Case Histories
The Individual Plan Used in a Group ApplicationCase #1
A towing company in MINNESOTA with 10 participants was looking for a more cost effective employee benefits plan.
The owner told me she paid 100% of the cost, but at current rates she couldn't afford them any longer. The Magnum plan fit her price range and is available in Minnesota.
She understood the pre-existing condition clause, which is applicable on an individual product. This clause meant that for one year people couldn't submit claims for pre-existing conditions, but for the difference in price, and specifically because of the “Accidental Medical Benefit”, Magnum gave her the peace of mind she needed.
Case #2
A towing company in CALIFORNIA and their sister company, an auto parts store, was located in a small town, off the heavily traveled highways. They had never had benefits because of the high cost. Again, the owner was used to paying 100% of the costs.
They asked if the two different businesses were eligible. Because both businesses were owned by the same person, and both were in roadside assistance (auto parts stores sell to the industry) they were both eligible. Both the group and individual plans are available in California, but again, it was the price range, and the “Accidental Medical Benefit” that appealed to the group. They also had some participants who wanted dental. So all participants opted for Magnum, and only some chose to include dental.
When asked about the pre-existing condition clause, and how it would apply to a diabetic, the answer I gave was:
“Since diabetes was a pre-existing condition, the participant would not be allowed to submit medical claims related to this condition for one year, however, since the prescription benefit was not an “insured” benefit, only a discounted benefit at the point of sale, the exclusion didn't apply to prescriptions.”
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