Myth Busters of Buying Health

Insurance DirectSusan McGinnis, RHU

Vice-PresidentBenEx Insurance Agency

“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. 1

“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. 2

“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.

Myth No. 3

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:

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.

What to Expect From Your Agent:(continued)

Insurance companies are rated for a reason◦ AM Best◦ Weiss

Regulated by the Oklahoma Insurance Dept.◦ www.OID.ok.gov

Insurance Company Ratings

Legitimate Tax Deduction Portability Guarantee Issue Pre-Existing Condition Waiting Period

(Federal Law limit is 6/12)

Individual vs. Group

Employer Size Does MatterSmall Group (2-49) Large Group (51+)

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/%

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

Oklahoma Coverage Options

Group –

Individual – ◦ Oklahoma High Risk Pool◦ Temporary High Risk Pool

State/Federal Subsidized Options:

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

PPACA (What’s Up?)

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

Selecting a Agent/Broker

Questions?