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Another HSA case - with some numbers
Old 12-30-2006, 07:34 PM   #1
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Another HSA case - with some numbers

I recently submitted a BCBS HSA health insurance application online for my wife and I. We were accepted at the standard rate instead of preferred.

The up-rating for DW was due to physical therapy on a running injury that I listed as "active". She's actually about done with it and she can do a 3 mi. run with no pain. I'm wondering if they could do an exclusion or something and re-rate her (the injury was tendonitis of the knee/leg). I have a urethral stent that fixed a stricture that I've had for as long as I can remember. Not sure if other carriers will also rate me for it, but I figured I should check around.

I'm 42 and she's 43 and we would have paid $301 per month for a $10k family deductable policy at the preferred rate. The standard rate premium for us is $452 a month.

The policy covers preventative stuff like mammogram, pap, colonoscopy, etc. with no deductable if you stay in-network. I figure that's probably worth $500-700 per year or $50 a month.

One thing I'm learning (based on talking to a BCBS sales rep) is that when a couple applies together for family coverage, they seem to rate the policy based on the least healthy of the pair. If one of us can could get an individual policy at the preferred rate and the other got the standard rate, individually we'd have premiums of $166 and $252 per month, which comes out to $418. With a family policy, the standard rate premium for a couple is $452.

I'm trying to better understand how the deductable works. With a $5k individual/$10k family deductable policy, if you have family coverage, the BCBS web-site indicates only the $10k deductable applies (not $5k per person). That alone might be a good reason to go with 2 separate policies, each with $5k deductables.

Anyhow, if anyone has insights as I work through this decision, I'd appreciate the comments. I plan to keep this policy for a long time, so it will be worth it for me to "buy it right"

Thanks,

Jim

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Re: Another HSA case - with some numbers
Old 12-31-2006, 01:01 PM   #2
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Re: Another HSA case - with some numbers

Hi Magellan"

It is true with HSAs, if you apply as a family, then you have a family deductible, which is two times the individual deductible. I have quite a few clients that are couples who purchase separately so that they will each have an individual deductible instead of a family deductible. There is no disadvantage to doing this, other than having to deal with separate bills. You can each put up to the IRS maximum per individual in your HSA accounts in the year 2007. Plus, if you are both over 55, you can each open separate HSA accounts so that you can both take advantage of the "catchup" contribution (on top of the IRS defined maximum) that is allowed for individuals over the age of 55.

As far as rating is concerned, I have never experienced a carrier rating the whole family based on the unhealthiest individual. Each individual is underwritten and rated separately, regardless of whether they are on the same policy. My guess is that Blue Cross decided to give both of you the "standard" rate, because that's how you were each underwritten separately. Recently, BCBS changed their underwriting guidelines to allow for rating up instead of excluding conditions. In the past, they used to give everyone the same standard rates and exclude pre-existing condtions. If you would rather take an exclusion vs. a rate-up, then you might want to look at a different carrier such as Humana One. Different carriers have different underwriting guidelines, so some might just exclude the conditions instead of rate up. A good idea would be to hire a broker who can do the pre-screening for you so you can get a good idea of likely outcome with several different carriers before applying. The cost is the same to you whether you use a broker or not.

Also, what is your age bracket? I just have to say that I get very few individuals in the 50+ age category that get preferred rating. A few...but not many. If there are any pre-existing conditions at all, I usually see them get standard rates, vs preferred. In order to qualify for preferred rating, you also typically must have optimal height and weight based on either the height/weight charts or the BMI chart, and optimal cholesterol and blood pressure readings.

One last thing....on the running injury, you might be able to appeal the rate up in a year or so, if the health remains optimal, and ask for the preferred rate later on. Insurance carriers are usually willing to look at an appeal a year or so down the road, with an excellent physical and a clean bill of health from the Dr., including optimal height/weight, and optimal cholesterol and BP readings.
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Re: Another HSA case - with some numbers
Old 12-31-2006, 02:55 PM   #3
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Re: Another HSA case - with some numbers

Mykids,

Thanks very much for the reply, it was very helpful. Although some folks on this board have given you grief for your posts, I've found your contributions interesting and valuable.

As far as age, I'm 42 and DW is 43. I had thought we were in excellent health. We're both pretty active and right in the middle of the weight charts. No BP or other problems and mostly routine health stuff. The running injury was a bit of a curve ball, but DW now runs for 3 miles 4 times a week with no pain.

I originally contacted a broker who was recommended by a friend, but after an initial conversation, he hasn't returned any of my phone calls. That was a couple of weeks ago and I really don't know what happened. He has an admin answering the phone who says he's unavailable and sends me to his voicemail.

This morning I applied online for a policy from Assurant Health. The Assurant policy works with an HSA and has a $5700 family deductable. Their preferred rate is $359 for both of us.

Also, just as a warning for others (and I'm sure mykids knows this well), if I had applied to assurant first, the urethral stent (which got me up-rated with BCBS) might not have come up since it hasn't required treatment in the last 5 years and all the assurant questions go back only 5 years. unfortunately, because I was up-rated by BCBS, I had to explain the reason on the assurant application.

Anyhow, If assurant underwrites at the preferred rate, I'll take it. Otherwise, I'd be willing to look at exclusions if doing so would get either of us a better rate. I'm expecting to keep this policy for a long time.

This process is a bit gruelling and I do wish I had a broker working with me. If I had it to do again, I'd work harder to find an interested broker early in the process.

Jim
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Re: Another HSA case - with some numbers
Old 01-01-2007, 10:12 AM   #4
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Re: Another HSA case - with some numbers

Hi Magellen,

Assurant Health, at least in the state of Colorado, will do exclusion riders. Here is an exclusionary rider section from their underwriting book, and the code for the associated riders (This was out of a Colorado Specific Book, but I imagine it is going to be pretty similar from State to State):

179 Any illness, disease or physical disorder of the penis or urethra
URINARY
Condition Specific Riders
201 (Specific condition), including but not limited to any diagnostic procedures,
surgery or complications thereof
202 Urinary incontinence, including but not limited to any diagnostic procedures,
surgery, underlying causes or complications thereof
204 Any diagnostic procedures, treatment or surgery for enuresis, including
causes or complications thereof
222 Urinary tract infections/cystitis/urethritis, including but not limited to any
procedures, treatment, surgery, underlying causes or complications thereof
224 Urinary tract stones, including but not limited to any diagnostic procedures,
surgery, underlying causes or complications thereof
226 Urethritis including but not limited to any diagnostic procedures, treatment,
underlying causes or complications thereof

And here is the build chart showing what weights will qualify you for preferred:

Assurant Health
Medical and Non-Medical Underwriting Guidelines
10/31/06 Edition 11
Build Tables - IM
Age 16 and Older
In" (1st column)
Ft' In" (Second column)
Preferred Range
Males (3rd column)
Preferred Range
Females (4th column)
Max for Standard
Males and Females (5th column)
Max for Rating Assurant Health
Medical and Non-Medical Underwriting Guidelines (6th column)

Anything above the Max for Rating is going to be a decline:

10/31/06 Edition 11
Build Tables - IM
Age 16 and Older
In" Ft' In" Preferred Range
Males
Preferred Range
Females
Max for Standard
Males and Females
Max for Rating
Males and Females
58 4'10" 90-138 157 190
59 4'11" 92-140 163 197
60 5'0" 98-152 94-143 168 203
61 5'1" 101-155 96-146 174 210
62 5'2" 103-159 98-150 180 217
63 5'3" 105-162 101-153 184 224
64 5'4" 107-166 104-158 188 231
65 5'5" 110-171 107-163 192 239
66 5'6" 112-175 109-168 197 246
67 5'7" 115-181 112-173 204 254
68 5'8" 118-186 115-178 210 261
69 5'9" 121-191 117-185 216 269
70 5'10" 124-197 119-192 222 277
71 5'11" 126-203 122-197 229 285
72 6'0" 129-208 123-202 235 293
73 6'1" 132-215 126-207 242 301
74 6'2" 135-220 130-213 248 310
75 6'3" 139-226 134-219 255 318
76 6'4" 143-232 138-225 262 327
77 6'5" 146-240 141-235 269 336
78 6'6" 147-250 147-241 276 345
79 6'7" 151-256 151-248 283 354
80 6'8" 155-263 155-254 290 363

And here is a copy of the preferred rating questionnaire:

If a proposed insured meets any of the following conditions, that proposed insured is not eligible for a
preferred rating:*
– Condition Specific Deductible (hazardous activities, hearing loss, inguinal and umbilical hernias, infertility and
fractures may still qualify for preferred)
– SPECIAL EXCEPTION RIDER (hazardous activities, hearing loss, inguinal and umbilical hernias, infertility and
fractures may still qualify for preferred)
– Special Class Premium
* Note: A proposed insured may be eligible for a Preferred Smoker rating if he or she is able to truthfully answer questions 2, 3 and 4 “No.”
Underwriting reserves the right to apply tobacco ratings based upon lab results, phone verification or medical records.
Each proposed insured must complete and sign the appropriate sections. Spouses are considered separately for
preferred rating eligibility and must also answer this questionnaire. This information is not required for dependents.
Primary Spouse
1. Has the proposed insured used tobacco products at any time
during the past 3 years? (If NO, go to question 5.) ■ Yes ■ No ■ Yes ■ No
2. Did the proposed insured previously smoke or do they currently
smoke 10 or more cigarettes per day? ■ Yes ■ No ■ Yes ■ No
3. Did the proposed insured previously smoke or do they currently smoke
more than 1 cigar or pipe per day? ■ Yes ■ No ■ Yes ■ No
4. Did the proposed insured previously use or do they currently use
chewing tobacco? ■ Yes ■ No ■ Yes ■ No
5. Is the proposed insured currently outside the weight range listed in the
build chart on the reverse side? ■ Yes ■ No ■ Yes ■ No
6. Has the proposed insured had blood pressure readings in excess of 140/90
or been treated for elevated blood pressure in the past 12 months? ■ Yes ■ No ■ Yes ■ No
7. Has the proposed insured had cholesterol readings above 220 or a
cholesterol/HDL ratio above 3.5 or been treated for elevated cholesterol
or triglycerides within the past 12 months? ■ Yes ■ No ■ Yes ■ No
8. Has the proposed insured had any citations for DUI or more than 1 moving
violation including speeding ticket(s) within the past 2 years? ■ Yes ■ No ■ Yes ■ No
9. Has the proposed insured had a complete physical exam within the past
3 years? ■ Yes ■ No ■ Yes ■ No

It says that if you get an exception rider, you will not be eligible for preferred rates.
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Re: Another HSA case - with some numbers
Old 01-01-2007, 10:27 AM   #5
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Re: Another HSA case - with some numbers

MKLD -- this is great information. Thanks very much for posting it.
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Re: Another HSA case - with some numbers
Old 01-01-2007, 10:34 AM   #6
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Re: Another HSA case - with some numbers

I thought it would help take some of the "guess work" out of the underwriting mystery. Like I said, all carriers have different guidelines, so it is important to have a broker who can do the prescreening for you. Otherwise, it's a big, frustrating, time-consuming guessing game.
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Re: Another HSA case - with some numbers
Old 01-01-2007, 12:40 PM   #7
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Re: Another HSA case - with some numbers

Quote:
I originally contacted a broker who was recommended by a friend, but after an initial conversation, he hasn't returned any of my phone calls.
Several years ago, I had trouble finding a broker who would admit to selling health insurance in my state (Wasington). When I finally found one he told me that the margin on health insurance policies is so low, no one wants to rep it.
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Re: Another HSA case - with some numbers
Old 01-01-2007, 12:56 PM   #8
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Re: Another HSA case - with some numbers

Quote:
Originally Posted by mykidslovedogs

And here is the build chart showing what weights will qualify you for preferred.
...Anything above the Max for Rating is going to be a decline:
Thanks for this info. I'll have to see how their underwriting turns out.

The weight charts actually seem reasonable if I read them right. At around 6' it looks like I could weigh as much as 208 and still get preferred.

As far as the other exclusions, I had to answer those questions as part of the online interview and I should be ok with them.

One surprise was the question about more than 1 moving traffic violation. The DUI makes sense, but speeding tickets?

Talk about a triple whammy. Get a ticket. pay the fine, pay higher auto insurance, pay higher medical insurance! There's a local cop that gave me a couple of verbal warnings for speeding that I really owe a favor to.

Jim
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Re: Another HSA case - with some numbers
Old 01-01-2007, 01:44 PM   #9
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Re: Another HSA case - with some numbers

Quote:
Originally Posted by magellan
Thanks for this info. I'll have to see how their underwriting turns out.

The weight charts actually seem reasonable if I read them right. At around 6' it looks like I could weigh as much as 208 and still get preferred.

As far as the other exclusions, I had to answer those questions as part of the online interview and I should be ok with them.

One surprise was the question about more than 1 moving traffic violation. The DUI makes sense, but speeding tickets?
According to the info. I provided, you would probably not qualify for preferred rating, because of the fact that you may get a special exception rider for the urethral stent. As far as the stent is concerned, even though it is greater than 5 years old, the fact that it still exists is enough for a carrier to want to place a rider on it. This is due to the risk of possible future complications. Now, if the carrier does not see a risk of possible future complications, and they decide not to rider it, then you will probably qualify for the preferred rating. See the following:

"If a proposed insured meets any of the following conditions, that proposed insured is not eligible for a
preferred rating:*
– Condition Specific Deductible (hazardous activities, hearing loss, inguinal and umbilical hernias, infertility and
fractures may still qualify for preferred)
– SPECIAL EXCEPTION RIDER (hazardous activities, hearing loss, inguinal and umbilical hernias, infertility and
fractures may still qualify for preferred)"...



[/quote]
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Re: Another HSA case - with some numbers
Old 01-01-2007, 04:21 PM   #10
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Re: Another HSA case - with some numbers

This thread may be getting into too much detail, but I'm a bit confused by some of the terminology here and I want to make sure I understand...

BCBS has offered to underwrite a policy at the standard rate without any exclusionary riders or other conditions. Apparently they are concerned about the stent, but instead of excluding coverage for it, they're just charging more.

With Assurant (if I understand this correctly), they may only want to underwrite the policy with an exclusionary rider on the stent, and if they do, I won't qualify for the preferred rate because of the rider. The rider means that I'm not covered if anything ever goes wrong with the stent.

Of course, if that's that's how Assurant works out, the BCBS policy becomes a much better deal since I'd probably pay less or the same for the policy and I wouldn't have the exclusion.

I didn't understand the interconnect between the rider and access to the preferred rate. I was hoping I could self-insure for problems with the stent (which only cost around $8k) in exchange for a preferred rate with savings of a couple thousand a year.

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Re: Another HSA case - with some numbers
Old 01-01-2007, 05:01 PM   #11
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Re: Another HSA case - with some numbers

Quote:
Originally Posted by magellan
I didn't understand the interconnect between the rider and access to the preferred rate. I was hoping I could self-insure for problems with the stent (which only cost around $8k) in exchange for a preferred rate with savings of a couple thousand a year.
Yes! You got it! So then, it does sound like BCBS might be a better deal for you. You might want to still wait and see what kind of offer Assurant comes back with. Perhaps the standard rate wouldn't be much higher? One other thing to note is that I have found that Assurant Heath's coverage is more portable when moving from state to state. You are not always required to requalify if you move like with BCBS.

Have you checked with Humana One? Typically, if they exclude a condition, they will still give you the quoted rate.
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Re: Another HSA case - with some numbers
Old 01-01-2007, 05:15 PM   #12
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Re: Another HSA case - with some numbers

Quote:
Originally Posted by magellan
I'm 42 and she's 43 and we would have paid $301 per month for a $10k family deductable policy at the preferred rate.
That's quite a deductible. You probably know this, but the maximum you can contribute to an HSA in 2007 is $5,450.

Edit: oops, the treasury's site is wrong. The 2007 limit is $5,650.
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Re: Another HSA case - with some numbers
Old 01-01-2007, 09:11 PM   #13
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Re: Another HSA case - with some numbers

Quote:
Originally Posted by mykidslovedogs
A good idea would be to hire a broker who can do the pre-screening for you so you can get a good idea of likely outcome with several different carriers before applying. The cost is the same to you whether you use a broker or not.
About that word "hire", I hope you don't mean that "the cost" to the prospective client is anything but free.
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Re: Another HSA case - with some numbers
Old 01-01-2007, 10:56 PM   #14
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Re: Another HSA case - with some numbers

Quote:
Originally Posted by astroboy
About that word "hire", I hope you don't mean that "the cost" to the prospective client is anything but free.
We get paid by the insurance carriers on a commission basis. The client pays the same for their health insurance whether they use a broker or not. Assuming that you are insinuating that the commissions we are paid are built into the price, then you are correct, but if brokers didn't exist, then you would just pay higher admin fees to the insurance companies on a direct basis, so it all works out in the wash!
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Re: Another HSA case - with some numbers
Old 01-04-2007, 09:22 AM   #15
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Re: Another HSA case - with some numbers

Another update on the health insurance application process...

Just got off the phone with BCBS trying to see if I can get a preferred rate for DW now that her running injury is behind her and she's no longer in Physical Therapy.

They explained that their underwriting guidelines for PT are that you must be out of treatment for as you were in treatment in order to be eligible for preferred. Since DW was in PT for 5 months, we could reapply 5 months after the last treatment and perhaps be eligible for a preferred rating.

I was hoping they would offer a preexisting condition exclusion and still give us the preferred rate, but apparently that's not how it works.

Jim

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Re: Another HSA case - with some numbers
Old 01-04-2007, 12:40 PM   #16
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Re: Another HSA case - with some numbers

Quote:
Originally Posted by magellan
Another update on the health insurance application process...

Just got off the phone with BCBS trying to see if I can get a preferred rate for DW now that her running injury is behind her and she's no longer in Physical Therapy.

They explained that their underwriting guidelines for PT are that you must be out of treatment for as you were in treatment in order to be eligible for preferred. Since DW was in PT for 5 months, we could reapply 5 months after the last treatment and perhaps be eligible for a preferred rating.

I was hoping they would offer a preexisting condition exclusion and still give us the preferred rate, but apparently that's not how it works.

Jim

Blue cross recently changed their underwriting guidelines to remove the existance of exclusionary riders and replace them with premium ratings. If you had gotten coverage prior to 1/1/06, they might have just excluded it.
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Re: Another HSA case - with some numbers
Old 01-12-2007, 07:38 PM   #17
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Re: Another HSA case - with some numbers

Another update on our insurance application process in case anyone is still interested...

Summary:

Our Ages: 41 and 43
(All policies are HSA qualified)

BCBS (10k family deductible)
- Accepted both of us at standard rate of $452 per month (preferred rate would have been $301)

Assurant Health ($5500 deductible)
- Declined DW due to basal cell carcinoma removed from nose 3 years ago (which BCBS seemed to not be phased by).
- No decision yet on my application.

Celtic ($5500 deductible)
- Declined me due to urethral stent. No option for exclusionary rider given (and I probably don't want one anyhow).
- No decision yet on DW although they requested to see doctor records on basal cell carcinoma treatment.
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Re: Another HSA case - with some numbers
Old 01-12-2007, 08:48 PM   #18
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Re: Another HSA case - with some numbers

Magellan,

Is there any way you can check with Blue Cross to see if they would issue you and your spouse's policies separately? They might charge a bit more to separate the policies, but at least you would each only have a 5000 deductible instead of a 10,000 combined deductible. You might want to check into that with underwriting before you accept the coverage.

MKLD
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Re: Another HSA case - with some numbers
Old 01-12-2007, 09:08 PM   #19
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Re: Another HSA case - with some numbers


MKLD,

BCBS is willing to write 2 policies at $259 each with a $5k deductible. That would mean around $850 more in premiums per year to remove $5k worth of deductible.

At that price, it's actually cheaper for us to go into the state high risk pool, which would cost us about $240 each for $5k deductibles. Although I still like the BCBS plan because the coverage is better and the limits are higher.

I'm still waiting for the final answers from Celtic and Assurant to see if it might make sense to use a different company for each of us. My guy feel is that the BCBS policy is going to be the best bet and the only decision is whether to go with 2 individual policies or a single family policy.

Jim
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Re: Another HSA case - with some numbers
Old 01-13-2007, 09:35 AM   #20
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Re: Another HSA case - with some numbers

I, too think BCBS is much better than the risk pool available in our state. Good idea to see how Assurant and Celtic come back. Celtic became really competitive this year in my state. The other nice thing about Celtic is that it is very portable from state to state, so if you move to another state where Celtic does business, you don't have to requalify. With BCBS, you usually have to requalify when you move.
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