Featured in the Shopper

The Shopper is a local paper that features businesses in the area so the community can learn more about who they are and what they do. I recently had a feature article in the paper. Of course you can read the About Paula page, but this article gives you even more insight as to what makes P Q Wallace Insurance Consultants different from other insurance companies and how I came to be an insurance agent. Click on the image below to enlarge the document so you can read it. Or you can download the PDF file.

shopper article

Recognition from United Health

It is an honor indeed, to have United Healthcare recognize me as a level 2, “Authorized to Offer” agent.  Every “A2O” agent is required to meet rigorous criteria to become “Authorized to Offer” status.  Even though I pride myself on being a professional to all my clients and the insurance companies that I represent, it is this particular company who recognizes that professionalism.  In order to qualify for this I had to meet certain standards and ethics.  Some of these include:

  • Demonstrated competency and experience requirements
  • Commitment to community service
  • Required agent training on product, ethics and needs analysis, as well as regulatory training requirements
  • State licensure
  • Annual disciplinary history and background check review, including third-party credit and criminal checks

I must:

  • Requalify every year
  • Sign a code of Ethics
  • Protect consumers through required Errors and Omissions insurance
  • Not engage in door-to-door marketing or cold calling
  • Meet with you in the place of your choice
  • Place you with the best product for you.  I am commission “neutral” meaning I don’t push you to a product that pays me the most.
  • Give you a clear explanation of who you are doing business with
  • Clarify all consumer disclosures and provide you with the limitations and exclusions of product

It is important to you because an “Authorized to Offer” agent:

  1. Can provide you with personalized service and can assist in finding solutions to fit your needs.
  2. Can address the complexity of many of the insurance and financial products you may need in order to have protection and a sense of security.
  3. Can meet with you in-person to address your specific questions and concerns and can lead to a more thorough understanding of how the solution addresses your unique needs.

You can expect me to be a trusted professional and practice four core principles:

  1. Approach every interaction with integrity
  2. Put client needs first
  3. Be an expert and stay informed
  4. Display a commitment to the community.

For further information, please refer to the official Introducing “Authorized to Offer” Local Agents brochure (You will need Adobe Reader installed on your computer to view this document. Adobe Reader is available for free here.)

Original Medicare Benefit Coverage

What is the difference between a Medicare Supplement policy and a Medicare Advantage policy?

They both are meant to enhance Original Medicare (Part A and Part B) benefit coverage. However, they are distinctly different and can not be interchanged.

A Medicare Supplement (also known as a Medigap policy) is purchased for a premium from a private insurance company. The plans are standardized and a good plan (such as Plan F) will basically cover all medical expenses that are not covered by Original Medicare.

Medicare Advantage Plans (also known as Medicare Part C), are plans that are contracted with the Center for Medicare and Medicaid (CMS). You enroll in a specific plan managed by an insurance company. That plans then is responsible for paying for your medical expenses. You are responsible for co-pays and co-insurance.

These plans have to be ,by law, be as good as or better than Original Medicare. They may include extra benefits such as a built in prescription drug plan and discounts on medical related services

Medicare Prescription Plan

What is a Medicare Prescription Plan and how do I get one?

Medicare Prescription Drug Plans (also known as Medicare Part D and PDPs) are generally highly recommended if you have Medicare and no other creditable prescription drug coverage. To get Medicare Drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. Sometimes a PDP is included in your Medicare Advantage Plan at no additional cost. These plans are called “MA-PDs”.

Medicare Advantage Plans

What is the difference between PFFS, PPos and HMOs in the Medicare Advantage Plans?

PFFS is a private fee for service plan. There is no contract between the medical provider and the insurance company other than the underling Medicare rules. You can use any provider who accepts Original Medicare payment, who is willing to treat you and accepts the plan’s terms and conditions. The provider can decide on a patient-by-patient, and a visit-by-visit basis at the time of service whether to treat you. Emergencies are an exception to these guidelines.

PPOs are Preferred Provider Organizations. There are contracted with certain medical providers and prefer that you use them. However, you may go outside of the provider list and still have coverage without a referral. This however, may result in additional costs for you.

HMO’s are Health Maintenance Organizations. The insurance companies restrict you choice of providers to those they have contracted with. In addition, a referral from your primary care physician is generally required.

Donut Hole

The Donut Hole, also known as the Medicare Part D coverage gap, can be very stressful (read expensive.) However, it is better this year (2012) than before. All approved Medicare Part D plans allow only a limited amount of benefits each year. In 2012, when you and your insurance company have spent $2,930 on drug costs, you end up paying for prescriptions out of your pocket. Starting this year, when and if you reach this gap, you receive a 50% discount on most brand name drugs and a 14% discount on generic drugs.

As always, after you’ve spent a certain amount for prescriptions out-of-pocket ($4,700 in 2012), catastrophic coverage starts and you only pay 5% of your prescription cost for the rest of the year.

This year, the 50% discounts are applied to your out-of-pocket totals, so it may be faster to get through the donut hole.

Also, Prescription Drug plans can change significantly from year to year. It is a wise idea to shop for the best plan for you each October/November. For more information or help, call your agent or visit www.Medicare.gov.

Caution – Old Universal Life Policies

Being an insurance agent, I try to help people, not scare them. However, sometimes we have to face some unpleasant realities. Most evident is that each and every one of us will die at some point. That is why we buy life insurance to financially protect those we love. Another reality is that maybe even if we bought life insurance at one point, that policy may be failing to do what we wanted it to do. This is especially true of Universal Life policies that were purchased in the 1980’s. Many reputable insurance companies sold policies to consumers who may have been mislead (or did not fully understand how UL policies worked.) These policies were sold as permanent policies, (not term). They may have been misrepresented as policies with “vanishing premiums” or “wealth generating”. These are interest dependent policies and provide a death benefit only as long as there is cash value in the policy. Interest rates have dropped significantly from those of the 1980’s, yet the internal cost of insurance goes up as the insured ages. The policy can run out of money (fail). Unfortunately, this has happened to many people and is continuing to cause much consternation to unsuspecting life insurance owners.

Your insurance company is required to send you an annual report on your policy. They are keeping you informed. But what I see in the “real world”, is that the majority of people do not read the statements, and even if they do, they do not fully comprehend them. This can lead to a lot of heartache. Please, do yourself and your loved ones a favor. Call me for a no obligation consultation about your policies. I will be happy to review them and try to help.


Long Term Care Policies…How Do They Pay?

To say that there are many variable options in Long Term Care insurance (LTCi) is a gross understatement. With this blog, I will attempt to explain the differences between a reimbursement type, indemnity, or cash plan.

Essentially, no LTCi policy will pay until the beneficiary meets the basic criteria of not being able to perform at least 2 of the 6 activities of daily living (ADLs) or suffering from a cognitive impairment. Then, typically a waiting period has to be met. If I’ve lost you there, please give me a call and we will start with the basics.

However, once benefits are triggered and payments begin, the money starts flowing different ways depending on your specific policy. One of the more common types is a reimbursement policy. You have purchased a “pool of money” that can be used to pay for care and other qualifying expenses. For example, Mr. Jones needs a home health care aide to come in for 4 hours per day to help him get up, toileted, bathed, dressed and fed first thing in the morning. The home health care agency bills him at $15 per hour or $60 for that time period. Even though his policy covers home health care up to $100 per day, he will be reimbursed the cost of care, $60. Please note that some policies offer a daily maximum benefit, some offer a weekly maximum while others offer a monthly maximum benefit.

If Mr. Jones had an indemnity policy, and Mr. Jones had $60 in qualified expenses that day, his policy would pay out the full $100. However, if Mr. Jones does not need care on Saturday because his daughter can help out, there is no benefit paid for Saturday.

With a cash type policy, once Mr. Jones has been certified as suffering the loss of 2 of 6 ADL’s or that he has a cognitive impairment and has satisfied any elimination (waiting) period, he would receive $100 each day or in the case of a monthly benefit, $3,000 each month regardless of whether any money was spent for care or not. The big advantage of a cash plan is that it is the least restrictive and most flexible and can provide benefit dollars to help cover expenses not normally covered by traditional LTCi.


What is “LUTCF”?

People often ask me, “What are those initials behind your name?”

I proudly add LUTCF after my name. It is an acronym for Life Underwriting and Training Course Fellow. It is a professional designation conferred only upon those individuals who meet or exceed the exacting qualification standards determined by the two organizations that jointly sponsor the designation, The American College and the National Association of Insurance and Financial Advisors (NAIFA).

According to them, the designation marks an agent’s long-term commitment to professionalism on behalf of clients, establishes the agent’s competence and business experience, marks a commitment to The American College’s and NAIFA’s Code of Ethics and fosters additional professional development.

A Fellow has successfully completed five courses of the curriculum, in addition to an Ethics Course and be a member in good standing of NAIFA.