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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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