Secure Advantage
What is the max out of pocket for a 70/30 $3,750?
$9,750
Explain what fixed indemnity and first dollar coverage is.
There are fixed benefits built into the plan to use towards each itemized benefit. If in network, a PPO negotiated rate will be reduced as well
What additional questions need to be asked if a client tells you they have hypertension?
Are you taking a medication for that?
How long have you been on your medication?
What is your height and weight?
Do you see a cardiologist or is this through PCP?
The price is too high
*OBJECTION PREVENTION: If you can get their household size/income, special enrollment eligibility, and comparable price options, you can usually avoid this objection.*
I can see if you might qualify for government assistance, it looks like the lowest possible premium that I'm seeing is $__ / mth (Stripped SA). However, that's going to be the absolute bare minimum, so if there's any wiggle room I would definitely recommend a little more coverage.
What are 3 other names for the marketplace
Affordable Care Act
Obamacare
State Insurance
Explain the additional amount for max out of pocket per coinsurance level.
80/20: $2k
70/30: $6k
60/40: $10k
Are there out of network benefits on the plan? If so how do they work?
Yes- the first dollar coverage can be used towards in network or out of network facilities. Most out of network facilities will require a claim form on the back end!
I am on an anxiety med. What do you ask and how would you list IF standard?
How long have you been on it?
Do you see a psychiatrist or PCP for that?
- Under 12 months and PCP: Mild anxiety, treated with oral medication for under 12 months, no psychiatric or hospitalization treatment
- Over 12 months and PCP: Moderate anxiety, treated with oral medication for over 12 months, no psychiatric or hospitalization treatment
*OBJECTION PREVENTION* We can absolutely increase those benefit amounts if you'd like, but that would obviously raise your monthly premiums but I'm happy to run a quote on that! As far as doctors visits, you have telehealth, 6 doctors visits, plus preventative care. I quoted this plan assuming we probably would never be using all of those benefits in a normal given year, but if we are going to be going once a month or every other month, we may need to revisit going with a guaranteed issue plan. IF you don't use all of those visits in a year, they do roll over into the next year as well.
What is the difference between Medicare, Medicaid and Obamacare?
Medicaid: Under $20k income individual
Medicare: Over 65 years old
Obamacare: Low income but do not qualify for medicaid
Explain the separate deductibles
Sickness Deductible: Cancer, Heart attack, Stroke, Major sicknesses
Accident Deductible: Ex: Fell down stairs, car accident, got chased by a bees nest down a hill
Explain the difference between Plan 1, Plan 2 and Plan 3
All have first dollar coverage for benefits.
Plan 1: Daily benefits. Will need MOP for any surgery
Plan 2: Outpatient surgical benefits
Plan 3: In patient surgical benefits, Out patient surgical benefits, maternity benefits (state specific for maternity)
Explain what plan and who would be approved on an underwritten plan that takes a GLP-1
You can only be approved on Premier Advantage with a GLP-1 IF only for weight loss. The medication can not be for diabetes.
Client must understand the medication will not be covered and cannot be related to a disease or disorder.
I do not like United Healthcare.
"Sure, have you been insured with them in the past? What exactly were you needing covered that they weren't helping with? I will say, for your major healthcare corporations, there are countless different plan options. I'd assume that if you had a policy with them you didn't like, it could've had more to do with the deductible or copays rather than the specific network. All major carriers will have more comprehensive plans verses more catastrophic options, but maybe we should look into comprehensive coverage for you!"
What are the benefits of applying for a marketplace plan?
Subsidized rates if you qualify income wise
Fully inclusive-> No restrictions on preexistings, pregnancy, mental health, drug/alcohol abuse
Explain how Colorado's Health Plus works!
Different levels of how many doctors visits, prescription coverage, urgent care. All is provided before deductible!
NO PREVENTATIVE CARE COVERAGE!!!!
Explain how the upgrade on the policy works and how long you have Premier Med for.
When a claim comes in over $3k you have the option to utilize your Premier Med. You need to call in and ask to utilize it. After that, you will be covered at 100% for 3 months for all other claims whether it is doctors visits, prescriptions, surgeries, etc. Exclusions still apply for mental health, pregnancy, drug/alcohol abuse
I own a floor installation business and want an underwritten plan. Can I be underwritten? How would you list my job title if so and what 3 job descriptions would you coach them on?
Yes you can be underwritten as long as they say Business Owner and do NOT state they lay any flooring.
Three Descriptions:
1. Manage employees
2. Chat with clients
3. Desk work
I think I will just go with a healthshare instead.
Okay.. well so I normally don't recommend health shares because because they're not full coverage. A health share is simply a cost sharing program and is not going to constitute as real insurance, so you may run into issues with facilities accepting it and getting them to pay the claims since there's not specific contract for what they will or won't cover. It's a little more grey, so there's more risk with that.
What are the downsides to a marketplace plan?
Limited networks
Risk of Tax Penalties
Higher monthly premiums with higher deductibles
High Max Out of Pocket
No PPO negotiated rate
You chose the $100k max for a policy. How much does it increase each year?
$250k
What level can you get maternity coverage and how does it work?
Plan 3 (a few states do not). There are up front benefits for pre natal visits. There is a 270 day wait for labor and delivery coverage but then have first dollar coverage that accumulates towards it.
My child has asthma, ADHD and allergies-> What would you list?
Nothing-> Children will be declined for any medical condition listed. Always tell them it will follow the child along after they turn 18. They can not see childrens medical records
I do not want to give you my routing and account.
*This objection is 1,000% preventable. If you are getting bucked on routing and account, there is a good chance it's because you did not establish enough trust with your client or preface that you were going to need this information*
"I hear you. So for this policy, the insurance company is completely covering the cost of your underwriting and time with the verifiers. Since they are assuming that cost, they simply want to make sure that the applicant is genuinely interested in pursuing the policy with the intention of taking it if approved"
What is the Employer Affordability Rule?
If the client has a work plan offered, and it is less than 9% of their monthly income, they will not qualify for subsidized rates through the government.
If the plan is more than 9% of their monthly income, then the client may qualify for subsidized rates based on the fact that their work plan is not affordable for their tax bracket
Special Enrollment will be needed if outside of Open Enrollment