Hi all:
I have a client that just received restrictive riders from GR. 1) 14 day waiting period deleted (don't even know what this is). 2) Cholesterol outpatient (indefinite duration). 3) Increased PCS DED +$900 (Indefinite Duration).
Not sure what to do at this point. She has 20 day free look, but I don't think I can get her through underwriting with another carrier quickly enough. Is this common? Also, what should I get in writing from GR?
She doesn't have any coverage presently. Should I just have her keep the policy and look for another? I think I should have her fill out an Aetna app since she has Credible Prior Coverage. No other carrier will waive without prior coverage.
Lastly, she does qualify for a portability plan now, but if she accepts this coverage and Aetna doesn't take her, then she's stuck in this plan.
The 14 day waiting period is an illness only waiver GR applies to new policy holders. It is waived if they currently have coverage.
If the cholesterol rider is tight then accepting it might be advantageous. Other carriers will rate up for cholesterol (or also place a waiver that may be more restrictive). Depends on how the rider is worded, how much her meds cost, and what other carriers (such as Aetna) will rate up to cover the cholesterol.
I have no idea what an increased PCS deductible is. Explain.
If her condition is such that she cannot get a fair shake from other carriers, then a HIPAA plan might be her best option. Of course most of the HIPAA plans I have seen are lousy & extremely pricey.
Don't think for your client - let your client think for themselves. Present all options, explain all options and let them choose. Do they want to pay an extra premium to be covered on Aetna? Let them choose.
I'd run it through Blue Cross, Aetna, and possibly Assurant's pre-screens to get the likely decision. Then present the rates including the Aetna and Assurant rate up's and let her pick. Aetna, Assurant and Blue Cross will not rider cholesterol.
When I have my client's choose between any rider and a rate up about 95% choose the rate up.
------------------------------------ Health Insurance Agents: Training, Support, Discounts, E&O for $440 www.ihiaa.com
Did you check with the other carriers (e.g., Time, Aetna, BCBS, AMS, etc.) to find out other offers? If I can get a client covered with a higher rate or CSD I do not prefer riders, however, to each their own.
Riders are an absolute last resort. If your client can't afford a 25% rate up to get an very important condition covered I'd make sure my E&O was up to date. There is a lot of potential liability attatched to having clients sign riders for on-going medical conditions. Nothing I'd want to go to sleep at night thinking about. You'd better at least have presented all options. The jury will want to hear that during the trial.
I did run her past other carriers. I need to see what they said again. Also I will have to go back and check what she wrote on her app. I don't think she listed any cholesteral problems on the app. She takes meds for HBP. They may have found something on the HBP form from the doc.
BTW John. Thanks for the suggestion to just put the ball in her court. Sometimes I feel like I can do more for my clients than what I really can.
If the cholesterol rider is tight then accepting it might be advantageous. Other carriers will rate up for cholesterol (or also place a waiver that may be more restrictive). Depends on how the rider is worded, how much her meds cost, and what other carriers (such as Aetna) will rate up to cover the cholesterol.
I have no idea what an increased PCS deductible is. Explain.
The PCS Deductible for GR is $250 for all RX but generic. Looks like they just increased it to $900.
As far as the cholesterol rider, I will call and ask them about it. Does Aetna always rate up? I think I remember that they said +25% for her HBP. I guess HBP and Cholesterol are related in this case?
Anytime you get an adverse underwriting decision it is indeed important to present the client with likely decisions of other carriers. It's not only the ethical thing to do but we live in a very letigious society. Anyone I deal with pre-ex conditions I email a:
Company A will do "this" and the rate is "X"
Company B will do "this" and the rate is "X"
Company C will do "this" and the rate is "X"
I've had many case where I think a rider is a non-issue; maybe it's only for a year on a fully recovered small surgery. Yet when presented with options they'll go against my advice and take another company with a rate-up. That's their choice and their level of comfort, not mine.
Thanks for the replies. I called GR and they won't send me the rider. So, I asked that the UW call me and I should hear back within 48 hrs. I think I should be able to get a copy of the rider from him/her.
I contacted BXBS and they stated that there isn't a rate up and they won't put riders on. It's either decline or accept. It sounds like they will accept her since my client stated that her Blood pressure readings are normal and controlled with meds. Of course, after having GR put a rider on for Cholesterol, I'm wondering what else is happening with this client.
I am going to call my client with the news and then follow-up with an email like John's.
I at least would like to present the client with the rider as soon as it comes out. That's not the way GR chooses to do business. The client must wait for the policy to come in the mail. Not the way I like to conduct business.
We also now have a situation where the client has paid money down and has to wait to recieve a refund. That can hold up going to "company B." I really don't see where GR fits in unless you have spotlessly healthy clients. They are not set up for pre-ex conditions - hence the low-ball rates.
At the least you will get to see the rider wording when the policy is sent to you for delivery. You should have that in a few days. Make a copy of it for current & future reference.
Would their be any logical reason behind GR not making the rider available for clients before they receive their policy? I can't think of one.
There are also states where riders don't have to be signed. This is a very dangerous situation. Assurant won't mark any policy as "active" until the rider or CSD is signed. GR will mark it as active before it's signed.
Makes it easy for an unethical agent to not explain that they even received a rider and just mail out the policy. Hope the client doesn't read it and once they find out they don't have coverage everyone says "gee....you really should have read your policy."
Jacodaro:
I know, but she doesn't have a cholesterol problem which is why I don't understand why there's a rider. I'm waiting to speak to the u/w at gr to find out why they put that rider on the policy.
If she is on Cholesterol meds she has a Cholesterol problem. When I get a rider on a GR policy , my underwriter explains and sends me a copy. With this case, it appears that the rider is just for outpatient expenses, such as visits to the cardiologist to monitor the meds. I personally think this might be ok compared to what I have seen other carriers do. The office visits aren't more than twice a year at probably 200 a pop. The increase in PDC deductible is directly related to the cost of her meds, probably on a non generic med.
The 14 day waiver is a positive, not a negative. I would put the policy in force and then shop. This client should pay very close attention to what they do because it is a good chance that she will have a hard time getting anything if she has any other events. If the patient has a weight problem and if their blood sugars are borderline normal, they are on the path to Metabolic Syndrome then to Diabetes. Get her covered immediately.
Thanks Blue Marlin. She isn't on Cholesterol meds, she's on high blood pressure meds. This is the reason why I'm so confused. I am very anxious to speak with the u/w. BTW, she's not even close to obese. Well within weight limits. In fact, small. I doubt Diabetes would pop up on her.
I go through this almost daily, unexpected medical information. Guess what, in every case this came up the docs had submitted records that support their UW, right or wrong.
Trvlnut,
Golden Rule will not rider cholesterol and other minor conditions if the customer selects a deductible of at least $2500 for an individual or $5000 for a family with no upfront Rx feature. If you're trying to use GR as a carrier for people that want immediate coverage for their existing conditions, that won't work with them. They're underwriting is set up to be more liberal on those that accept higher risk (deductible) before the coverage begins. Blue Cross/Blue Shield plans in most states will pay you less commission but will tend to accept people who want immediate coverage on things they already use.
However, according to jacodaro, the AZ Blue Cross may not be as liberal as the Blues I work with.
Golden Rule will not rider cholesterol and other minor conditions if the customer selects a deductible of at least $2500 for an individual or $5000 for a family with no upfront Rx feature
Waivers from GR, what to do?
Linear Mode
