What if Your Client Has Missed Open Enrollment?

Now that Open Enrollment is over are you considering Fixed Indemnity and Short Term Medical plan options?

Unless your clients qualify for a Special Enrollment Period (SEP), your clients may not be able to enroll in an under 65 ‘ACA’ Medical plan.

That doesn’t mean they can’t get medical insurance to cover significant financial risks – it just won’t be an ACA plan. So, what are their options?

Fixed Indemnities.

Fixed Indemnity plans come in a number of designs. Some are a less expensive alternatives to an ACA plan, providing first dollar coverage for everything from Preventative Services to Major Surgical procedures.  One example is UnitedHealthone’ s Health Protector Guard where the benefit can either be a supplement to an ACA plan or designed rich enough to be a viable alternative.

Hospital indemnities are designed to provide a fixed amount for each day in the hospital; or an indemnity that provides a lump sum in the event of an accident.   Combination indemnity plans may cover Critical Illnesses & Accident (such as IHC’s Metal Gap.)

The money received from Indemnity plans can be used for any purpose; to cover deductibles, out of pocket medical expenses, used to pay your mortgage, or any expense of daily life.  With today’s high medical costs and deductibles, indemnities are a great way to protect families from the financial shock of medical treatment.

The benefit of some indemnities, such as IHC, are fixed; while others, such as LifeSecure, are flexible, which means that the benefit can be adjusted to match the ‘Per Diem’ charge with hospitalization under a Medicare Advantage plan.   It can also be used to cover the total out of pocket maximum for a family without major medical coverage up to $25,000.

Indemnity plans are not Minimum Essential Coverage (MEC) as defined by the ACA.  However if someone has missed Open Enrollment, is not prepared to pay the ACA premiums, or wants a plan to cover their ACA deductible or other out of pocket costs, Indemnity plans can provide much needed financial protection and maybe the right choice for your clients.

Fixed Indemnity plans can include:

  • $0 deductible plans
  • Lump-sum or ‘Per Diem’ benefits for any purpose
  • Choose any doctor or hospital, and receive additional savings via access to network providers
  • No open enrollment period restrictions; sign up year-round

For example, a Health Protector Guard plan from UnitedHealthOne can be designed to provide the following benefits for a 50 year old male nonsmoker:

  • $4,000 per day for a hospital admission
  • $8,000 per day if in intensive care
  • $400 per day for emergency room visits
  • Up to $10,000 for surgery
  • $1,000 for outpatient facility fee
  • $300-$800 per diagnostic test (1 per year)
  • $100 per office visit (5 visits a year)
  • $20 or $40 toward the cost of prescription drugs (12 per year)
  • Benefits roll over in subsequent years.

The premium for this plan is $265.42 per month – much less than an ACA premium in most states.

The coverage is underwritten and pre-existing conditions are excluded.

The plan is available in over 35 states with agent commissions averaging 35%.

Call LeClair Group for a quote or to get appointed with UnitedHealthOne.

To learn more about Fixed Indemnity plans view the LeClair Group BrightTALK webinars with UnitedHealthoneLifeSecure and IHC

Short Term Medical plans.

STMs are an essential part of any advisors portfolio.  If you have clients in transition, missed Open Enrollment or starting out on their own business enterprise, Short Term Medical can be an essential financial protection.  Clients can currently sign up for multiple 3 month plans (subsequent  90 day plans are Guaranteed Issue, although the Deductible resets) that provide coverage up to 9 months.  Government regulations are being changed that may allow clients to sign up for a STM for a year at a time.

Short Term Medical Plans are available in many States from UnitedHealthOne, IHC and National General.

  • Features of a Short Term Medical plan:
  • Can be enrolled anytime and not subject to open enrollment periods
  • Designed for those in transition and without coverage
  • STM plans can now be purchased to cover 9 months or more
  • Begin any day of the month—as early as the day after you apply and enroll
  • Include benefits to help pay for unexpected medical care
  • Can be tailored to your needs in terms of deductible, coinsurance and plan options
  • Typically have much lower monthly premiums than major medical plans
  • Are not guaranteed issue and do not cover pre-existing conditions
  • Does not include essential health benefits like preventive care
  • Even though short-term medical isn’t as comprehensive as major medical, the minimum coverage it provides may be more than enough for critical illnesses, accidents, or injuries.  For some this is all the catastrophic coverage from financial risk they want.

To learn more about Short Term Medical plans view the LeClair Group BrightTALK webinars with UnitedHealthone and IHC.

Contact the LeClair Group at the Thrivent-dedicated phone line,  877-706-5807 or by reaching out to a member of the Sales Desk team to get appointed for a quote, product information and to get appointed.