What to do for someone uninsurable in Georgia?Go to Top
Hello,
I am trying to get a client covered in Georgia. I've submitted apps to 3 carriers (Assurant, BCBS & Aetna) and all declined her. (She takes medication for High Blood Pressure, Diabetes & High Cholesterol).
Are there any other options? (Besides group coverage) Is there a Risk Pool in Georgia for people like her?
GA does not have a risk pool. Once COBRA expires she can go on enhanced conversion or in the assignment system. Her best bet is to contact the GA DOI for placement. There is nothing you can do for her and you may have already messed up her chances of the DOI helping.
You might try calling the carrier before actually submitting an app to see how they would handle the pre-existing conditions. It's kind of a disservice to the client to to put them through underwriting without first talking to the underwriters. With 3 declines she probably wouldn't be touched with a 10 foot pole now by any reputable carrier.
With 3 declines she probably wouldn't be touched with a 10 foot pole now by any reputable carrier.
Thats BS....I had a client go through 5 apps before....4 declines and one issue.....each co's underwriting is different...but this case....I would have put all three in at once which I am sure you did and told the client chance's are slim....
thats BS....I had a client go through 5 apps before....4 declines and one issue.....each co's underwriting is different
Sti,
Yes, each carriers underwriting is different. But here in Georgia, the major players almost won't even look at a case if the person has recently been declined. And with the combination of ailments this person has, it's not likely that she would get covered by any of the major players. For an underwriter to look at a case that has been declined, you have to prove to them that the decline was based on bad information.
A phone call to the underwriters prior to submission of the case would have been the best thing for this agent to do. It would have saved both of them a lot of time.
thats BS....I had a client go through 5 apps before....4 declines and one issue.....each co's underwriting is different
Sti,
Yes, each carriers underwriting is different. But here in Georgia, the major players almost won't even look at a case if the person has recently been declined.
And who told you that....but with the trio layed down in this thread would have to advise the outlook would not be good...had a lead this week that had a heart mummer,high blood pres. and was a smoker and declined by mega life....had to tell them if mega won't take no one will....but you might try UA...
Uhhhhhh...the major players did. Just speaking from my own experience here in Georgia. If you have some personal experience here in Georgia that is different I'd love to hear about it.
I have not had that experience. This year alone I have placed at least 2 cases with GR that were turned down by other carriers. I have also written business with carriers after it was turned down by KP or BX.
Granted, someone that shotguns their app all over the place is likely to get nowhere. I rarely submit more than one app on a client. Lots of due diligence and pre-screen underwriting saves the headache, time & expense of multiple apps.
I'd rather call beforehand and verify how the insurance company will handle any pre-existing conditions...doesn't make sense (to me anyways) to shoot applications "blind". The only time I'll do that is if the client is healthy.
Here in California if you talk to the underwriters if you're declined you must wait 6 months (that I know of...BC, BS, Nationwide, Aetna..) to reapply with the same company. I'd love to hear if anybody has had any different experiences in Cali!
Of course I am talking about the big dogs of health insurance.
All that aside, why would any agent submit a diabetic to any reputible insurance company in Georgia? Diabetes is a big "no no" in Ga. A simple 3 minute call from the agent to an underwriter with any carrier would have dissolved this case.
Even better, mabye you could just simply open any carrier's Agent Guide and read a little bit before you start selling to people....
The two major players here in the metro ATL are BCBS and Kaiser. Both will tell you if a case has recently been declined, unless there is something that has changed since the decline, they aren't likely to issue either. Bob mentioned Golden Rule as a carrier to possibly use. They are not currently what I would consider a "major" player here. Especially since they had to leave Georgia for several months and have been back for less than a year now (give or take a little).
Their rates just aren't that competitive unless you are looking at the HSA product. I recently had someone that had breast cancer 9 years ago. BCBS wouldn't even consider it (they have a 10 yr wait for it - of course I called to see if there would be any chance of an exception). Sent it to Golden Rule. Not only was it issued, but at Preferred. Go figure.
The "top" carriers in GA for individual coverage (in no particular order) are:
Blue
KP
Aetna
Humana
Time
GR
World
Celtic
CGI
Blue still writes the lion's share because of size and buyers who are mostly uninformed about what is a quality product.
KP writes a fair amount but is limited (by virtue of being an HMO) to the metro area.
Time & GR are writing most of what is not written by BX & KP. The other carriers in the list are fighting over a very small remaining market share. CGI is already a non-player. Celtic & Humana might as well be. I will be surprised if they are still writing business here in the next 3 years. Aetna has been here for about a year & a half and still has yet to make significant in-roads. They are only in 40 or so counties and very slowly expanding. It will take them 5 years to be a major player at the rate they are going now. World writes a fair amount and of the smaller players (Humana, Aetna & Celtic) write more than any of them individually.
Anyone else that is left off the list is a non-player.
Individuals really have 4 carriers to consider in the first tier. Everyone else is marginal.
The two major players here in the metro ATL are BCBS and Kaiser. Both will tell you if a case has recently been declined, unless there is something that has changed since the decline, they aren't likely to issue either.
hummmm....then if thats the case then when you have a possible at risk condition then that would be the place to start and double app. them....but really ....it does not sound like you know this from experience when somarco has stated it has not been the case for him....
Blue has become very difficult to deal with from an underwriting standpoint. They used to take almost anyone who could fog a mirror; not so now. If someone has been declined by another carrier, chances are Blue will not take them, but this was not always the case.
KP doesn't even ask if you have been declined or rated, so it is a non-issue with them. That does not mean they will take cases declined by other carriers. They are still very picky and will reject cases other carriers will take.
An agent has to know the market, know their carriers, know the application and use the underwriting guide to their benefit. Every applicant is pre-screened by me personally before an application is ever submitted. If someone has an issue in their health history that is 6 years old and a carrier only asks about the last 5 years, chances are that carrier will get the business.
An applicant is not obligated in any way to disclose something that is not specifically asked for on an application.
The two major players here in the metro ATL are BCBS and Kaiser. Both will tell you if a case has recently been declined, unless there is something that has changed since the decline, they aren't likely to issue either.
hummmm....then if thats the case then when you have a possible at risk condition then that would be the place to start and double app. them....but really ....it does not sound like you know this from experience when somarco has stated it has not been the case for him....
If you say so sti. It makes no difference what Bob's experience has been. It doesn't change what I have personally experienced. I'm not going to get in a pissing contest with you. Evidently you know better than me about what's available here in Georgia so I'll bow to your expertise.
All that aside, why would any agent submit a diabetic to any reputible insurance company in Georgia? Diabetes is a big "no no" in Ga. A simple 3 minute call from the agent to an underwriter with any carrier would have dissolved this case.
Even better, mabye you could just simply open any carrier's Agent Guide and read a little bit before you start selling to people....
Ok......? Thanks for your help... People are vicious on this forum.. Wow..
Once COBRA expires she can go on enhanced conversion or in the assignment system. Her best bet is to contact the GA DOI for placement. There is nothing you can do for her and you may have already messed up her chances of the DOI helping.
Hi Somarco,
Could you please explain the enhanced conversion & assignment system? And why did you say i may have already messed up her chances?
I've been trying to speak with someone at the GA DOI.. They keep telling me it will be 48 hours before they call me back.. They are also pertty rude.. Must be a Georgia thing?! :wink:
Enhanced conversion is available on most group plans once COBRA expires. If EC is not available, the individual (if qualified) is assigned to a carrier who must take them and cover their pre-ex. The carrier of last resort is BX, but the assignment is made on a rotational basis as determined by carrier share.
If more than 63 days have passed since COBRA expired, or if multiple applications have been submitted, or if other coverage has been placed (such as STM or mini-med) the individual may not qualify for EC or assignment. The rules are quite strict on handling of these cases.
Any misstep by an agent and you can be held liable for disqualifying them from coverage under the state system.
I dont even get involved in these things. When it comes up, I give them the number of the DOI consumer services and let them handle it. Last thing I need is an E&O claim requiring me to provide health coverage for an uninsurable.
The best thing you can do for this person is tell them to get a part time job somewhere, and pick up benefits. If the person is here, in the Atlanta area, Baby's R Us, on Mount Vernon (in Dunwoody) is looking for part time work, and you get benefits after two weeks employment.
If you try to be the "hero" and find them something that no one else can, you will be spinning your wheels. I, personally, won't write anything with CGI or GR. My major plan is still the One Deductible with Assurant, the Benefit Wise product with World, KP's stuff (metro Atlanta area), and then the Evil Empire when someone forces me into it.
Each insurance company has their own "niche". As a professional, it is our job to constantly read literature, call DM's and get feedback to learn who is better in what market.
Though I hate saying this, if they don't want to get a part time job, and they are uninsurable, then I would present them with a discount card. I have one that I use, and make it clear to them that it is not insurance, and there is no stop limit. I've had to place three people on these discount plans in the past four years, and they are somewhat satisfied, but fully understand it is not insurance, but something is better than nothing.
Now, before you guys jump down my throat, and send me links to how bad these companies are, I MAKE THAT CLEAR TO THE CLIENT. It is much less hassle for them, and gives them coverage, while they are dealing with the dear, sweet ladies at the DOI's office. In all cases, they give up and just keep the discount card.
Also, have her contact her credit card company. Some of those offer a bare bones health coverage. Don't know who it's with, or how it operates.
What to do for someone uninsurable in Georgia?
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