UNDERWRITING
What is a decline?
If the client is on PA, can they jump from plan 1 to plan 3?
What is no?
The lump-sum amount that is paid out in a critical event
What is Medguard
Renews every couple of months and underwrites on the back end
What is a short term plan?
The client has an employer-offered plan that is expensive for his family so he is looking for other options. The client's spouse takes Lexapro for anxiety, the kids are healthy, and he takes metformin. What would be recommended for this client?
Recommend doing a split policy and putting the family on private and the husband does his employer coverage
The client has a heart attack on premier med and steps up 4 months later, what's his coverage and how does premier med work?
3k deductible, 100% coverage after that, short term plan, has to jump off next OE
The client has had the saver plus dental coverage for over a year. The client's child needs braces now. What is the coverage?
Not covered
Organization where medical expenses are paid from a pool of money contributed by members
What is a healthshare policy?
The client is looking for coverage for her and her newborn daughter that is 25 days old. She needs her insurance to start on Feb 1st. Can you submit the policy now?
No, the baby needs to be 31 days old with 2nd well-baby visit
The client has PA, plan 3 and has been on the plan for 3 months. Clients son needs tubes in his ear. What's the coverage?
No coverage, 6 month waiting period for ENT
The client has a 75,000 medguard benefit on their plan, they are hospitlized due to COVID complications. How much of the medguard benefit will they receive?
10% 7,500
What's the standard duration of a COBRA plan
What is 18 months
Female 52, sleep apnea controlled with a CPAP machine, been taking lisinopril for 4 years, been taking atorvastatin for 4 years, height and weight 5'4 130
Male 53, been taking amlodipine and hydrochlorothiazide for 3 years, take timolol eye drops for glaucoma for 6 months, height and weight 5'10 200
What is a decline?
The client is on secure advantage with a 5k deductible 70/30 coinsurance, what is their total out of pocket max?
What is 11k? ... 5k ded ... 6k out of pocket
Client has medguard and is diagnosed with life-threatening cancer within 60 days of having coverage, what is his benefit amount?
$500 any cancer within 90 days only gets $500
What type of plan is appropriate to supplement a high deductible major medical plan
What is a limited benefit plan
Family plan ... dad has been taking lisinopril for 2 years, height and weight 6'0' 180, also takes fluoxetine
Mom ... has been taking lisinopril for over a year, gastric surgery 3 years ago ... height and weight 5'8 170
Son- rotator cuff surgery 7 months ago
Daughter- 19 has been taking sertraline for a year
what is a partial decline?
The client is on SA with a 5k ded 80/20 coinsurance and an EX Diamond association. The client has a heart attack and is hospitalized for 35 days. What is the clients out of pocket expense?
5,000 80/20 coinsurance 2k MOP = 7k MOP But the client has an ex diamond association, so the client will get a check for 24,000. The client uses the money to pay off 7k and pocket the other 17,000
A 61-year-old male wants to purchase life protector, what is his max benefit?
Have to be 60 or younger to purchase life protector
What's a situation that allows someone to keep COBRA for 36 months?
Spouse and kids are eligible to keep COBRA for 36 months
- If the employee dies
- If the covered employee loses employer benefits because they aged to medicare
- The couple divorced