Richard L. Lungen
August, 2010

In the wake of healthcare reform, agents are under more pressure to generate value and transparency for their clients. One thing is clear: revenue will be curtailed with the onset of local exchanges as well as cost and medical-loss ratio requirements that are being imposed on carriers. Agents will have to work harder than ever to keep customers engaged and maintain their own revenue streams.

The situation is further exacerbated by recent trends, such as increased competition in the individual health insurance market, more insurers in the market, shrinking margins and opportunities, cost cutting among carriers, and more products with a broader range of prices. Agents who survive and thrive in the coming years will be those who provide exceptional, well-researched and backed options, as well as superior customer service.

Limited Liability to the Rescue
Guaranteed issue limited liability medical insurance is one of the best low-risk products in the market. It’s excellent for people who don’t qualify for individual major medical coverage or are priced out of the market. Limited liability medical insurance offers the following advantages:

• No declines.
  
• Immediate coverage – consumers can go the doctor or other medical provider the day they sign up.
  
• Low cost.
  
• Choice due to product options.
  
• Access through a national network of providers, a team of medical advocates, and tele-health programs.
  
• Web and telephone sales and ancillary services such as Rx, and tele-health.
  
• Rich commissions.
  
• Penetration into a previously underserved market.
  
  Limited liability can serve businesses of all sizes as well as the self-employed and individuals. Limited liability, which provides best-in-class services, seems suited to deliver the greatest health benefit to the estimated 47 million people who are underinsured or unemployed in the United States.
  The ideal candidate for limited liability is someone who isn’t eligible for medical coverage or works part-time. Virtually all employers have some employees who fit this category. Limited liability also can be a great complement to a high-deductible plan for those who do not have adequate health insurance or those who are burdened with high deductibles or out-of-pocket expenses.
  Individuals who choose limited liability, through the right provider, can expect access to greater health coverage. Coverage has been simplified so that it’s easy to understand the purchase, the options, the appointment process, the communications, and the use of the plan. The simple and direct operations side of limited liability can be customized based on volume. For brokers, it provides innovation and tremendous growth opportunity.

What to Look For in Limited Liability
A typical limited liability program should include the following key features:

• Membership and insurance benefits to people from 18 to 64 with coverage terminating at 65.
  
• Guaranteed issue for members and their spouses age 18 to 64 and dependent children to age 19. Also guaranteed for children up to 25 if attending an accredited school full-time.
  
• $1 million lifetime maximum per covered person.
  
• U.S. Citizenship not required, only U.S. residency for 12 consecutive months.
  
• In-hospital daily indemnity of $500, $750, $1,000, or $1,500.
  
• Surgery, anesthesia, lab, X-ray, wellness, emergency department, and ambulance benefits.
  
• Doctor office visits with a choice of $25, $50, or $75 per-visit benefit.
  
• Doctor’s office wellness visit with a choice of $50 or $75 for one visit benefit.
  
• $2,000 accidental injury medical benefit.
  
• $10,000 accidental death and dismemberment.
  
  The program should also include lifestyle benefits with a focus on wellness, often including gym memberships, vitamin discounts, hearing services, and weight-loss programs. Some forward thinking programs bundle in travel service discounts, car rental discounts, and shopping discounts at no extra charge.

Finding a Limited Liability Provider
The simplest way for agents to start offering limited liability is to find a top healthcare assistance provider. Similar to big box retail shopping clubs, these providers offer convenient and cost-effective options for healthcare services. They offer insured and discounted programs through a private network of dentists, physicians, pharmacies, and other healthcare professionals. Nobody is excluded, including non-citizens or those with pre-existing conditions.

It’s important to find a healthcare assistance provider that’s backed by companies that are experienced in the insured, limited liability, and discounted healthcare markets. A private label, custom healthcare program not only works with large employers, but can also provide care and attention to your individual customers through a healthcare advocate. Look for a provider that has assembled best practice companies into a single platform and offers the following:

• A pharmacy benefit card with discounts and tiered co-pay programs.
  
• Competitive premiums: limited liability and short-term medical as well as hospitalization coverage, discount dental, telemedicine, and medical tourism.
  
• Programs that include guaranteed issue, price transparency, immediate coverage, and no declines.
  
• Bilingual/multi-lingual advocacy and customer support.
  
• Telemedicine: telephone calls from board certified licensed physicians that eliminate wait
  times for office visits and reduce costly emergency-room visits.

Going Forward
As the gears of healthcare reform are being set in motion, it’s more important than ever for employers, groups, associations, and individuals to gain access to affordable and comprehensive medical care. High quality healthcare products and services improve health and welfare and address long-term health reform goals, such as greater health and financial sustainability for everyone.

Limited liability is a medical insurance option designed for people who would otherwise fall through the cracks. Plus, it serves as a boon for agents looking to distinguish themselves during tough times.

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Richard L. Lungen is president of National Health Options. Following 16 years of leadership in managed care, life & health insurance, and overall healthcare service industries, Lungen co-founded National Health Options (www.nationalhealthoptions.com), the first healthcare assistance program of its kind designed to offer an affordable, accessible, and comprehensive coverage solution for Americans, employers, groups and associations including an estimated 47 million people who are under-insured.