If you are looking for an idea that can capture the attention of employers, consider helping them provide employees the means to bridge the gaps in their medical plan. I have identified five distinct gaps that, if addressed, can create a huge sales opportunity for group health agents.


1) Employee perception gaps

Consider your last 10 sales. What strategies were implemented to control costs? My guess is that in 70% of those cases the employer increased deductibles and coinsurance, utilized an HSA or shifted premiums to the employees. In those cases employee morale was negatively impacted. Any time that employees feel that they are losing benefits they become less enthusiastic about the employer. While you can use an employer-paid critical illness policy to bridge the gap, there are other inexpensive ways to offset the negative impact of increased out-of-pocket exposure or loss of benefits.


2) Navigating the system

Imagine an employee or dependent that was just diagnosed with multiple sclerosis. Their world has been turned upside down and they are likely feeling confused and overwhelmed. They want to get a better understanding of what the diagnosis means, and what options are available to them beyond what the physician has suggested. Perhaps they have a dependent that needs end-of-life care and they do not know where to begin. How great would it be if you could help the employer provide a health care advocate who could help the employee navigate the health care system?


3) Insurance company dealings

Consider the employee who just had a claim denied or who just had a procedure deemed "not covered." Who is there to help that employee negotiate with the insurance company? Certainly as an agent you lack the medical knowledge to advocate for that insured. The health advocate can be there for the employee.


4) The financial gaps

The obvious financial gaps are the deductibles and coinsurance inherent in any medical plan. In a one-time medical crisis such as an appendectomy or hernia repair, the out-of-pocket costs may be an inconvenience, but they are not financially catastrophic. But when a critical illness occurs, these same costs become just one piece of a financial catastrophe. In addition to the normal out-of-pocket costs there is the loss of income on the part of the patient, as well as the spouse or parent of the patient. There may be travel expenses, child care expenses and more. And then there is the potential of incurring those out-of-pocket costs two years in a row. These gaps can be bridged by offering a critical illness policy, a cancer insurance policy, a hospital indemnity product or even a medical gap policy. Agents may be tempted to ignore these products, thinking that the incumbent may have talked with the employer, but that is almost never the case. Just look at your own clients to see how few of them have dealt with this issue. Certainly in every account that I am in the group medical agent has not talked with his client about this issue.


5) The income gap

The financial gaps discussed above are complicated by the income gap in two distinct forms. Of course there is the loss of income when an employee cannot work due to an accident or illness. In this case having a disability income policy can replace that lost income. But disability income does not replace income lost due to becoming a caregiver or simply being by the side of a loved one. When income is lost it is not just the out-of-pocket costs associated with the health plan that become an issue. Now, in addition to those out-of-pocket costs, the employee must deal with the following financial issues: the need to pay COBRA premiums, rent or mortgage payments, child care expenses, and much more.

When you combine the financial gaps inherent in the medical plans with the loss of income it then becomes easy to understand why 62% of all bankruptcies are related to a medical event.

Reach Schlesinger, RHU, REBC, through email at mel@melschlesinger.com.

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