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Deerfield Beach Sample Case

Sample South Florida Health Insurance Case

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Here is an actual case, names withheld to protect the innocent, of a couple in Deerfield Beach.  Their medication are listed below and they wanted individual health insurance.  As we are currently appointed with everyone and they live in Deerfield Beach, they had many choices, but because they were both on medication it was a very complex case.  I will tell you the outcome at the end.  Here is their Deerfield Beach Florida Health Insurance Quotes with my notes included.

BOTH 60 in Deerfield Beach

 

She – Jane Doe

Effexor

Levothyrozine (replaces Synthroid)

Pantoprazole

Lipitor

He- John Doe

No changes on mine.  I take:

Tricor

Qvar

My Findings with the Florida Health Insurance Underwriting pre-screens of a sample health insurance shopper and what I found in the Under-Writing Guidelines:

As per Aetna, it seems that both of you would be possibly approved at a C risk level which would mean a 50% rate up.   This means of course, that they were faced with an extremely high rate up.  Class C with Aetna is a 50% rate up minimally.

With AARP you could be a possible B rate (25% rate up) and Jane Doe could be a possible A rate with review of records for both for final determination.  Aetna is the underwriter for the AARP plans but as you can tell their underwriting is more lenient, however their rates are higher which of course means that they the Aetna and AARP plans are essentially the same thing.  Still if you are to apply with the AARP plans it would behoove you to also apply Aetna, and vice-versa. 

I would say that we forget about AvMed, since as per their underwriters – you could apply and would have a minimal rating, at best. Medical records would need to be ordered, and based on your history, could possibly result in a high rating or even a decline. Jani would have a significant rating, at best, and most likely would be a decline, however, she could apply and medical records would be ordered.

Avmed is also very strict, however they are very quick to underwrite.  Of course their individual plans are brand new so we expect them to get better on all counts eventually, and one day hope they are the leaders in South Florida health insurance, as they do seem to also be a caring company.

 Also, AvMed does not waive their 12 month pre-existing coverage period regardless if you have proof of creditable coverage – so we’re better off not even going with them.

LATER>>>>>he was confused, so we emailed him some clarification as shown below.

 

As we found with the prescreening with AvMed they are probably the most stringent; while AARP was probably one of the more lenient in their underwritingIt looks like Cigna is going to probably rate up Jane at least 25% over the standard premium, and you may or may not be approved with a 25% rate increase.  Ultimately, even with the prescreens and the underwriting guidelines that I use to assess the possible outcome, I am often surprised at the final premium that some of my clients are approved.  I am usually conservative in my estimates and many times they will come back with an approval of preferred for someone I thought may get an increase, or vice versa.

I would suggest that our best option is to submit your application with Cigna, as they withdraw your first month’s premium upon approval.  If there is a rate increase or an exclusionary rider issued (they are PPOs and are able to issue riders although I do not see that happening in your case) they would need your signature authorizing the issuance of the policy at that new rate or with Cigna just verbal confirmation that you want to accept the policy at the new increased rate if applicable.

I’ve attached the applications for both respective insurance carriers along with the completed proposal I had sent before that illustrates the same rates applicable for September effective dates.  If you would like me to submit the applications electronically you can complete one of the applications (Cigna’s is a little better with respect to being clear and offering more space to write) and I would then input that information electronically to you for final review and electronic signature in so the applications are electronically submitted.

Conclusion or What Health Insurance Policy Did They Buy

Jane was outright declined by Cigna, and a few others all of them listed in this Florida health insurance case study.  They only applied with Cigna, though we advised them to apply with AARP, and Aetna, but they chose to go with those two carriers because not everyone listens to us.  Their premium after the rate up $1446 per month.  That is more money than most people make in a month, but they didn’t have much choice.  Of course now in light of the economic conditions in Florida, they are considering our initial advise.

 

AETNA UNDERWRITING DETAILS:

 

Blue Cross Blue Shield Underwriting risk analysis

Blue Cross Thyroid Underwriting Table

 

 

 

CIGNA UNDERWRITING DETAILS:

 

Cigna Florida Asthma Underwriting Table

Cigna Anxiety Underwriting Table

Cigna Gastric Reflux Underwriting Table

 

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