Producer guide - IHC Health Solutions

Underwriting Decisions, continued3. Offer a rating on one or more applicants: An application can be approved with a rating. A rating will increase themonthly premium of the certificate. The minimum rating issued on an applicant is five percent and the maximumis100 percent. Ratings increase in five percent increments. Common medical impairments that usually warrant arating include builds that fall outside the height/weight guidelines and elevated blood pressure.4. Offer a higher deductible: In order to lower the Company’s risk on a certain individual, the underwriter may offerthe applicant coverage with a deductible higher than initially requested. Increasing the deductible may also be a wayto lower a rating and therefore keep premium as low as possible (see the Empowered Underwriting Matrix above).5. Decline the application: In the event that the underwriter feels that more than three exclusionary riders or more thana 100 percent rating are needed, the application will be declined. Certain health conditions will be declined uponreceipt of the application due to the severity of the condition. See the list of “Unacceptable Health Conditions” onpage 8.Please note, coverage cannot be declined if the applicant is a HIPAA-eligible individual in the state of Arizona orTennessee.Requirements to PlacePending RequirementsCorrespondence for pending requirements is sent to the producer. All pending requirements can be viewed on thehttp://thinkihc.iacusa.com Web site. Requirements must be received within 60 days of application date to avoid closingthe case.Exclusionary RidersThe exclusionary rider is faxed to you or is available on the Web site. The rider must be signed by the primary applicantand returned to IAC before the case can be placed in force. A fax copy of the rider is acceptable. Riders are alsoavailable in correspondence on the Web site. The rider must be signed and returned or verbally accepted on IAC’srecorded phone line within 15 days.Premium RatingIf the case is rated, the applicant must accept the premium rating. Coverage can be placed inforce once acceptance isgiven and if 85 percent of the required standard premium has been paid. Any premium shortages due to a rating arebalance billed to the insured. An amendment must be signed by the primary insured.Producer Kit/Delivery CertificateAll issued certificates and ID cards are mailed to the insured. Any outstanding delivery requirements must be completedand returned within 30 days of the date they were mailed.Effective Dates and BillingEffective DatesThe applicant may request a plan effective date of either the 1st or 15th of the month. IAC must receive the applicationfor insurance on or before the requested effective date. IAC will honor the effective date requested if they can approvethe application within 15 days of the requested date.If the applicant is replacing coverage, it may be in his/her best interest to elect an effective date of the 1st of the monthfollowing approval and keep his/her current coverage in force until notice of approval is received. Please note: Arequested effective date cannot be changed once the certificate is issued. You have up to 60 days to submit allunderwriting requirements based on the date the application was signed. After 60 days, the case will be closed out.*** Never advise an applicant to cancel existing health coverage until the company’s coveragehas been approved by underwriting and accepted by the client.***15