T&T Marketing
Insurance and Adjuster Service
P.O. Box 84321
Lexington, South Carolina 29073
Tel: 803.808.6020
It's important to know which questions to ask your Insurance Representative.
They're not hard and they could save you money.
Here are some of the most important.
About the Company
- What is the A.M. Best Rating? This is an industry rating issued to ALL companies, based on their
Claims Paying Ability & Experience (A+ - C-) - How Long has the Company been licensed in South Carolina? Many companies come and go,
leaving their policyholders with no recourse. - Where is the Local, State or Regional office located? You may need policyholder assistance.
- What is the "Trend Factor" (%tage of Annual Rate Increase) for the Company's State-Approved
Health Insurance plans? (see Compare Rates page)
5 years or less.)
About the Policy
- Is the policy "Guaranteed" or "Optionally" Renewable?* If not, for what reason(s) may it be
cancelled or non-renewed? - Is this a Comprehensive Major Medical or a Limited Hospital/Surgery Plan?
- Are premiums based on "Attained Age" or "Issue Age"? ( Attained Age premiums typically increase
more frequently than Issue Age premiums) - Are there premium "Classifications"?** (Preferred, Standard, Sub-Standard, Tobacco User)
- Is there a "Healthy Insured" Discount? (No Medications, Medical Condition(s)/Diagnosis or Hospital
Confinement within last 10 years) - What is the "Co-Insurance"*** factor for this plan? (50/50, 75/25, 80/20) Are there any premium-saving
Options? - What is the "Out-of-Pocket" or "Stop Loss" Maximum?**** Per Person or Family? Are there any
premium-saving options? - What is the Maximum Benefit payable per Cause or Occurrence?*****
- Which Benefits (if any) are NOT subject to the Deductible? (Wellness, Accident, Prescription Card,
etc.) - How long will I have to wait before a Pre-Existing Condition****** is covered?
- If my needs change, does the policy have a "Conversion" privilege? (if not, you have to re-apply,
subject to the 2-year pre-existing condition clause) - Is this the best plan of those offered by your company or agency? WHY?
c) fit your budget.
* Guaranteed Renewable - plans cannot be cancelled by the Company for any reason, other than Non-Payment of premiums.
** Premium Classification - Some Companies combine all risks. Therefore, the premiums are higher and Benefits are more
restricted.
*** Lower the Co-Insurance (at risk) factor, you'll pay a higher out-of-pocket percentage up to the Stop Loss Maximum, but you
reduce your premium cost.
**** Out-of-Pocket (OOP) - The maximum amount paid by the Insured, at the Co-Insurance percentage. The plan pays 100%
thereafter.
***** Benefit Maximum - Some Plans have a "Per Cause or Occurrence" maximum. Others have a Calendar Year maximum.
BOTH are different from the Lifetime Maximum.
****** Pre-Existing - A medical condition or diagnosis for which services or medications have been provided, prescribed or
recommended - usually within the last two (2) years.
About the Marketing Agent/Representative
- Are you a Bonded & Licensed, Resident Agent/Solicitor in SC? (If not bonded, he/she may NOT be
legally accountable for what they tell you) - Are you a FULL-TIME Agent/Representative for this company?
- Have you been licensed in SC for three years or longer? (The 1st Year attrition rate for Agents is
relatively high.) - Do you reside and/or regularly work within 50 miles of my residence?
- Do you represent more than one Company?
- Do you offer other insurance products and/or services?
- Are you willing to meet with me at my residence or place of business, if needed or requested?
- Will you personally deliver and review the policy when it is issued?
- Is the plan you recommend identical or similar to one you would purchase to secure your family's
needs?
probably more interested in their Short Term goals than your Long Term Financial Security and Peace of Mind.
Insurance Shopping TIPS
- Avoid Tele-Marketers and Agents who encourage you to apply or enroll over the phone or online with
REGARDLESS of what you are told, your personal and financial information should not be entrusted
to someone you cannot see, or with whom you have not established some level of trust and
confidentiality.
- Research the Insurance Company and its credentials.
Call the State Insurance Commissioner's office and ask if consumer complaints have been filed
against the company or agent.
Ask your doctor or healthcare provider about the company. They know which ones to avoid.
Examples: "Do you accept assignment from this company?" "Do they pay claims fairly and timely?"
"Are you on one their Provider lists (PPO)?
- Ask to see agent credentials (State License, ID & Bond Certificate). If he/she is reputable, they will
comply.
- DO NOT attempt to apply for coverage IF: you are pregnant, have recently been diagnosed with a
medical condition, recommended for surgery, or plan any extended travel outside the US.
COVERAGE WILL NOT BE ISSUED.
- Answer ALL questions during the application process truthfully. DO NOT withhold any medical or
medication information.
the underwriter from other Insurers and/or the Industry-sponsored Medical Information Bureau (MIB)
in Baltimore, Md.
Even so, some companies will unscrupulously issue limited coverage, collect your premiums, then
deny a claim, cancel your policy and keep your money on the grounds the coverage was "...issued,
based on fraudulent information". (Yours or Theirs?)
- READ the QUESTIONS and CHECK the ANSWERS if your medical history is taken by an agent, as part
Most reputable companies have a designated toll-free # for this.
UNFORTUNATELY, some agents will alter information, just to get paid an "advance" to submit the
application. They may not care if you get coverage or ever receive any benefits from it. Should you
become suspicious of this activity, "Do the Right Thing". Call the Insurance Commissioner's office to
file a report because if he/she does it once, they will most likely do it again.
The monetary penalties are severe, but not as serious if an insured is unknowingly denied a claim in
the future.
- DO NOT cancel your existing coverage before you receive your new policy. Your signature on a
policy delivery receipt stating your health condition has not changed since the medical underwriting
information was submitted. However, all health insurance policies in SC have a 30-day "Grace
Period" and you may be able to avoid paying premiums for coverage by both policies (existing &
replacement) for the same month by "suspending" your bank draft until you receive the new policy.
Ask the agent how to safely accomplish this, without jeopardizing your present coverage.
- BE SURE the agent reviews, then gives you a signed copy of the required "Replacement
Comparison" form. You may have rights concerning pre-existing condition(s) that, without this form
become null & void. ASK to see the Replacement form to make certain the agent has completed it
correctly. Most companies require a copy of this form to be submitted with the application.
- IF you have been declined coverage by an insurer, BE CAREFUL what you do next, but there are
some options.
Medical plan. If you should be declined by one insurer, chances are good you will be declined by
another. DO NOT immediately apply for coverage with another company until you talk with an
experienced agent, licensed with one or more companies that accept special risk applicants. He/she
will review your options in detail and even help you get the underwriting information needed to
make a proper assessment. It may be recommended that you simply wait 6-12 months before re-
applying. During this period, a Short Term plan may be issued to cover you for any "non" pre-
existing condition or occurrence. They are GREAT!!!
Otherwise, if you have a condition that is non life-threatening, there are Limited Benefit plans you
may qualify for, and YES - even be covered for the pre-existing condition(s), after a period of time.
T&T Marketing represents 2 of those Special Risk companies. Under no circumstances will we
recommend an application to either of those companies UNLESS you can be reasonably assured of
adequate coverage.
However, if all other traditional insurance options become exhausted, you can be guaranteed
coverage as a resident of South Carolina through the State-funded Risk Pool (SCHIP), regardless of
your health. It is managed by BC/BS of SC and the premiums are relatively high, but you will be covered,
IF you can afford it.
THINGS YOU SHOULD CONSIDER WHEN SHOPPING FOR HEALTH INSURANCE.
· Company Rating – AM BEST publishes the Ratings for all Insurance Companies. These Ratings are based on Financial
Stability and Claims-Paying Reliability. NEVER consider purchasing Health Insurance from a company with less than
an A- Rating. ASK TO SEE THE AM BEST RATING CARD.
· Health Insurance premiums are based on one of two ages. ATTAINED AGE – Your present (attained) age, and ISSUE AGE –
Your age at the time of policy issue. Most Life and some Health plans use this age. However, the majority of Health plan prem-
iums are determined by your Attained Age. That is one reason they increase at least once each year – 12-28%, depending on
several factors. Your individual Claims experience may, or may not cause your premiums to increase. ONLY a few companies
still offer Issue Age premiums. They may, or may not increase, but they are certainly less likely to. In addition, when they do
increase, it is at a much lower rate. ASK YOUR AGENT WHICH AGE HIS PROPOSED INSURER USES.
· A more important consideration than age is RENEWABILITY. There are ONLY 2 Renewal options. They are: A. GUARANTEED
Renewability and B. OPTIONAL/CONDITIONAL Renewability. All but two Health Insurers in SC offer B only. The majority of
insureds are 30-45 days away from receiving a Notice of Cancellation from their Carrier, regardless if it is Group or Individual
coverage. That is all SC Insurance Law requires from a Carrier.
ASK YOUR AGENT WHICH OPTION HIS PROPOSED INSURER OFFERS.
· “Will an Individual Plan cost more than a Group Plan?” NO. Premiums for a “True Group” (usually 15 or more
employees) are based on a specific category/classification of employees, engaged in a similar occupation or location. For
various reasons, some businesses are rated higher than others. The Carrier requires the “True Group” Employer to pay at least
75% of the premiums for ALL eligible employees, regardless of their medical history or condition. The Employee ALWAYS pays
Spouse & Dependent coverage. Due to the average Spouse/Dependent risk, premiums are usually rated in favor of the greatest
risk for recurring claims - women & children. Additionally, there is a charge for Maternity Benefits - whether you need them or not.
Employee rates are usually the same for either Male or Female. THEREFORE, since an Employee’s coverage is Employer-paid, the
Employee can usually shop around to find similar coverage for his/her family at a much lower rate with an Individual Plan.
· “What is the BEST option for Affordable Health Insurance?” By Far and Away, It’s an HSA!!! The 2003 Medicare
Reform Act included a provision for cost-conscious consumers to set up a Health Savings Account. Since January 2005, it
allows consumers to take a 100% tax deduction for ALL medical-related expenses. Unfortunately, due to many self-serving
insurance agents & their brokers, the public has not been properly educated on its tremendous benefits. Essentially, an
insured can reduce premium cost an average of 40-60% by purchasing a plan with a $2k, $3k-$5k deductible. (NOTE: This
scares many people who would truly benefit from it) HOWEVER, the real advantage is realized when a portion of the premium
savings is inves-ted in a qualified, tax-free, interest-bearing savings account. The Insurance Carrier issues a Debit Card to use
for any medical expenses (even band-aids). Up to the Deductible, any amount may be deposited into this account every year.
Some smart individuals roll over a CD or another Savings Plan into this account to cover the deductible, then build from there.
Any unused funds at the end of each year roll over to the next and continue to do so until used, OR until age 65. If you are over
55, there is a $600/yr. per insured “Catch-Up” provision. After the Deductible is reached, deposits may be discontinued at any
time. THEN, remaining funds may be rolled into any IRA or Immediate Annuity to supplement other Retirement income. What’s
more, once the deductible is met, there is NO co-insurance (80/20 or 70/30). The plan pays 100% of all healthcare expenses up
to $3,000,000. This plan, once it is understood is by far the best alternative to reduce overall healthcare costs. For more about
Health Savings Accounts, go to: www.horizon2000.org/HSAFAQs.html
· “Do I have to set up a Health Savings Account through an Insurance Carrier?” NO. More financial institutions
are offering them as stand-alone accounts. BUT, leave the Health Insurance business in the hands of a capable, licensed and
reputable agent – not a banking officer.
· “How much should I plan to budget for Health Insurance?” Think about a luxury or habit you spend money for that
you can eliminate or curb. Doing without some may even be healthier. Most people can find enough there to cover the cost of a
Basic Plan. Encourage your employer to set up a Section 125 so you can Payroll Deduct. They may even offer to contribute the
Payroll Tax savings toward your premium.
· “Can I get a better Health Insurance deal on the web?” It depends on what you consider a “better” deal. I encour-
age clients to do some shopping around, but BE CAREFUL when you share personal information over the phone or Internet,
you could be severely compromised. Almost every company (not Brokers) offering rate quotes over the Internet can put you
in touch with a reputable, local agent who will properly asses your needs and budget. Most important, they will only offer the
plans you may qualify for, instead of purchasing something you may not qualify for – then having to wait indefinitely for a refund.
Besides, application/processing fee on an Internet purchase is usually non-refundable.
Also, at some point in time you will need the personal services of a licensed agent. Let them help you.
· “What is C.O.B.R.A.?” As part of the Health Insurance Privacy & Portability Act (HIPPA), COBRA was established to
guarantee temporary coverage for employees and their dependents after certain “Qualifying” events, such as termination of
employment. It is a very expensive “Toll Bridge” intended to provide coverage until other insurance is in effect – either through
a new employer Group or Individual plan. The Carrier can legally charge up to 140% of the Group Rate. They DO. The Carrier
must be notified within 61 days of your last date of employment (eligibility) and it can be renewed for up to 18 months.
A Short Term Major Medical is a much more affordable alternative for this temporary need.
· “If my current coverage lapses before I get replacement coverage, does it matter?” You must have coverage
in force before you can get a “Replacement”. Again, you have only 61 days to get the full advantage for any pre-existing con-
dition. Otherwise, you start over with what is usually a two-year waiting period, before benefits for a pre-existing condition are
payable. NEVER let a current policy lapse before a new policy is issued and delivered to you. Depending on your policy
renewal date, in some instances you can use your Grace Period, while waiting for new coverage to take effect. Your agent can
advise you on how to get up to 30 days of coverage at no cost when changing carriers.
· “Are there are Good Health Insurance Plans available to insure virtually anyone?” ALMOST. Unless you've
been diagnosed with a life-threatening disease or condition, some type of insurance can be obtained. Some people ask, “What
kind of Health Insurance is the BEST?” The correct answer is – “the kind you can qualify for and afford to pay for”. Today,
ANY Health Insurance is better than NO Health Insurance. There is a perception among many Healthcare Providers that, if you
don’t have insurance, you’re probably a poor risk to pay their bill. Most plans will pay something, and many providers will set
up a payment schedule for the balance, and/or will “adjust” the amount owed by at least 25% IF you have some kind of coverage.
That’s because they know you are doing your best.
Have a Question??? Comment??? Opinion???
Many of these came from my other clients and I welcome yours.
Simply visit my website at: www.horizon2000.org/INSURANCE.html and click on the “Contact Us” email link.
RESPECTFULLY,
Johnny H. Tate
Shopping for Health Insurance on your own is not fun.
You need and deserve expert advice and counsel.
Please let us know what we can do to help make your Insurance Shopping experience as easy as it can be.
