Insurance broker question

[stargazer08]

DH (47)and I (44) are applying for health insurance in preparation for leaving our jobs on June 29th. I know we can apply on-line but thought using a broker would be a good idea in case the application is going to be denied...assuming the broker can keep an eye on the process and could pull the app before it's denied. The broker we found said he can't pull an app like that. Am I wrong ot is he? If I'm wrong then I guess an on-line app would suffice. We're located in Illinois and are most likely going with BCBS.

 

[mykidslovedogs]

What I do if there is any question of a possible decline is I call quite a few carriers in advance and do what I call an anonymous prescreen. I go over the general health status with an underwriting rep, and they will usually tell me what the likely outcome is going to be BEFORE even applying.

Blue Cross recently changed their underwriting guidelines, and they no longer exclude conditions from coverage, so, if you have too many "rateable" conditions, they will sometimes just decline. It really all depends on current health status.

Here are a few gotchas: If anyone has recently been diagnosed with elevated BP or Cholesterol, it's an automatic decline untill you have been stabilized on fewer than 2 meds for at least 6 months or controlled with diet and exercise within 6 months. If you have three or more "rate-able" conditions, conditions for which you could be up-rated, the likely outcome with BCBS will be a decline.
A body mass index of >30 combined with elevated Blood Pressure or cholesterol will lead to a decline with BCBS, regardless of whether or not the condition is controlled.

Any kind of health condition for which there isn't a clear outcome or treatment plan usually leads to a decline until a doctor either gives a clean bill of health or a definitive treatment plan. This is because the insurance carriers don't like any kind of uncertainty as to whether a surgery or expensive treatment could be lurking in the near future. Examples include back/neck injuries, suspicious moles, cysts or lumps that have not been examined, etc.

Any kind of history of cancer during the past 5-10 years, history of drug or alcohol abuse (even if currently clean) or history of attempted suicide will lead to a decline.

 

[stargazer08]

I looked over the app on-line to see what questions they ask. I have migraines for which I take 3-4 Rx pills per month (which I assume will lessen when I retire) and DH took depression meds from 2000 through 2003 and had elevated cholesterol in 2002 (250) when we had life ins physicals but in 2004 his cholesterol was down to 200 when he switched life ins carriers and had another physical. We both visit chiropractor once a month. That's the extent of our medical issues. I'm not sure if they are considered rejectable problems. We plan on going with high deduct (5000/person) HSA plan. I guess we should have the agent make those pre-screening calls and go with the carrier that seems to have the least possibility of declining our app.
edited to thank you for your reply

 

[mykidslovedogs]

I looked over the app on-line to see what questions they ask. I have migraines for which I take 3-4 Rx pills per month (which I assume will lessen when I retire) and DH took depression meds from 2000 through 2003 and had elevated cholesterol in 2002 (250) when we had life ins physicals but in 2004 his cholesterol was down to 200 when he switched life ins carriers and had another physical. We both visit chiropractor once a month. That's the extent of our medical issues. I'm not sure if they are considered rejectable problems. We plan on going with high deduct (5000/person) HSA plan. I guess we should have the agent make those pre-screening calls and go with the carrier that seems to have the least possibility of declining our app.
edited to thank you for your reply

What kind of Migraine Rx are you taking? Immitrex is something like $600/30-day supply at the retail price at Sam's club. I just checked into it on Fri. for one of my clients. With BCBS, if the cost of your current meds exceeds a certain percent (I think it's 19.5%) of your premium, it can result in a decline. If you don't mind self-funding your prescription, you might want to consider a carrier that has the ability to exclude your headaches from coverage (if your state allows carriers to exclude conditions from coverage - some states don't). A good alternate choice of carriers might be Humana, Golden Rule or Assurant Health (if they do business in your state). At least in Colorado, all of these carriers will typically exclude pre-existing migraine headaches from coverage rather than declining you from coverage alltogether.

Depression and the use of a chiropractor don't usually present too much of a problem with underwriting, unless the depression is very serious or if the associated medication(s) are extremely expensive. If there hasn't been any treatment for depression for at least a year, most carriers don't even underwrite that. (offer is standard). However, sometimes carriers frown upon spinal manipulation, especially if it is associated with regular therapy for a past injury that has never completely recovered.

With the past history of elevated cholesterol, any carrier you apply with might want a current cholesterol reading before offering coverage. This might mean that he will have to get a physical before underwriting is completed. I would try to apply first on that, and see what the underwriter asks for. If he can get away without having to have a physical first, that would be the ideal scenario. I wouldn't run out and get a physical first unless an underwriter asks for it. (just to avoid having anything popping up in the physical that you are currently unaware of). Perhaps he could negotiate a paramed or just a lab test for the cholesterol reading rather than a complete work up. It would be cheaper and less risky as far as bringing to light any undesirable conditions that might be divulged in a complete physical exam.

 

[stargazer08]

MKLD - Thanks for all the info. I take Zomig which costs $12/ pill which is much less than Imitrex. I have very mild migraines thank gawd. We have Humana here as well as some other carriers...some I have never heard of. I really appreciate all the info!! We have BCBS coverage now through my job. Maybe I should get a broker who has more knowledge of health ins. The guy we found down state has never done a HSA policy. My agent up here hasn't returned my calls. Guess I'll bug her more today and try and catch her in the office.