Disability Insurance Demystified: What Every Physician Needs to Know

Lawrence Keller: But I think what a lot of residents and fellows do not understand are one of these common things that are going to cause a modification, a rating, or a decline. And once we understand that, you will quickly realize how important what we are talking about is and why you really need to, first things first, be sure if there is a GSI program available at your institution.

Welcome to Finance for Physicians, the show where we help physicians like you use money as a tool to live a great life. I’m your host, Daniel Wrenne, and I’ve spent the last decade advising physicians on their personal finances with the mission to help them understand that taking control of their finances now means creating a future where they can practice medicine where, when, and how long they want to.

Daniel Wrenne: Larry, what’s going on, man? It’s been a long time.

Lawrence Keller: It’s been too long.

Daniel Wrenne: I know.

Lawrence Keller: I think that was one of your early guests on the podcast. 

Daniel Wrenne: I think you might’ve been like one, two, or three. I can’t remember, but we’re back with lots of updates. There’s a lot of—we were catching up before we hit record, but there’s a lot of stuff brewing in the world of disability insurance in particular for physicians.

And I think a lot of it, I wasn’t even aware of, and I’m sure a lot of you guys listening are not aware of these big potential, we’ll call them landmines, I guess, that are brewing in the disability world, that’s what we’re going to get into today is some of these important need to knows in regards to disability insurance in particular for physicians.

So Larry, I’m sure a lot of you guys listening know Larry. But for those that don’t, he is the man when it comes to physician disability insurance. How many year, veteran? 

Lawrence Keller: 34 years.

Daniel Wrenne: 34 years. All right.

Lawrence Keller: Yep. 34 years as of August. So…

Daniel Wrenne: Nice.

Lawrence Keller: Thank God, you know what they say, right? You know, in the insurance world, unlike medical school, if you took your average class size of a hundred.

We know probably 95% of them are going to graduate and get their MD or DO, and they’re going to go on to practice or go into the private sector. In the insurance world or financial planning world, believe it or not, in that same hundred, within the same four years as medical school, the dropout rate is 89%.

So 11 will remain standing, so very, very interesting, unlike when you’re growing up, and most of you that are listening to this probably remember having a white coat on or a plastic stethoscope around your neck, and you had this epiphany of, I want to be a healer or a physician or a surgeon, and this is what I need to do to make it happen.

Unfortunately, that really doesn’t happen in our industry. Most of the time it’s either by accident, which was my story. Or someone brings you in and they mentor you and they help you grow. And that’s basically how you get into the insurance or financial planning industry.

Daniel Wrenne: Yeah. And he’s worked with about a zillion physicians. I’m sure it’s thousands, right? Physicians.

Lawrence Keller: Yeah. It’s thousands across the country, all walks. Med students, residents, fellows, practicing those that are retiring, those that have left the clinical practice to go work as medical directors or big pharma, so I can’t say I’ve seen it all, but I will say I’ve probably seen most.

Daniel Wrenne: Yeah. So he knows a lot of the intricacies within, I don’t know if anybody’s listening has read through a disability insurance policy. If you have, kind of what I’m talking about. You probably fell asleep while you were reading it, but there’s a ton of legalese within those contracts. And there’s a lot of stuff, you got to read it like 15 times to kind of get it. But Larry knows that by heart. So.

Lawrence Keller: I try to live in the minutiae, you know, like when you first come into the industry. You know, it’s really all about, they tell us, like, sell the need why someone should have disability insurance. And I was like that for the early part of my career, the first couple of years.

And then I said, you know what? I don’t want to be the guy that sells the need. That’s for, you know, a younger, newer agent. I want to be the person that helps the physician that knows that they need it, find as close to the ideal solution based on their individual needs, goals, budget, and philosophy. So I live in the weeds, you might say.

Daniel Wrenne: Well, so we were getting into it a little bit before we, like I said, before we started to record, but maybe we could back up a little bit and start with some of this stuff. We were getting into what’s called Guaranteed Issue Disability Insurance. So maybe Larry, for starters, you could explain what Guaranteed Issue is versus like the individual policy versus group policies.

Lawrence Keller: Yeah, so what we’ll find is, if we look at Guaranteed Standard Issue or we love acronyms in insurance. It’s just not only for you guys in medicine and the military and the VA hospital, just stands for Guaranteed Standard Issue or GSI. And the first thing to know is that this is the same individual disability insurance policy that you would go out and buy in the open market. The big difference is generally there is either no medical underwriting or there’s going to be what’s known as gatekeeper questions or a couple of knockout questions.

Other than that, if you’re looking at what’s called a fully underwritten policy, this is where you’re going to answer medical questions. The insurance company behind the scenes is going to do a prescription drug check. They can go ahead and they can request a copy of your medical records.

There’s a HIPAA compliant medical authorization in the application, and based on what the underwriter, the person reviewing you as a risk, sees, whether it is medical, whether it’s financial, whether it’s hazardous activities that you might participate in, they can come back and either decline you and say, “We’re sorry. Based on what we’re seeing here, we’re unable to offer coverage for any number of reasons.” They can come back and say, “Well, Daniel, we can offer coverage to you, but we’re going to have to modify your policy, and we’re going to exclude or not pay benefits for either specific body parts or specific medical conditions that you might have.”

And these exclusion riders are written in a very broad manner, so much to the point that you might say, wow, this is really broad. Like, I went scuba diving and I got some foreign matter in my right ring finger, and I’m a surgeon, and they want to exclude my right hand. Well, we’re always going to look for a causal or a contributory relationship.

So, let’s say you did have an exclusion rider on your policy. We’re going to say, did having that foreign matter in your hand as a result of your scuba diving, did that cause or contribute to your disability? And if the answer is, well, yes, it did, that exclusion rider is going to be upheld, and that claim would not be paid.

If it did not, I was in a car accident, I was rear-ended, and my ligaments were shattered, and I could no longer work as, say, a general surgeon. Well, having that foreign matter in your right ring finger is not going to have caused or contributed to that disability and that claim would actually be paid.

Daniel Wrenne: So individual is going to have these exclusion riders, modifications, and it’s not going to be guaranteed standard issue is going to be boilerplate, like boilerplate isn’t—it’s got the same sort of chassis as an individual policy, but it’s just going to be, like, approve or not approve.

And then the individual policies are going to be like approve, modified with, your example of the hand exclusion, or declined, right?

Lawrence Keller: Yes. And what you’ll find is a lot of people think a GSI plan or a GSI program, is its own type of insurance, and it’s not. It’s the same individual policy that you would purchase, it just removes the medical underwriting component of the process.

Daniel Wrenne: Is there any other differences between guaranteed standard issue and individual policies?

Lawrence Keller: For the most part, the only real differences are depending upon the insurance company. And the big players currently in the individual GSI marketplace are Berkshire, which is a Guardian company, you can use those interchangeably, Standard Insurance Company, Ameritas, to a much larger extent, MassMutual, used to be much larger, now they’re down to a handful of hospitals.

And what they’ll do is they will structure the GSI plan and how it looks. So there are going to be some parameters that are really pre-done. That’s usually going to have a 24-month limitation for claims resulting from mental or nervous conditions. So when I say mental nervous conditions, I think, at least I like to think the way I probably should as an insurance agent, right?

Anxiety, depression, stress, chemical dependency, drug addiction, burnout, anything in the DSM.

Daniel Wrenne: That’s a pretty standard thing on a lot of policy, like individual or guaranteed and standard issue. There’s a pretty fair amount of policies. Maybe probably the majority, I don’t know for sure, but the majority I see have 24-month exclusion.

Lawrence Keller: Yes. It’s usually going to be either 24 months over your lifetime, or it’s going to be 24 months per episode of disability, and that can vary by company, or that can vary by state of residence. Most companies, depending upon your state of residence or your medical specialty, they might even make available to you outside of a GSI plan a choice.

Well, Daniel, built into the policy is a 24-month limitation. If you’d like to remove the limitation, you can basically forfeit the discount and you can have unlimited coverage. Or we might say it comes unlimited, not a GSI plan. And if you’d like to add a limitation for a discount, we can do that as well.

But the GSI plans really do include that 24-month limitation as part of the structure or the plan parameters.

Daniel Wrenne: Are there discounts sometimes on the guaranteed standard issue?

Lawrence Keller: There’s always discounts and you’re going to find—

Daniel Wrenne: That’s just kind of a dependent upon, like, maybe your, your individual policy could have discounts as well and Guaranteed Standard Issue could.

Lawrence Keller: Yeah. Well, remember, this is still the same individual policy. So you’re going to find—

Daniel Wrenne: So the discounts are not affected by the guaranteed standard issue, I guess. Is that what you’re saying? 

Lawrence Keller: No. Not at all. Not at all. 

Daniel Wrenne: Okay. Yeah. That makes sense.

Lawrence Keller: The other thing that you’ll find is the benefit amount is going to be limited. 

Daniel Wrenne: Okay.

Lawrence Keller: And plans are now getting more aligned with each other, but some of them, like in Ameritas GSI plan, I saw them with an all-in maximum monthly benefit of $6,000, all the way up to $15,000.

Guardian’s GSI plans go to $15,000. You’ll find Standard’s GSI plans go to $15,000. MassMutual is generally a lower amount. The ones that I’m aware of are $7,500, but just know it’s not the same as a fully underwritten plan where it’ll go up to $20,000 or $30,000.

You can actually combine, assuming you’re eligible and you qualify, and let’s say the reason you’re buying the GSI plan is either simplicity, it’s a fast track to get insurance.

Or you’re going to get an exclusion rider. Let’s say you’re an orthopedic surgeon, you had surgery on your right shoulder and there’s some hardware in there, and that’s going to be a permanent exclusion as a result of that surgery. And you don’t really want to be limited to $15,000.

You can buy two policies from the same company. One’s a GSI with no exclusion rider and then the other one would be fully underwritten with an exclusion rider. Odds are pretty good. You would want to maximize the increase option and get to that $15,000 without the exclusion rider first, and then you could circle back and increase your fully underwritten policy.

So, let’s say that $30,000 a month is your maximum. And I will mention this, a lot of physicians are unaware that if you have no other coverage at all, in order to reach $30,000 a month, your net income, so if you’re self-employed, it’s after expenses before taxes. If you’re an employee of an institution, it’s going to be typically box five on your W-2 plus whatever moonlighting income you might have.

Daniel Wrenne: Which one? 

Lawrence Keller: You got to be earning about—

Daniel Wrenne: Federal wages.

Lawrence Keller: Yeah, you gotta be, you gotta be earning about a million and a quarter to get there. 

Daniel Wrenne: So to max out disability at $30,000 a month, you gotta be earning one and a quarter million a year.

Lawrence Keller: Yeah. And that assumes you’ve got no other coverage at all. So certain medical specialties, which are known to be on the low-income side, you know, sometimes they’ll raise this concern to $15,000 a month.

I was talking to this other agent, you know, and he or she says that $30,000 a month is the magic number. And I’m like, let me ask you before we get there, what do you think your maximum income potential is?

Daniel Wrenne: Yeah.

Lawrence Keller: And it’s not even remotely close.

Daniel Wrenne: Right. Does the guaranteed standard issue, they no longer have sex-neutral rates, right?

Lawrence Keller: Well, gender-neutral rates are interesting. So in Ameritas, in a handful of states, still offers that. 

Daniel Wrenne: And that’s through the Guaranteed Standard Issue? 

Lawrence Keller: Yes, only for the guarantees. 

Daniel Wrenne: So that’s important because that’s a special type of, especially for females, they basically make the rates the same for male and female, and so normally, when you just buy it on the market individually, females’ rates are a lot higher than male. And so, with this sex-neutral or gender-equal rates, it’s going to be considerably lower for females just as a result of buying it through Guaranteed Standard Issue.

Lawrence Keller: Yes, and what you’ll find is in the Ameritas world, it’s a handful of states that are still using the old product.

For Standard Insurance Company, there are three institutions, where there still are unisex rates on their GSI offerings. All the other ones are now gender distinct. And then all of the Guardian GSI plans are gender distinct. So you can make an argument if someone is really price conscious, especially your female physicians, if they’re fortunate enough to find a unisex rate, they can literally save somewhere between 50% to 60% off of the normal female rates. So you’re 100% right there.

Daniel Wrenne: Right. Okay. So why is this a big deal? I think that would, if I’m listening, I’m thinking, well, what’s the big deal? Because I was kind of teasing out, like, this is a big deal at the beginning. The reason this is a big deal, this whole Guaranteed Standard Issue thing, is because a very large amount of people have modifications, like Larry explained the hand example, like, a pretty large amount of people we work with. We see a lot of disability policies as financial planners.

There’s a large amount of people that have those modifications, whereas, like, your back’s excluded or your hand’s excluded or whatever. And, or even some of them are declined. And so when you have that modification, or especially if you’re declined and you had access to Guaranteed Standard Issue and you didn’t know it, that’s a major problem.

Say you have a hand exclusion, you get disabled. They don’t pay because it was related to the hand thing. And you all along had a guaranteed standard issue program in your hospital. And you didn’t even know it. That’s, like, millions of dollars we’re talking about there. They could be in play, and no one wants an exclusion if they don’t have to have one.

It’s never a good thing to have an exclusion if you can avoid it. And so guaranteed standard issue is a big deal because it can potentially allow you to avoid exclusion or even declines, individually speaking.

So it should be something you’re always, I mean, especially before you get coverage and even after you get coverage, be something that’s on the radar as far as like, I wonder if I have a guaranteed standard issue available. But then the question is, like, well, how do I know? I mean, well, first of all, did I break that down correctly there? 

Lawrence Keller: Yeah. So I would say the first thing, if you’re looking for disability insurance, or you’re even remotely thinking about disability insurance, whether you know you have a medical history or you don’t know you have a medical history, you really have to make sure that you remain eligible for a GSI program.

So general rule is if you apply for a medically underwritten or fully underwritten policy, like what Daniel and I described, you’re answering medical questions, prescription drug check, they’re getting your copy of your medical records. If you are declined, if you are offered a modified policy with an exclusion rider, a rating, which is a fancy terminology for an additional like substandard premium charge, in some cases, if you put an application in, and let’s say I’m dealing with one of Daniel’s clients and we’re talking and I say, Daniel, look, you know, this person is going to get this, this, and this, I think I really should pull their application.

Removing an application or withdrawing an application from the medical underwriting process can, in and of itself, make someone ineligible for a GSI plan. Now, there’s a couple of very specific rules. So, current date, Standard Insurance Company. If you’re declined by another company, you are ineligible, but if you are offered a modified policy or a rating or some other modification, that is still in play.

Ameritas, if you’re declined, modified, rated, withdraw a pending application, even if you applied to Ameritas, the GSI plan is no longer on the table. Guardian has some very unique rules. So number one is if you apply to Guardian on a medically underwritten basis, currently they will still accept you even if you were declined, offered a modified policy, withdrew a pending application. As long as you went there and you didn’t go to a company besides Guardian, you are still eligible.

So you can apply safely to Guardian on a medically underwritten basis, and the GSI is still available. So if you’re not sure, you’re like, I’m not sure what’s in my medical records.

Daniel Wrenne: That’s kind of confusing. That’s a lot of moving parts. 

Lawrence Keller: Yeah. So the big moving part there is if you’re looking for a Guardian GSI and you uncover that that is the one in your hospital, you can still apply to Guardian medically and know that the GSI is still there as an option, as a fallback.

Number two, it’s kind of interesting, right? So number two is, let’s say you’re listening to this in a couple of months, and you’re an MS4, you’re getting ready to match, you’ve been told that you need to buy disability insurance, and you really want to do it as soon as possible. And let’s just say you’re in medical school ABC.

And you’ve matched, and you’re going to be doing your residency in hospital XYZ. And you apply medically to a company other than Guardian. And you are declined for any number of reasons. Because that decline took place prior to your hire date at the institution in which the Guardian GSI plan leaves, you are still eligible. You basically get a clean slate and a fresh start.

You basically get a clean slate and a fresh start. 

Daniel Wrenne: Interesting.

Lawrence Keller:  That’s right.

Daniel Wrenne: Even more confusing. 

Lawrence Keller: Yes. And then the third one is probably the most confusing of them all. So let’s say you finished medical school. You matched, you knew you were going to hospital XYZ, you didn’t apply for any insurance.

And two months into your PGY-1 year, you apply for coverage. I’ll just say you went to a company besides Guardian and you are declined or modified or rated or you withdrew a pending application like your agent told you, “Daniel, the Titanic is going to sink. We need to pull your application.” If it happens to be you’re in a hospital that has a Guardian GSI and the knowing or you becoming aware of the modification, decline, withdrawing of the application rating, is within the first nine months of your hire date at that institution.

So let’s say you started July 1st. If you became aware of this modification, decline rating through the end of March, you are still eligible for the GSI plan with Guardian, not only through your entire residency but up to 90 days after you graduate.

If that’s when you are knowing of the modification took place, it doesn’t mean you have to buy the GSI plan within nine months. You had to be aware of that modification, decline, withdrawal of the application within that timeframe. So timing is very important.

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Daniel Wrenne: Yeah. Okay. Let me repeat this because I don’t know if I got all this, but especially this last one, I definitely didn’t get that, but let me see how close I am on all this. So standard, it sounds like any decline at another company or standard you’re off limits for GSI, right?

Lawrence Keller: Yep. A hundred percent. 

Daniel Wrenne: Okay. Ameritas. It’s like any adverse, like modification decline at any other company or with Ameritas, you’re off-limits for GSI. Pretty they’re the more, they’re the most strict on it.

Lawrence Keller: Yeah. Even if you pull the pending application with Ameritas and another company, you’re out.

Daniel Wrenne: Yeah. Okay. So, and then Guardian’s got this. Well, if it’s Guardian policy, then they’ll let you be eligible. So if you applied individually with Guardian, you would still be eligible for the guaranteed standard issue. If it’s other company and it’s before you start, then you get a clean slate when you start.

Lawrence Keller: Yep. So that could be—that could be you finished medical school and you didn’t start residency. It could be you finished residency, declined by another carrier. Now you’re starting your fellowship in a different institution.

Daniel Wrenne: If you’re switching hospitals, just you’re in practice, you’re switching hospitals. 

Lawrence Keller: It would not work if you’re in practice. 

Daniel Wrenne: It’s got to be training to practice, resets it. So when you go into practice, you get a reset. Or training—

Lawrence Keller:  Well, remember training to practice, it would be only if you applied within 90 days after finishing your residency or fellowship and you still needed to qualify for the Guardian GSI. Once you’re in practice.

Daniel Wrenne: There’s some details on that one. And then the third one, I don’t even, it may be lots of details. Talk to Larry. I don’t know.

Lawrence Keller: Yeah. Third one is basically nine months. If the bad outcome happens within the first nine months of your hire date at the institution in which the Guardian GSI plan lives, even if you subsequently apply in residency, the GSI is still an option, but if you get stuck, just know the answers are there.

You can email me or reach out to Daniel. I’ll give him the answers in more detail.

Daniel Wrenne: What we just went through is a big deal because that kind of will screen or some people may not be eligible already, I guess, and this will kind of, this is, there’s a few different things to be thinking about as far as whether or not you could get some of this guaranteed standard issue stuff we’re talking about.

One of them is your history of applying for individual coverage. And that’s just what we went through. So there could be these qualifiers that occurred in your past related to you trying to get individual coverage on your own through medical underwriting that caused you to be disqualified completely.

With certain companies and they vary, like we were just going through there, it gets a little confusing with Guardian, but we can kind of refer to Larry when, when those questions come up, but then there’s the other part of the equation. So you also have to be working for an institution that offers it or is eligible for it. Or how do I know? I mean, that’s sort of a black box.

Lawrence Keller: Agents that are well versed in the medical marketplace, we tend to know. So let’s look at this, and it’s still the same. Yeah, it’s still the same plan. So think about it this way. So I’m going to use two terms. I’m going to use an endorsed GSI program. So this is where the institution, an agent, and an insurance company kind of got together. 

The institution signs off on it. The institution says we’re willing to promote this or at least make our residents aware of it.

Daniel Wrenne: Yeah. 

Lawrence Keller: This is the situation you’re in and you call GME. “Hey, I’m looking for a guaranteed standard issue plan. Can you tell me, does our hospital have it?” They’re going to know the majority of plans.

Or I’m going to use the term non-endorsed. So I have several of these. So this is where I go to the insurance company. “Hey, Guardian. Hey, Ameritas. I do a lot of business at this hospital. I don’t have any relationship with the GME department or the executives at the hospital, but you can see what my numbers look like. And you could see how many clients I have there. Would you be willing to help me help you and allow me to have a GSI plan at that institution?”

And now it’s the insurance company giving me the GSI plan. So even on all of my brochures that I send out for my programs, it says “XYZ Hospital does not endorse.”

“XYZ Hospital is not promoting.” “This insurance company is not an official vendor of XYZ hospital.” It’s really Guardian’s offer to the residents or fellows at that hospital. Now, what’s most important, and this is what we should drive home, is we kind of outline the rules as to like how you become ineligible.

But I think what a lot of residents and fellows do not understand are one of these common things that are going to cause a modification, a rating, or a decline. And once we understand that, you will quickly realize how important what we are talking about is and why you really need to, first things first, be sure if there is a GSI program available at your institution.

So, Daniel, I got to imagine as a financial planner, you probably see some of this, but it’s mainly interactions with insurance agents behind the scenes, or you reviewed a policy and you see all sorts of exclusion riders.

So, number one, these are not necessarily in any particular order, but you can kind of get an idea. So, number one is let’s go with self-prescribing or peer-prescribing. So, you’re writing scripts for yourself. I’m not talking about the really easy stuff like a Z-Pak because I’ve got something going on. I’m talking about your self-prescribing an SSRI or anti-anxiety medication. Maybe you’re married to another physician or another healthcare professional and they’re prescribing for you.

And you’re going through medical underwriting and the underwriter comes back to me and they say, “Larry, can you go ahead, we’ve done this prescription drug check. We see this person is taking this prescription. Can you go ask them what symptoms are being treated, what is the current status of the symptoms, and where can we get a copy of the medical records that go along with this prescription?”

And the answer is there are none. Well, generally that’s going to be an instant decline with any company. You know, number two, you can see this is going to generally be an exclusion. Females, you’re currently pregnant, or you have a history of pregnancy complications. Or you’re going through infertility treatments.

That’s generally going to get you an exclusion rider for pregnancy or complications of pregnancy. You’ve been diagnosed with, hard to believe, or being treated for stress, anxiety, or depression. Go find me a medical resident or fellow where—

Daniel Wrenne: Everyone. 

Lawrence Keller: They don’t really have that, or maybe they’ve been diagnosed with ADD, ADHD.

They’re taking Adderall or Vyvanse. That’s going to get you a mental or nervous exclusion rider. Here’s an instant decline for you. Diabetes, right? Type 1 diabetes. Every company is just going to flat-out say, we’re not interested. So, I had someone the other day that applied medically. In my intake form, they told me they were a Type 1 diabetic and they were using insulin.

And I said, why did you apply medically? Like, you’re an instant decline. No company will ever consider you. “Oh, well, the insurance agent didn’t ask me any medical questions. So, I applied to the insurance company and then I found that out.” Well, you need to do your due diligence. This’ll get you an exclusion rider.

How about a recent needlestick where you did not have a negative HIV, hepatitis B, or hepatitis C test six months post-exposure? So, that’s not a bad exclusion. I would say that that’s kind of a temporary exclusion as long as you come up with the negative test six months post-exposure. But a GSI plan, like a Guardian GSI plan that would not have an exclusion rider, recent surgery, or like I mentioned before, surgery where hardware was placed, if there was hardware placed and it’s still there, that’s a permanent exclusion for that specific joint or body part.

You don’t see this too much with younger people, but a history of cancer. That’s generally going to be a client decline for a period of time. Being treated by a chiropractor. But, Daniel, I go prophylactically. I just want to make sure that I’m a surgeon. I’m an interventional cardiologist. I wear a lead vest. That’s going to basically get you some kind of an exclusion because your medical records are going to state that you have an issue, even though you might be doing it prophylactically.

Daniel Wrenne: So, how do I know if I’m able to even, I know some people can go to their hospital and say, “Hey, do I have access to this guarantee standard issue?” But then the majority of them, it sounds like, are non-institutionally endorsed options, 

Lawrence Keller: Yeah.

Daniel Wrenne: And so you’ve got to just talk to agents that know, right? I mean, that’s—

Lawrence Keller: Yeah. You can either talk to agents. You can literally just Google Guardian GSI plans. They will typically come up and the list can change because one of the big things that the insurance companies are looking for, because people say, “Well, this sounds too good to be true. Like, why would the insurance companies…”

It should come up as number one.

Daniel Wrenne: Well, this is disabilityquotes.com. But there’s a bunch of them on here. So, like Mount Sinai, Mayo Clinic, LSU, Midwestern University, New York Presbyterian, Ohio Health, Philadelphia College of Osteopathic Medicine, Rowan University.

Basically almost all, or maybe all, fellow resident programs are on DSI?

Lawrence Keller: I wouldn’t say all, I would say an overwhelming majority. It’s, you’d be more likely to not find one than you would to actually—

Daniel Wrenne: Yeah, University of Kentucky, that’s near me. Like, I’m looking for a non-residency fellowship program on this list.

Lawrence Keller: You won’t find that they’re all GSIs, for the most part, are all geared towards residents and fellows. Now, that does not—

Daniel Wrenne: So, if I’m working for a hospital that doesn’t have a residency or fellowship program, it’s unlikely that I would have a GSI available.

Lawrence Keller: Yeah, if you’re working for a big hospital or you’re working for a large private practice, they might have a GSI plan that dovetails as a supplement to the group insurance plan, but you won’t find that online. That’s going to be more, you got to go to like—

Daniel Wrenne: A Baptist, like a Baptist Health kind of a thing, like that would most likely have GSIs available?

Lawrence Keller: More likely to have it than a private practice that’s very small, that’s for sure. But it always makes sense. Ask the agents. I always tell people it’s amazing how many people don’t ask me. So these days you go to the physician blogosphere, you listen to podcasts. I mean, everyone has been taught to go ahead and speak to several agents. And if it was me, there’s a couple of questions that I might ask, “Hey, how long have you been doing this?”  Right.

Daniel Wrenne: 35 years.

Lawrence Keller: Yeah. How long have you been doing this? What’s your typical client? How many of my specialty do you work with in a given year? How many have you worked with in the past? But I think the big one would be, “Daniel, I’m going to reach out to several agents, or I’ve been in the process of doing this. Let me ask you, do you know of, or do you have access to, a discount or a guaranteed standard issue plan that others might not?”

And right away you can start to whittle down because all of these plans, and this kind of runs right into a massive conflict of interest, all of these plans have either an endorsed agent or a group of endorsed agents. And these are the people that actually have the ability to sell the guaranteed standard issue plan to you. 

So, I’ll speak for myself. If you come to me and you say, “I’m a physician, I’m a resident at such and such hospital, and I see, or I want to make you aware of a GSI plan, just so you know, it’s an option.” I will say, just to let you know, there is a GSI plan at your hospital with Standard, with Ameritas, with Guardian, with MassMutual. I am not the endorsed agent. In your case, I cannot do it for you, but let me give you the name and contact information of the agent that can.

Now you can go ahead and you can do your due diligence. Now, most of the time I have the software and I can run these quotes anyway. I can go through them with clients. I can tell them the positive about it. I can tell them how it might compare to something else. Even if I’m not the person that can actually be their agent initially, I can have that policy sold to them by the endorsed agent. And then I can come back and I can become their agent of record and service that going forward in real simple language. In these situations, I don’t have the keys to the castle, but once you’re in, I can show you around, right?

A couple of other big things, and these are kind of new. If you’ve been diagnosed with psoriasis or psoriatic arthritis, you really need to investigate a GSI. If you are beyond the skin and it’s going to your joints, so you’re taking some third-level medication, you’re not only going to get an exclusion rider for psoriasis or psoriatic arthritis, you’re likely going to get a payout for 5 years rather than to the age 65 or longer, and you’re going to get a rating, which is an additional premium charge. 

A lot of residents have sleep issues. Now it could be sleep apnea or another sleep disorder. You do see this a lot, you know, ulcerative colitis or Crohn’s disease, but I want to kind of leave it with this. A GSI plan is not only for people that have medical issues. A GSI plan is a great way to shortcut the system, because medical underwriting can be anywhere from a couple of weeks to a couple of months. And at the end of it all, after all the medical records are gathered, the prescription drug check is done, you could end up being declined.

Daniel Wrenne: Yeah. 

Lawrence Keller: And if you’re not declined, you might get a policy that does not look anything the way you wanted it. 

So I will say, unless you know what is in your medical records, what billing codes are being used in your medical records as far as diagnoses, if you’re completely sure that you have not had a prescription written to you for something by a resident or a fellow that you’re colleagues with, and you know for sure you haven’t written a script for yourself for something other than something that’s completely innocuous, the GSI should really be what you purchase. 

Right. Conversely, you could say, well, why wouldn’t I buy the GSI? Well, maybe the company at your hospital that specific medical specialty really is not very competitive with that company. But I certainly would want to know whether that GSI plan is available. And I would like to be able to make that decision myself rather than having the decision being made for me.

Daniel Wrenne: Yes, definitely. Definitely. GSI is like probably the first tier of protection to consider. And most people, probably almost all physicians, eventually go through a phase where they’re working at a place that qualifies them for it.

Lawrence Keller: Yeah.

Daniel Wrenne: Typically residency and fellowship for sure. 

Lawrence Keller: But yeah. Even looking at this, like one of the great GSI myths and some well-known blogs talk about this or some podcasts I’ve listened to, they say, but Larry, a GSI plan is more expensive. It is not. 

If the policy is structured the same way, 

Daniel Wrenne: Same prices.

Lawrence Keller: Same prices. It’s going to be exactly the same cost. In some cases, like Daniel mentioned, I might have access to a GSI plan that has a gender-neutral or a unisex rate. That’s even less expensive than a fully underwritten one. So it kind of goes back to do your due diligence. 

The first thing to do is to be aware or investigate: is a GSI plan available at my institution? And the agents that frequent the medical marketplace, we typically know.

Daniel Wrenne: Okay, cool. Well, as we start to wrap up, I think it would be good to maybe share how people can reach you, because we’re going to make you the person that can verify all these GSI-related questions if you’re okay with it. 

But what’s the best way for people to ask questions about this kind of thing or reach out to you for help with this?

Lawrence Keller: Yeah, so email is great. It’s LKeller, L-K-E-L-L-E-R, @ physicianfinancialservices.com, all spelled out. You can certainly call me or my office, (516) 677-6211. I’ve been in this a long time.

I’m happy to have you guys use me as a resource. If you’d like me to review an existing policy that you have, if you’d like me to let you know, like, does a GSI plan exist at my institution? Does it make sense for me? Is there anything that I’m missing? You know, I review these policies all the time and what takes me five minutes could literally save you hours of work. So use me as a resource. Don’t be shy. We’re here for educational purposes.

We’re here to help you make the decisions that are best for yourself and your families, and a little bit of education, which is really all that a podcast is, will go a tremendous way.

Daniel Wrenne: Awesome. Well, I appreciate you coming on and sharing all that. And we’ll have to do this more often.

Lawrence Keller: I appreciate it. Always great to be here. Enjoy the rest of the week and we will chat again.