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Myth Busters of Buying Health Insurance Direct. Susan McGinnis, RHU Vice-President BenEx Insurance Agency. Myth No. 1. “I can save money by purchasing direct.” Wrong : In most cases, the products cost the same as if you purchased through an Agent/Advisor.

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Myth busters of buying health insurance direct

Myth Busters of Buying Health Insurance Direct

Susan McGinnis, RHU

Vice-President

BenEx Insurance Agency


Myth no 1
Myth No. 1

  • “I can save money by purchasing direct.”

    • Wrong: In most cases, the products cost the same as if you purchased through an Agent/Advisor.

      • Insurance companies file rates with OID

      • Lose your advocate

      • Agent/Advisor usually saves your money by shopping and implementing strategic strategies


Myth no 2
Myth No. 2

  • “I can buy online and save money.”

    • Wrong:

    • This is the same as purchasing direct with even more opportunity for discontentment.

      • Health insurance is not like buying music or a book

      • Benefits are complex, critically important and are different among insurers

      • Strong possibility for losing your Agent/Advisor


Myth no 3
Myth No. 3

  • “I have a policy which I purchased direct and am locked-in.”

    • Wrong:

    • Typically an AOR is acknowledged but not paid if received during the first 12 months of the policy.

    • Advantage for you is that you have an Advocate/Advisor if/when needed.


What to expect from your agent
What to Expect From Your Agent:

  • Work with you to evaluate your needs for insurance coverage.

  • Explain the details of different plans

    - Group Health - Long-Term Care

    • Vision - Group Life

      - Dental - Worksite Marketing

      - Disability - COBRA/§125

  • Make specific recommendations based on your needs and budget.


What to expect from your agent continued
What to Expect From Your Agent:(continued)

  • Serve as your advocate.

  • Communicate the benefits to your employees.

  • Review, Shop and Renew your plans annually.

  • There for you every day when you have issues arise with insurer.


Insurance company ratings
Insurance Company Ratings

  • Insurance companies are rated for a reason

    • AM Best

    • Weiss

  • Regulated by the Oklahoma Insurance Dept.

    • www.OID.ok.gov


Individual vs group
Individual vs. Group

  • Legitimate Tax Deduction

  • Portability

  • Guarantee Issue

  • Pre-Existing Condition Waiting Period(Federal Law limit is 6/12)


Employer size does matter
Employer Size Does Matter

  • Cannot receive a Decline to Quote

  • Cannot get claims info

  • Can receive a Decline to Quote

  • Can Self-Insure

  • Can get claims info

  • Employer Decides

  • Definition of Full-Time

  • Employee Waiting Period

  • Contribution Amount/%

Small Group (2-49)

Large Group (51+)


Oklahoma coverage options
Oklahoma Coverage Options

http://www.coverageforall.org/pdf/matrix/OK_Matrix.pdf


State federal subsidized options
State/Federal Subsidized Options:

  • Group –

  • Individual –

    • Oklahoma High Risk Pool

    • Temporary High Risk Pool


Ppaca what s up
PPACA (What’s Up?)

  • Patient Protection and Affordable Care Act

    • 2,500 page law

    • Phased-In over 8 years

    • US Supreme Court review

    • Health Care Exchanges per state

    • MLR


Selecting a agent broker
Selecting a Agent/Broker

Consider the following:

  • Bio (length & type of experience)

    • Employee Benefits Specialist (not P&C)

    • Professional Association activity

      • Look for active members vs. just members

  • Carriers appointed with

  • Licensee Look-up

    • https://sbs-ok.naic.org/Lion-Web/jsp/sbsreports/AgentLookup.jsp

  • Physical location/office

    • Support Staff

    • Nat’l Broker Agency vs. Locally Owned

  • Client Referrals



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