rider for HBP + Col... Lets say client accepts the rider, then has a HA 1 yr later... now what...? Not familiar with Aetna but other riders seem to exclude coverage for such an event due to the HBP + Col = prone to coronary artery disease....?

I am never in favor of riders unless there is NO other option... I would NOT accept one personally, so I am biased by that opinion.

healthagent · 01-26-2009, 04:07 PM

My clients do not sign riders for any condition that poses any kind of major future liability. I'm not going to leave it up to the carrier to interperate the language of the rider.

somarco · 01-26-2009, 05:06 PM

Lets say client accepts the rider, then has a HA 1 yr later... now what...?

Depends on how the rider is worded.

GR riders exclude outpatient treatment (doc visits, Rx) for conditions like HTN & cholesterol. They do NOT exclude coverage for related conditions such as MI or CVA.

Most carriers, such as BX, Time & H1 write broad riders that would exclude not only the treated condition but anything related to it.

You have to look at each situation differently.