Part 2: PA v. SA (Healthy Client)

Break the Ice Again If Scheduled as a Follow Up Call - Follow up on personal things you talked about last time 

Recap 

I did some research for you, and just to recap, because you are in such good health, you should be able to qualify for some of those stronger approval style options we talked about. We wanted to make sure we found some nationwide PPOs with a well recognized company and of course we want to pay attention to those deductibles as well as the catastrophic coverage to protect you in a worst case event. I just sent you an email - if you have a laptop in front of you feel free to pull it up. 

Screen Share/Review Email 

ACA:

The first one you’ll see at the top is an Affordable Care Act option from the Health Insurance Marketplace, this one does have a pretty high monthly premium with a pretty high deductible. This is a public plan and an example of one of those Guaranteed Issue plans we talked about that anybody can get on, so naturally, it is a little more expensive. I don’t necessarily think these are the best fit for you, I just wanted to include it as a point of reference. 

APPROVAL PLANS - COMPANY / NETWORK:

I also included a couple approval style options for you, both are nationwide PPOs running through UnitedHealthcare so you’ll have access to a large network of providers. Both allow you to keep your doctors and see any doctor you’d like to without needing a referral for specialists. Do you travel often? Since they are nationwide, you can take it with you when you travel to see friends, family, etc. 

Optional: I also confirmed that your doctor ____/facility is in network with them as well, so you’re fine to keep  your same providers. 

OPTION A:

Great, this option A is going to be your $0 deductible which means you don’t have a deductible to meet before your benefits kick in, you’ll have upfront benefits for things like annual exams, doctors visits, prescriptions, as well as chiropractic, lab work and x-rays with no copays. I was thinking this one might make more sense for you given that you are so healthy, it’s not likely you’d meet a deductible so this one allows you benefits right away. You also have access to something called MD Live, which allows you unlimited virtual visits with a primary care doctor anytime you want, they are available 24/7 for free. 

COPAY QUESTION / DR VISITS: Now I do want to walk you through what to expect in the event that you use a doctor’s visit on that policy. So first things first, no deductible, no copay. I wish that meant everything was free all the time, I have yet to find a policy that does that so if you find one, let me know! (LOL). So you don’t pay anything when you get to the doctors office, just hand them your card and go about your day. The first benefit you’re going to receive is what’s called a PPO discount. So doctor’s love it when you have insurance, right? That’s how they get paid. 

So if you’re with a well known company, you can get an in network discount, just for having insurance and honoring that agreement between the insurance company and the provider’s office. So that takes off on average 40-70%, again just for having insurance and honoring the agreement between the insurance company and the provider’s office . On top of that, the insurance company will also offer additional itemized benefits, which you will see throughout the brochure. So you don’t pay any copays, you get an in network discount, a benefit, so your out of pocket for most routine services should be pretty minimal if anything at all. Does that make sense? 

As far as major medical, this policy is also going to have a $3000 max out of pocket. So what that means is if at any point on this policy you need something like a surgery or a stay in the hospital, you’d pay the first $3,000 and the insurance company is going to pay 100% thereafter.

OPTION B:

So I think Option A is a solid option, but I did also want to offer an option for something more affordable as well, and that’s gonna be your Option B. This plan is also with United, but it’s going to be a high deductible. Your deductible on that is going to be $___. Now you do get benefits for your annual exams, but pretty much everything else is going to be paid by you until you meet that deductible. This will work more as a catastrophic plan, sort of designed just to protect you in the event of major claims. So this one is sitting at $___/mth, so you would basically be getting a lower premium but also you’d have less coverage. This will just help you get in for that annual exam and you can at least say you have coverage if the sky starts falling tomorrow.

I will say that on this option, you do still have the unlimited telemedicine service so you can always speak with a doctor over the phone if you’re not feeling well, and that’s free to use. If you had to go in person for a service outside of a routine check-up, you wouldn’t have to pay a copay, because when they send it to billing, you’ll still get an in network discount, but you’d get a bill on the back end and that would be paid towards your deductible. Does that make sense?

So are you thinking you’d like something more comprehensive like the first plan or more affordable, more for just preventive care and catastrophic situations like the second plan? 

Reel It In:

“What other questions can I answer for you?”

Ok so just a couple reminders, these rates are subject to change anytime, and you do have to be approved for this plan first, which can take some time. Once we submit an application though, you do reserve that current rate which is nice so it can’t go up on you while you’re waiting for approval. And to confirm, you’re thinking _____ for your start date?

Ok great, we should be able to make that work just fine. It’s pretty easy for the most part, basically you’ll just fill out an application with me which entails basic demographics like your height/weight, middle name, where you wanna mail your cards to, stuff like that. 

We’re also gonna choose your start date and get a form of payment on file, although nothing comes out until your selected start date. Beyond that, we’ll touch on some medical history questions, how’s your heart/lungs/liver. And if everything looks good I’ll set you up for a quick call with the underwriters, they’ll basically just want to call and confirm everything, and they’ll review your application and let us know if you’re approved. If we’re approved we’re good to go and your policy will kick in on that start date!  

Do you have a few minutes to knock out that first part with me and we can get you scheduled for that call?” ***Move to Application if so*** 

If they say no (They want to look it over)

Absolutely, take as much time as you need, there is no rush on my end. This is an important decision and I want you to feel comfortable with anything we move forward with. So this stuff can be overwhelming and once you read through/review with spouse, you’ll probably have some extra questions - cause everyone does - so why don’t we set up a second phone call to make sure I get those questions answered thoroughly for you? Wanna take tonight to look it over and we can follow up tomorrow for questions and eligibility?