Download Assurant-IM-Training-5.24.12

Welcome
Pre-Submission Agent Tips
Successful Agents Do These Key Things
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Eligibility Review (agent prescreen).
Field Underwriting Guide
– Ineligible Occupations
– Declinable Conditions
– Review the Build chart
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Complete Part 1 in total, no missing info.
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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
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Alcohol and Drug abuse
Aneurysms
Heart Disease and Coronary Artery Disease (C.A.D.)
Crohn’s Disease
Gastric Bypass/Stapling
Pulmonary Heart Disease
Strokes
Schizophrenia and Bipolar
Diabetes*
State Mandates
• Some States don’t 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 doesn’t allow Riders or CSD’s, 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
• 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
• IDQ’s (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 35- 50% 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
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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 414-2996020
• PHHI and call back Line 800-596-0049 (for applicant
callbacks)
• Inforce Underwriting 800-800-1212 (ext. 3665)
Thank You