C2C Questions - Health Insurance PDF

**[Script w/ C2C questions]** Hey (Their Name)? Hey (Their Name) it's (Agent)! I see you were looking for health insurance quotes, are you looking for just yourself or for you and your family? **Self / Family** Okay, what has you looking for coverage- did your premiums go up, did you lose coverage...

**[Script w/ C2C questions]** Hey (Their Name)? Hey (Their Name) it's (Agent)! I see you were looking for health insurance quotes, are you looking for just yourself or for you and your family? **Self / Family** Okay, what has you looking for coverage- did your premiums go up, did you lose coverage, what's your situation? +-----------------------+-----------------------+-----------------------+ | Premiums Increased | - - - | | +=======================+=======================+=======================+ | Lost/Losing Coverage | - - - | | +-----------------------+-----------------------+-----------------------+ | No Coverage | - - - | | +-----------------------+-----------------------+-----------------------+ +-----------------------------------------------------------------------+ | **Who do you work for?** | | | | **I am independently contracted through the state with** **[all the | | major carriers].** So, what I do is review your situation | | and match you up with the plan that will best fit your needs. We can | | go with any plan, BCBS, United, Cigna, or Aetna. My job is to educate | | you and help narrow down the options to fit your needs. | +-----------------------------------------------------------------------+ Alright (Their Name) as an advisor my license gives me access to all the plans in the state. I will pull up all of your options, so we can compare and contrast the best plans with the major insurance carriers. **Educate:** So outside of employer plans, there are two ways to get full health coverage. The first way is based on income, which is the public marketplace known as Obamacare, and the other is medically underwritten, which is based on your health. **Income:** Now, just so I can make sure you are not missing out on any discounts; do you know if you qualify for government assistance according to your income? **(if they don't know)** Okay, no worries. Do you know what your projected household income will be for the year? **Health:** Okay (Their Name) now how is your health, are you relatively healthy? Are there any **[medications prescribed in the last 12]** months you would like to see covered? (If yes, "Any other medications you may not have mentioned?") Medication Dosage? How often? How long? PCP or PSY ------------ --------- ------------ ----------- ------------ How about any major **[PRE-EXISTING CONDITIONS]**, Hospitalizations, back issues, or surgeries in the last 10 yrs? What kind of surgery? When? Fully released and recovered? Rx prescribed? ----------------------- ------- ------------------------------- ---------------- Do you use **any tobacco products your provider is aware of**? **YES/ NO** Now (Their Name) is there **[anything else you haven't mentioned that may show up on your medical report]**; I just want to make sure anything pre-existing is covered? -- -- +-----------------------------------------------------------------------+ | **[Email me "objection"]** | | | | Yes absolutely! I\'d love to send you an email. I\'d like for that | | email to be effective though and I haven\'t really narrowed it down | | yet. There\'s like 150 plans to choose from. So, if we can talk for | | like a minute or 2. I can make sure that\'s an effective email. | | sounds good? | | | | **If they ask for the email at the end,** | | | | Okay Great! and what would you like me to highlight in those | | brochures because it\'s 32 pages. I want to make sure that you're | | finding the right stuff and there\'s no confusion about what it is | | that you're wanting to look into so I can make sure to identify it | | and find it for you as well | +-----------------------------------------------------------------------+ **[EZAPP QUOTE]** **[BUILD QUOTES ON EZ APP AND HEALTH SHERPA]** **[POWER STATEMENT]** Okay (Their Name), based on the information you gave me and (you/your family's) low risk health history, I can ***[DEFINITELY]*** put you in a better position moving forward regarding your health coverage. It's a simple process, I just need some quick information. I have your Zip Code as \_\_\_, your DOB as\_\_\_? (Gather Families DOBs as well) **[STALL POINT, TAKE YOUR TIME!!]** Okay, (Their Name), just bear with me a moment, I'm entering your information to pull up the plans available in your area. **[(Start Putting all their information into EZAPP, then Health sherpa)]** **[KEEP THEM TALKING!!]** Okay, (Their Name) what's most important to you regarding your health coverage? - - - - - - **Frame:** Okay, (Their Name) Once we find a plan that is a better solution, we will be able to submit a free application for the start date of your choice. When we do find an option that makes sense, when would you like coverage to begin? Just so you know, an application usually consists of your basic demographic information, possibly a few medical questions, and a valid form of payment for the start date of your choice. +-----------------------------------------------------------------------+ | **Would your spouse like to get in on the conversation?** | | | | **I would like you both to have the same information so there is no | | confusion.** | +-----------------------------------------------------------------------+ Let\'s look at your options. Now, I am starting with the Public Marketplace plans, have you had a chance to look at Obamacare? **Note: (if they are currently on a Marketplace plan, locate the plan and briefly talk about it.)** **[SCREEN SHARE]** Alright (Their Name), I am narrowing down these options and would like you to be able to see what I am seeing, this way I can be fully transparent when explaining your options and looking up which carriers your doctors prefer. I am going to send you a link, this way you can see everything through my license. Are you near a computer or should I text it to your phone? **(First send license and business card)** Before I give you that link, I'm going to text you a copy of my state license so that you have my credentials. The number I am texting you from is my direct cell, I want you to feel comfortable knowing that I am her every step of the way and her to help out in the future. **(send crank wheel link)** Did you get the link? Okay, perfect, can you see my license? Great Make sure anyone you're speaking with shows you a copy of their license and reviews all of our options. Now I gave you access to see my full screen so you can follow along while I jump from plan to plan. **(optional to show background of self, family, kids) only show your license for a few seconds)** **[MARKETPLACE]** **[(Click on Health Sherpa Page)]** Remember**, there are two ways to get full health coverage**. One is the public marketplace, which is based on income, and the other is the private market which is based on health. Now, let's start with the plans available to you on the Public Marketplace, and then we can pivot to the private plans I believe are a better fit for you. **The least expensive plan** in your area on the Marketplace is starting at \$\_\_\_\_\_ a month with a \$\_\_\_\_\_\_ deductible. **[Now, are you familiar with how deductibles work? (Explain anyways)]** A deductible is the amount of money that you must pay before the plan pays any benefits for you. For example, if you are on a plan with a \$9,000 deductible, you will have to spend \$9000 out of your own pocket before the health insurance plan starts to pay any benefits. Does that make sense? Also, these are HMOs or EPOs, **do you know the difference between HMOs, EPOs and PPOs? (Explain Anyway)** **HMOs and EPOs** are **smaller restricted networks** that **typically only give you coverage in the county or state you live in**, and with HMOs, you will **need a referral to see a specialist**. So, **most people prefer PPOs** because you are **covered nationwide**. **No referrals are needed** to see a specialist and they also have **the largest network of doctors**. So, (Their Name) **how many times per year do you typically go to the doctor**? Well, **someone as healthy as yourself and your family will probably not spend \$9000in one year on medical expenses**, so I don't think a plan like this is going to be in your best interest, would you agree? **(If they are currently on a Marketplace plan make an effort to find it and give them a rundown)** **(Quickly -- go over a Gold-level plan and show one with a lower deductible)** If we **try to get that deductible down**, I do see a plan here with a deductible of \$\_\_\_\_, but now **the premium jumps up to** \$\_\_\_\_\_\_\_ a month. So, (Their Name), **these plans are really intended for people with major pre-existing conditions or those with very low income**. Now because you are relatively healthy, we can take a look at some medically underwritten options. **If you can qualify based on your health you will get lower rates and much better benefits.** **[PRESENTATION]** **[Open Health Coverage Summary]** **[(STAY ON MARKETPLACE SCREEN WHEN READING THIS PARAGRAPH)]** Now when I look up medically underwritten options, the plan I see with the best value, based on what we discussed, is the United healthcare Choice Plus PPO network for only \$\_\_\_\_\_\_\_\_ a month and this comes with a \$0 deductible and a \$3000 max out of pocket as well. For the right type of benefits, would this price point work for you? **[GET THE COST OBJECTIONS FIRST!!]** **(IF YES, show summary and highlight price. If NO, adjust plan and handle the cost objection)** Have you heard of United-healthcare? They are the largest insurance company in the United States and the most widely accepted carrier. **Search doctors on PPO Network Portal (Be Confident)** Let's take a look at the in-network doctors and hospitals in your area. **(Show all primary Care options, all hospitals THEN look up their doctors).** Just to make sure we are being thorough; are there any other providers you would like me to look up for you? **[Click Back to Health Coverage Summary]** Okay, now let's look at the **details of the plan**. You have **no calendar year deductible to satisfy**. You will have **6 built-in-visits, Urgent Care Visits, AND 6 chiropractic visits** as well. Now with those upfront visits, **if you do not use them, you do not lose them- they roll over year after year!!** +-----------------------------------------------------------------------+ | **[If they ask about the "7^th^ Doctor Visit.]** | | | | Great question! So as long as you are **going to an in-network | | provider, you would receive their network contracted rate, however | | the fixed indemnity benefit amount that would usually cover the | | balance of the fees for your services would not be applied and you | | would have an out-of-pocket expense**. (Now show EOBs and re-explain. | | You can also add "that would also go towards your max out of pocket. | +-----------------------------------------------------------------------+ So, the way the plan works is when **you go to the doctor you show them your insurance cards**, **get your treatment and you walk out paying nothing**. The doctor's **office then sends the bill to the insurance company to apply an In-Network contracted rate** with United HealthCare, which **usually reduces the bill between 50-80%,** as well as **applying your fixed plan benefit for your visit**. Next you will **get an explanation of benefits in the mail with a breakdown of your visit** or you can also view your claims in your user portal. I'll Show you **a few examples United Healthcare is giving on how you will see the coverage work** for you right away. **(1^st^ EOB- No Cost Visit)** As you can see- a **patient went to the doctor**, total **charges for the visit were \$160**, now because they went to a doctor or **facility that's in-network with UHC choice Plus PPO**, they **received an in-network contracted rate that took off \$98.38**. Then they went ahead and applied the benefit amount for the service they received, which **covered the \$61.62 at 100%**. So, **excluded charges are all that you would be responsible for** and as you can see **the patient was not out of pocket** **at all** for the visit. **(2^nd^ EOB-MRI Visit)** Here they are giving an **example of an MRI for \$1500**, the **contracted rate took off \$1311** and the **benefit amount paid \$238 at 100%**. This patient **did not pay anything for this visit**, where on most plans I look at there would be a large out of pocket expense that goes towards the deductible.  **(3^rd^ EOB-Dermatologist visit (specialist))** This is a Dermatologist visit for \$286, the contracted rate removed \$194.70, the amount left over was about \$91.30. The benefit that was applied was \$75, so there was a small out-of-pocket expense of \$16.30. So, if you do have a small out of pocket cost, it usually amounts to a small co-pay, you're just not paying at the time of visit, does that make sense? **(Only show the ER Visit EOB when ready)** **[Click back to Health Coverage Summary]** **[Wellness]** Your plan also has **your preventative care built-in** as well. As far as your **physicals, lab work** **Women: PAP Smears, Mammograms** **Men: PSA Test, Colonoscopies** **Adult and Children Immunizations** **Accidents** Now, Let's say you have something happen **outside of a regular doctor visit such as an accident**. Your worst-case scenario **for an accident or injury is \$250 PERIOD**. It doesn't matter if the accident is \$5000 or \$100,000 -- your worst case is \$250, and **the insurance company takes care of the rest**! +-----------------------------------------------------------------------+ | **[What's my ER Co-Pay?]** | | | | Well, the great part about this plan, **they've eliminated the | | Co-pays on the plan**. When it comes to any ER visit, it **would be | | for sickness or accident**. Remember the **worst-case scenario is | | \$3,000** and the **absolute worst case for any accident or injury is | | \$25**0. Give me an example of a time when you see yourself in the | | emergency room? (pause...let them make it up) Oh, ok so say you | | receive \$20,000 in bills for a broken arm, the worst-case scenario | | is \$500 for the \$20,000 broken arm. | +-----------------------------------------------------------------------+ **[Scroll to Premier Med]** **[Highlight \$3000 and 100%]** Now- Let's say you have something even bigger happen- **a catastrophic event**. God, forbid you **have cancer, heart attack, stroke, or a major hospitalization**. At that time, **you have access to your \$3000 maximum out of pocket** where the **insurance company covers you at 100% coinsurance with no cap on benefits amount**. So, whether your major **bills amount to \$10,000 or \$10 million- your worst-case scenario is only \$3000 and the plan pays the rest** **at 100%**. Is that clear? +-----------------------------------------------------------------------+ | **[What is my "Rx" Co-pay?]** | | | | Yeah, great question, remember they eliminated all the co-pays on the | | plan because you are in good health. When it comes to medication | | coverage it\'s just basic coverage. You get the contracted rate that | | would cover about 80% of the cost. They would then apply an | | additional \$40 for brand and additional \$10 for generic | | | | Mental Health medication, only contracted rate, no additional benefit | | applies. (Good Rx) | +-----------------------------------------------------------------------+ **[Scroll to MedGuard]** This plan also includes a **critical illness benefit** that **will satisfy your Max out of Pocket** so your worst-case scenario for a critical illness will result in NO out-of-pocket expenses. Plus, the **remaining benefit ensures that you do not have any financial stressors while you are out of work** dealing with a medical hardship. **(Tell them the amount they would receive)** **MDLIVE- (Association States Only)** **Show MDLive Brochure** Alright- Lastly, your plan comes with **MD Live**, which gives you **unlimited calls to a LIVE DOCTOR 24/7**, where they can diagnose you as well as send a prescription to your local pharmacy that you can pick up typically within the hour without even walking into a doctor's office. Things like antibiotics, eye drops and steroid creams. **[Dental]** +-----------------------------------------------------------------------+ | - - | +-----------------------------------------------------------------------+ For your dental you 'll have your **preventative care covered at 100%.** Your preventative care is covered **right away** at **100%** and includes **2 cleanings per year, every 6 months**. Now you're also going to have **basic care** included, things like **simple tooth extractions and fillings**. Your basic care is **covered at 80% after 30 days** You're also going to have **major care**, things like **caps, crowns, root canals, implants, dentures, and orthodontic** care. This is **covered at 70% after 12 months** In the event you **need any basic or major care covered before the waiting periods are satisfied**, as long as you **use an in-network dentist** you will **receive a 30% discount**. **[Vision]** --------------------------- **\$10 copay for lenses** --------------------------- Now for your vision you'll get your **comprehensive eye exam every year covered for free**, right away. So you'll get your eyes checked, poked, dilated, and all that fun stuff at no cost.! They'll also give you **\$150 towards your classes frames** and also **\$200 towards contacts** each year. **EXPLAIN 3 THINGS NOT COVERED** Now, there are **3 things that this plan will not fully cover** 1\) Drug and Alcohol Rehab 2\) Severe or In-patient Mental Health 3\) Maternity Care\... are any of those going to be an issue for you? Okay great! +-----------------------------------------------------------------------+ | **[Pregnant]** | | | | Great question, **I don't want you paying for maternity coverage | | until you actually need it, so if you do get the good news, just let | | me know and we will be able to add it in there or we will be able to | | compare it to other options that are strictly built for maternity** | | but maternity is something you don't want to pay for until you | | actually need it. So, when you get the good news and we know for sure | | she is pregnant then we will go ahead and get you the right coverage | | for maternity. | | | | (What would the price be for that) | | | | About \$250 more a month | +=======================================================================+ | **[Mental Health]** | | | | ***What happens if I want to see a therapist?*** | | | | Great Question, what I recommend is you **start with the FREE visits | | that you're going to get virtually with telemedicine under MDLIVE**, | | you're going to get **three of those** and **then it'll be \$90 per | | one-hour virtual visit**. | | | | Now if you want to see a **doctor in person**, you will get the | | **contracted rate however, no additional benefit would be applied**. | | It might be **better to pay cash for those visits** but you can **run | | it through the insurance to get the contracted rate**. | | | | Example, you might see a therapist and they bill you \$350, | | contracted rate brings it down to \$180 | | | | Example two, you are billed \$250 and the contracted rate brings it | | down to \$80, does that make sense? | | | | ***How often do you see yourself going to see a therapist?*** | | Multiple times a week? Maybe once a month? | | | | **(IF THEY SAY ONCE A MONTH)** | | | | Oh, ok perfect this will be the right plan then. It you want to get | | unlimited mental health that's comparable to this plan like | | \$300-\$400 more per month, so you are better off paying cash on this | | plan rather than paying for another plan that's more expensive, where | | they make you pay for it all up front and you get a \$9,000 Max out | | of pocket. | | | | Now on the ACA, getting mental health covered is difficult, you have | | to meet a high deductible first. The plans are more expensive and the | | coverage could be bad in all areas of the plan | | | | \*\*\* Mental health is better on employer plans | | | | \*\*\*(Freeze) Highest quantity of Therapist is online (broader | | schedules since they work from home) | +-----------------------------------------------------------------------+ **[Power Recap]** Just to recap, this is the **highest level of medically underwritten coverage**. In return for being considered low risk, United Healthcare is going to give you **the lowest rate with the most coverage**. Also, if I did not mention already, the **coverage qualifies as a full tax write-off if you itemize your deductions**. This is a nationwide PPO on the UnitedHealthcare Choice Plus network, you have a \$0 calendar year deductible for your everyday services, worst case is \$250 for any accident or injury, and your absolute WORST-CASE SCENARIO would be \$3,0001 That\'s it! So, based on the plan benefits and monthly premium of \$\_\_\_\_\_\_\_ (Their Name), you agree this would be the most suitable option for you/your family, correct? **(If not 100% sure, handle their concerns before moving on.)** **[CLOSE]** **CLOSING STATEMENT!** Alright, so here\'s what\'s going to happen next because you do have to get approved\... We\'re going to submit your application electronically to the insurance company. Application consists of:. - - - - - - - **(GO STRAIGHT INTO APP)** - - - - - - - **FILL OUT APPLICATION** (**Pause on steps 5, 6, 7(yes), release on 8 (medical questions), Pause on step 9 release on 10, pause on 11 stop at 12 with the Call scheduling and Stop Screen share** **(Left to right, not skipping any basic questions like MF, DOBs, HBP, Tobacco/ E-cig) Sometimes you just mention the answer selected. \"And the last four of your social security number for medical records?\"** **Check chart for HEIGHT/WEIGHT** (**For the riskier occupations**: Prep applicant that **verification call will ask what are two activities they do at work every day** **\"low risk answers\")** **EFFECTIVE START DATE:** So (Their Name), you have **two options** for your start date. You can have a start on the **date of application approval** or you can **select a specific date**. Which of those would you like to do? +-----------------------------------------------------------------------+ | **[What's the catch?]** | | | | (Laugh) So good question, this is the highest medically underwritten | | plan that you can get approved for and they are very selective. So, | | applicants need to be fairly healthy like yourself to be eligible for | | a plan like this. | +-----------------------------------------------------------------------+ **Next Page: (Usually Select all No's)** - - +-----------------------------------------------------------------------+ | **[Life Insurance- MIB App]** | | | | (if they were approved this doesn't mean that they are healthy for | | our standards) | | | | **(if denied, DON'T SUBMIT THE APP)** | | | | - - - - | | | | \*\*\*Life insurance companies will report an MIB code. "Credit | | report for health" the MIB code will sit there for 7 years. If our | | company goes through the process and sees the MIB code they will not | | let it go. It could be obesity, anxiety, heart attack and they told | | the insurance company about that. Even Weight, Height and any other | | possible information. They can be approved by that company but now | | these codes are on their report. | +-----------------------------------------------------------------------+ **PAUSE CRANK WHEEL- check supplemental coverage.** **Un-pause at Medical Questions Page** **Medical questions** So, this is the **most important part to this entire application**. These are the medical questions. Have you ever applied for coverage in the past that was based on your health with medical questions? ***(If they say YES then drill them down. They could have already applied or been on the plan in the past. Let your leader know if Yes)*** Now, please keep one thing in mind, I am your agent, I am not the insurance company, the more I know about you, the better we can write the application to get you approved. **Just so you understand we are in our full right to choose what we want to say and disclose on this application.** Sometimes it\'s better to say No to a question that we could say Yes to. Also, just so you have it ready, the very next page will be whatever bank account that you want to put on file for your monthly premiums to be drafted from on\_\_/\_\_\_/\_\_\_ so make sure you have that ready. The **first question here is in the last 12 months have you been prescribed any medications**? What I am looking for are **things like pain meds, muscle relaxers, ADHD, anxiety, depression, thyroid conditions, liver conditions, heart conditions, prostate conditions**, anything like that? (After prescriptions - START READING DOWN THE LIST) (Give them a recap of how we answered the medical questions.) I'm going to **read you off a long list of diseases, diagnoses & illnesses**. If you don\'t hear anything that stands out to you, don\'t stop me. If you do feel free to interrupt me and we will go into more detail. There are certain things we don\'t necessarily have to draw attention to, like seasonal allergies, or maybe you had asthma as a small child (little thing like that), but there are certain things we absolutely want to address to make the underwriting process a little more seamless. **PAYMENT/BANKING INFORMATION PAGE** - - - - +-----------------------------------------------------------------------+ | **[Credit Card]** | | | | "I thought I can use a credit card" | | | | So unfortunately, they will allow you to put a credit card on file | | but it\'s an 8% service charge, however, **I can't move past this | | screen without putting a routing and account number on file for your | | recurring payments**. This is a highly regulated plan that you have | | to be approved for. Based on being in good health. You don't want | | this policy to accidentally lapse due to a credit card being on file. | | Now remember, you can cancel at any point in time even the day before | | you're billing. You're not obligated to keep this for any specific | | amount of time but they do only accept a routing and account if | | you're planning on keeping this coverage. **GO AHEAD WHEN YOU'RE | | READY!** | +-----------------------------------------------------------------------+ V-CALL SCHEDULE PAGE - - **VERIFICATION CALL PREP** So, lastly, I\'m going to take a few minutes to prepare you for this verification call to make sure that you can get approved. Usually, they call 5 minutes before or after the scheduled time. The call will last 15-20 minutes depending on the verifier. I\'m going to text you their contact information. **(Send Contact Card)**. Be sure to save it to your contacts just to make sure the call goes through. Now, the reason I am saying that is because recently some carriers are blocking unknown numbers. Be sure to also save my number in your phone as well. I am your agent, and you can contact me if you ever have any questions or concerns. **(Confirm client saved the contact card)** Now (Their Name) The first thing they\'re going to do is introduce themselves as **Freedom Life USHealth Group** which is the underwritings department that **United Healthcare** owns. **USHeath Group** is handling your application for **United Healthcare\'s** approval process. They will validate your basic information - name, payment, start date, etc. It is a little bit boring, but hang in there. They\'re also going to verify that I am the licensed agent that you spoke with - (Their Name) Most importantly, they are going to verify those medical questions that we went over in the application. There are a few things I want you to keep in mind\... These verifiers are just following a script. Make sure to keep it simple and short and most importantly, **DO NOT CHANGE YOUR ANSWERS FROM THE APPLICATION. IT WILL RESULT IN YOUR APPLICATION BEING RED FLAGGED AND MOST LIKELY DECLINED.** Remember that we answered NO to all of the medical questions except (and) YES to US citizenship. Are we on the same page with that? **(Listen to their tone in their reply)** **They are not authorized to answer any questions**. If you do have any, just write them down and you can text or call me after. If you do start asking them questions, they will stop the call, and we will have to restart the whole process again. There are a few things they are going to go over with you as well. - - - - - - - **(if they DO NOT have a facility they remember) Look up a local walk-in clinic in their zip code and coach them on saying that for the call. (Google their doctor, they plan on listing to make sure it is not a specialist. You will need to list the facility/doctor in the note box at the very end as well.)** **(WITH POSITIVE ENERGY SAY THIS)** After that call there is nothing more you need to do. I will track everything for you and I will let you know the good news as soon as I get an update. Also, if you know anyone that I could help with health insurance put us in a 3-way text and I will make sure you get a referral bonus when I help them. Do you have any questions for me? Okay great! I enjoyed helping you (Their Name) l Talk soon!