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. 

 

With Blue Cross Blue Shield of Florida I cannot find out any details besides what I have obtained through the underwriting guidelines and that is, it looks good; as long as cholesterol and blood pressure are controlled with one medication and both of your body mass index levels are good so that’s great, and finally as far as Jane’s thyroid as long as it is not with Goiter and not hyperthyroidism – I imagine it is probably hypothyroidism then you will both be individually considered and could still get standard ratings with BCBSF.

Blue Cross is very strict on underwriting, and to complement their strictness, they take forever with complex cases like this one.  Still they are always worth a shot if you are considering individual health insurance period.

 

 

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 like Blue Cross 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 underwriting.  So between Cigna and BCBSF it 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 applications in with both carriers at the same time and see who comes in with the best offer; both Cigna and BCSBF 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 put all the details below, but I found that between much of the conditions being individually considered with BCBSF and the combination and stringency that Cigna has had in my experience BCBSF would probably be the less strict in their underwriting. 

 

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

They ended up with Blue Cross Blue Shield of Florida plan 597, who unexpectedly gave them the most Florida health insurance for the least amount of premium, true they were significantly rated up, but 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 and Blue Cross, 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.

 

BCBSF UNDERWRITING DETAILS:

 

 

 

 

CIGNA UNDERWRITING DETAILS: