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By Tim Jarvis
Before the advent of the Internet and electronic communications, Texas health insurance applicants would submit paper applications and then learn that a health condition resulted in the application being declined. The process from application submittal to declination would sometimes take as many as 45 days and could involve the applicant providing medical records to the carrier which was costly and contributed to the delayed decision. Although the applicant had access to the carrier’s underwriting guidelines, the guidelines did not address all of the conditions to which the applicant is subject to and outline allowances for varying degrees of a condition. Poor information created delays and additional expense in the application process.
Once carriers moved to Internet based applications and employed electronic communications, either through email or online submission, a Trial Underwriting Inquiry system became feasible. What Texas health carriers wanted to provide was the ability for the licensed agent to submit preliminary information which underwriters could use to determine if an application should be submitted. The goal was to reduce the number of applications that would be declined, which would also reduce the amount of underwriting resources needed for applications that should not have been submitted in the first place. The additional goal was to save the applicant time by dealing with carriers that would be more flexible in reviewing an application given the health history that would be disclosed. As carriers moved to the Trial Underwriting Inquiry system, the practice provided applicants with a more accurate assessment of how the application would be evaluated.
In order to submit a Trial Underwriting Inquiry, a licensed Texas health agent provides basic information to the insurance carrier. The amount of detailed information varies by carrier, but typically the information will include the condition that the inquiry will address, the applicant’s age, height, weight, diagnosis date, recent treatment history of the condition, and prescriptions. Carriers will sometimes ask what health insurance plan will be applied for and the level of prescription benefit. The requested information is transmitted to the carrier electronically, and a response can be expected with 48 hours.
Carriers will provide one of several responses: (1) application will most likely be declined; (2) application will be subject to rate adjustment; (3) application will be subject to a rider of benefits related to the condition; (4) application will require complete medical records; or (5) any combination of two through four.
A positive decision on the Trial Underwriting Inquiry will help expedite the health insurance application. Case numbers are assigned to the inquiry and once the application is submitted underwriters will review the case in order to establish what will be required to complete the underwriting review of the application. Also, if the Trial Underwriting Inquiry results in a favorable decision, the applicant can contact the physician and make the physician aware that a request for medical records will be forthcoming from the carrier. The applicant will not need to request medical records, because that is the responsibility of the carrier; but by alerting the physician, the medical records can be ready when the request is made.
Trial Underwriting Inquiries are a valuable tool when the agent and applicant are trying to determine the best course of action for the application. When a significant health event may result in a declination, it is advisable that applications be submitted to multiple carriers. The Trial Underwriting Inquiry helps focus efforts on carriers that have the highest probability of approving the application and reaching a decision in a timely manner.
About the Author: Texas Jarvis is a licensed
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agent with extensive experience regarding Individual Texas health insurance plans.
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Source:
isnare.com
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