Claims – Make Sure You Know

Last week on Coffee Break, we shared a few pieces of information with you. Elaine Marvin discussed the history and timeline of Care Solutions.  Niki Johnson shared the underwriting requirements for the Annuity Care products.  And, Jen Wagoner examined claims being paid daily versus monthly.

In Jen’s segment, she discussed claims paying by focusing on daily benefits versus monthly benefits.  This is something that you need to pay attention to.  It could dramatically impact your client’s claims experience and lead to a headache for not just them, but you as well.

In Jen’s example, she examined a client with a $100 per day benefit and a client with a $3,000 per month benefit.  On the surface, you might say what’s the difference – they are both 30 days of benefits.

That might be a fact, but a daily benefit only pays up to that daily benefit amount and only on the days that services were received.

Using an example where 15 days of care are provided during the course of the month at a daily cost of $200/day, only $1,500 of benefits would be received.  That same case using a monthly benefit would result in benefits paid of $3,000. Multiply that forward by 3 months and you have a pretty significant amount of money that has to be paid out-of-pocket for care.

So, when you are considering a policy for your client, look at how those benefits are paid. 

Most carriers that use this methodology display a monthly benefit on their illustrations.  Only after digging into the footnotes and description pages, you find that the benefits paid are daily.

Do yourself and your clients’ a huge favor – make sure that they are getting what they think they are getting.  And, if you need a hand in determining how a benefit is paid (daily or monthly)  – feel free to give me a shout.

For more information, contact either my internal Justin Fox or me.

Justin Fox               justinfox.isp@oneamerica.com                (844) 658-3725

Kevin Fisher               kevin.fisher@oneamerica.com                  (678) 512-9627

And – as always – thanks for taking a few minutes for me.