Skip to main content

Underwriting and Declines (Individual & Family)

I wanted to talk a bit about something that has come up quite a bit recently concerning declined coverage and health insurance underwriting in California.

I always maintian that, with the exception of MRMIP enrollments which require a decline, generating a decline unnecessarily is never a good idea. Many people have called me in the last few months who have been advised by another agent to submit an application for health insurance even though the health history appears to be problematic. This is never a good idea and is, truthfully, not necessary to determine within a reasonable degree the outcome of the underwriting.

We, as agents, are able to call into the carrier's underwriting departments and, anonymously request and underwriting "review" for any prospective applicant. In most cases, given a reasonably accurate history, that underwriter can tell us whether or not the application would be declined for coverage. Also, agents have an underwriting guideline for each carrier they represent and often the answer can be found there without the need to even call an underwriter. No need to expose you to a decline that will be on your record for 10 years.

Now, some will say "yes, but each carrier does its own underwriting without regard to another carrier's decision" and this is absolutely true. However, if a person is declined for coverage, for the next 5-10 years, depending on the question in an application, that person MUST indicate that he/she was declined for coverage. This will be an instant red flag to the new underwriter who will likely take a very thorough approach to the applicant. This question will appear on both individual and employer-sponsored group applications. It's a stigma that should be avoided whenever possible. Kind of like a ding on your credit rating.

Let your agent do the work up front, look at all of your options, and make your decision based on the most accurate probability, not just flinging an application into underwriting and hoping for the best.

Comments

Popular posts from this blog

Anthem Blue Cross (CA) Adding SilverSneakers® Fitness Program

Anthem Blue Cross (CA) announced this morning that they will be adding the SilverSneakers Fitness Program to California Medicare Supplement Plans A, F, and N.  The added benefit will begin on January 1st, 2017. 

Once approved for release into the market, more states have been added to the list as existing and new members in our marketed plans will enjoy the value-added benefits of the SilverSneakers Fitness program at no additional cost! Effective January 1, 2017, California members in our marketed plans will enjoy SilverSneakers, too.  The program offers members their choice of paths to better health. For those who enjoy a traditional workout setting, SilverSneakers offers access to more than 13,000 fitness locations across the country, including use of classes and guidance from a Program AdvisorTM. In addition, for those who can’t get to a fitness center, SilverSneakers Steps® kits focus on at-home or on-the-go general fitness, walking, strength training or yoga. And if that is not …

Anthem Blue Cross Announces Innovative F Medicare Supplement Plan for CA

Anthem Blue Cross (CA) has announced that they are releasing a new Medicare Supplement (Medigap) Plan for California residents.  The plan will be available beginning January 1st, 2018.

'Innovative F' will offer benefits not covered by a Medicare Supplement base plan.  These will include a hearing benefit (exam, fitting and allowance) and a vision benefit (exam, lens co-pay and allowances for frames and contact lenses).

Anthem states that the Innovative F will have a very competitive premium rate.  Innovative F will include the Silver Sneakers fitness program and will be eligible for the Plan F 'new to Medicare' $20 per month first year discount.  

http://www.davefluker.com/innovative-f-supplement.html



Dave
www.davefluker.com





What Multi State Plan (MSP) Really Means (Covered CA)

Lots of confusion on this term and many people think it involves coverage across state lines.  It does not.

This explanation from Anthem Blue Cross is the best one I have seen:



The U.S. Office of Personnel Management (OPM) Multi-State Plan Program (MSPP) was recently established under the Affordable Care Act. It directs the OPM to contract with health insurance carriers to offer at least two plans (one at the silver level and one at the gold level) in each local exchange. The MSPP is intended to promote competition in the Marketplace and help ensure consumers have more high-quality, affordable health insurance options. All MSPP plans will include “a Multi-State Plan” at the end of their name when listed on the exchange - this designates it as an OPM-sponsored plans.  It does NOT mean that consumers selecting the plan will have health plan coverage in multiple states.Select silver and gold level Individual plans that our company currently offers have been designated as OPM-sponsored MSPP…