Underwriting Considerations Gender Age Build Replacement Deductible Amount Optional Benefits Prior Claims and Policies Medical Conditions What’s Important to an Underwriter? 2
Preferred I – 7% less than Preferred II Meets preferred underwriting guidelines and had previous health insurance coverage in last 63 days* Preferred II – 10% less than Standard I Meets preferred underwriting guidelines and did not have previous health insurance coverage in last 63 days* Standard I – 25% less than Standard II Meets standard I build guidelines with minor health concerns Standard II Meets Standard II build guidelines with more complex health history.* Adult Rating Classes
UHOne Underwriting Tips….. Utilize Generic Only/Discount Card on Copay Select when applicable 50% rule for Non-copay plans Past medical cost can not be over 50% of the deductible. A person that spent $1250 in office visits, labs, and Rx in past 12 months would be declined for $2500 Deductible on a Plan 100 or HSA 100. Underwrite on the drugs client is currently on or have been in 6 months prior Expect a rate up; August 2011 shift to rate ups over riders Mental is Nervous is not cover unless the Rider is selected The underwriter may rate up for pre-existing mental nervous cost, or remove the mental nervous option.
Rider vs Rate Up 96% acceptance rate as applied for 92% acceptance rate with 10 percent rate up 88% acceptance rate with 20-30 percent rate up 75% acceptance rate with exclusionary rider If Declined broker can ask for consideration on different deductible or plan (Saver 80 or Copay Select Value)
Most Common Riders Back Disorders Kidney Stones Cervical Dysplasia Cholesterol
Rate Ups For Specific Conditions Asthma Well-Controlled with Low Cost Meds 10% Kidney Stones Last attack within 2-4 yrs 10% ADD Coverage is checked 10% Breast Implants 10% Cholesterol Well-Controlled with Low Cost Meds 30-40% GERD/Acid Reflux Well-Controlled with Low Cost Meds 10-30% Birth Control Pills Yaz-10% Azurette-30% Migraines Well-Controlled with Low Cost Meds 10%
Underwriting Resources Application Underwriting Phone Call Medical Records Prior Claims Third Party Data Sources
Underwriting Communication Info 43%-52% of applicants receive uw phone call 12% applicants receive more than one call Auto dialer begins at 8 AM in applications time zone. Calls 3 numbers but stops when vm is left Number shows as an 800 number under UHC Auto Dialer (Complaints happen less than 1% of the time) UW communications is open 8 AM – 11PM EST Monday – Friday 45% UW communicators -all are nurses, average speed to answer is 10 seconds