Presentation on theme: "Welcome. Pre-Submission Agent Tips Successful Agents Do These Key Things Eligibility Review (agent prescreen). Field Underwriting Guide –Ineligible Occupations."— Presentation transcript:
Pre-Submission Agent Tips Successful Agents Do These Key Things Eligibility Review (agent prescreen). Field Underwriting Guide –Ineligible Occupations –Declinable Conditions –Review the Build chart Complete Part 1 in total, no missing info. –Current or prior insurance information is required –eDelivery
Agent Tips cont.. EASE Submission –Prepare applicant(s) for EASE application. Blood pressure and cholesterol readings if diagnosed conditions, and all medications. Pre-sell adverse actions (potential ratings and riders). Sell counter-offers at time of offer. Follow-up with applicants to ensure interview/OVS is complete if they complete this outside your office. Monitor the status of your applications on EASE.
Declinable Conditions Alcohol and Drug abuse Aneurysms Heart Disease and Coronary Artery Disease (C.A.D.) Crohns Disease Gastric Bypass/Stapling Pulmonary Heart Disease Strokes Schizophrenia and Bipolar Diabetes*
State Mandates Some States dont allow Riders, Ratings and/or Condition Specific Deductible (CSDs). –Michigan only allows us to Rider/CSD for 12 months so you may see riders and rating combinations to cover risk. –Oregon doesnt allow Riders or CSDs, offers could include an increase in deductibles. CSDs/Riders are not allowed for applicants under the age of 19, therefore ratings may be applied. Sometimes due to these limitations we cannot offer.
Current Insurance A question will be presented in all quoting systems that will require applicants to indicate whether they have current insurance (that they intend to replace with our coverage). The applicant will need to indicate a Yes or No response. If a primary applicant meets the criteria for current insurance, we will waive ratings of 35% or less for both the primary and spouse. This applies to new business only and does not apply in the following states: CA, CT, ID, MI, MN, NH, OR, UT, and WA.
Current Insurance Cont… Effective Date States vs. Premium States –Premium Rate states are states where the applicant(s) must pay a higher premium if they do not have current insurance. (CA, AK, WY, MT) –Effective Date Delay states are states where the applicant(s) effective date must be moved to 30 days after the application signed date if they do not have current insurance. (CO, IA, ID, LA, ND, WY, MT)
Tools of Underwriting Health History Interview IDQs (In-Line Detail Questionnaire) MIB, Pharmacy Check and Claims Review Conference Calling to Provider Medical Records or Lab & Exams
Health History Personal, but necessary questions –Build. –Conditions, testing, treatments and current status. –Medication and exact dosage amounts. –Name and complete address of for their physician's. –Exact BP and Cholesterol readings with dates taken.
Preferred Questionnaire Height/Weight Tobacco use in the last three years Blood Pressure Cholesterol (HDL and Triglyerides) Driving Last Physical for age 40 or older within the last 3 years Policies that have certain condition specific deductibles or exclusion riders are not eligible for Preferred rates.
Preferred Questionnaire cont… For preferred rating an individual can have a maximum of 2 riders or 2 CSDs or 1 rider/1 CSD. –If we are taking action on an applicant with a mental/nervous condition because the state and/or plan does not provide benefits for the condition, preferred rates are not available. –If an applicant has an SER or CSD from any of the following categories, preferred rates would not be allowed: –mental/nervous, musculoskeletal, nervous (includes headaches and epilepsy), general SER and all x99 SERs (with the exception in SC only) –If an alternative offer of a drug-blocking rider is available rather than rating for the medications, an option is to apply the rider and allow preferred rates.
Specific Conditions Blood Pressure –When diagnosed? –What treatment? Provide medication name and dosage. If still taking or stopped –Provide 2 most recent blood pressure readings within the past 2 year at least a month apart. (Give readings and dates). We look for trends but take the last reading we do not average. Reading taken at home, health fairs and paramedical exams are acceptable.
Blood pressure Continued Males on medication expect % ratings plus meds unless extremely high BP averages 160/100 or higher may see declines. Females all ages 20% plus medications rating. If current insurance criteria is met, rating could be waived
Hyperlipidemia (Elevated Cholesterol) Date of Diagnosis. Treatment – provide name of medication and dosage Provide CURRENT lipid breakdown and date it was completed (Need Total Cholesterol, HDL, LDL, and Triglycerides) Readings 240 or over with meds may see rating of 20% on males depending on HDL level and cholesterol to HDl ratio however, women most likely will not see any ratings If current insurance criteria is met, rating could be waived
Diabetes All diabetics are declines except for gestational diabetes which will require a 10% load. Non Insulin Type 2 diabetics 55 and over may be considered for coverage based on risk factors of Co-morbid conditions such as Build, tobacco use, Blood pressure etc.
UW Actions: CSDs, Riders and Ratings CSDs /Riders are not allowed for applicants under the age of 19, therefore child ratings may be applied. If a CSD is available, we will always offer instead of an exclusion rider. Many CSD are not available for HSA plans CSDs do not block medications, and CSD amounts for drug card plans and non-drug card plans may differ due to the way drug costs are calculated on each type of plan. Riders can be applied for a limited time or permanently. Rating max is 75% unless there are state mandate limitations.
Underwriting Outcomes Issued as Applied For –Immediate access to policy ID card upon approval –No plan or premium changes –Policy mailed or eDelivered to customer Counter Offer –Condition Specific Deductible (CSD), Exclusion Rider, Premium rating, other plan changes –Client accepts or rejects Incomplete –Agent then applicant are notified. –Customer maybe asked to provide their medical records. Decline –No coverage for one or more applicants.
Important Numbers Fax # for Requirements and general correspondence PHHI and call back Line (for applicant callbacks) Inforce Underwriting (ext. 3665)