HealthFirst Decision Tree

"Start with the best solution. Only move down when the client forces you to."

Questions answered0 / 10

Client Qualifiers

Under 65?

Client's age is below 65

Generally insurable?

No major uninsurable conditions (AIDS, cancer, organ transplant, etc.)

Actively seeking coverage?

Client is ready to enroll

Coverage Needs

Needs maternity?

Client or spouse needs maternity coverage

Needs mental health?

Any member needs mental health coverage

Health Profile

Diabetic on >2 meds?

Has diabetes AND is on more than 2 medications

Has asthma?

Any member has an asthma diagnosis

  • No Manhattan knockouts triggered
TIER 1✓ RECOMMENDED

Manhattan — Package of Protection

Good fit for healthy clients under 65

Package: AFC Elite · Spec Disease 250k · 24hr Accident · HI Select 10k · DVH · Americo HMS125 · Living Benefits 50k
  • · Build OOP + HI to cover Spec Disease deductible
  • · Split age brackets when possible
  • · Asthma: no ER/hospital in 24 months, BMI < 25 required
Manhattan Life Agent Portal Americo HMS125 Rider
If Manhattan declines at underwriting, send the Milliman Suitability Tool before routing to IronHealth.

Backup Plans

TIER 2

IronHealth — PSM Thrive PPO $2,500

For maternity, mental health, or Manhattan knockouts

  • · Sign HIPAA before enrollment
  • · Send Milliman tool to client in advance
  • · PALIC accepts asthma where IronHealth declines
Milliman Suitability Tool PSM First Health Enrollment PSM MaxGuard Enrollment
TIER 3

LifeX — $500 Co-Pay Plan

Must prequalify with carrier before presenting

  • · Have client prequalify through the carrier before presenting
  • · Many limitations — review carefully with client
LifeX Enrollment

Plan Ladder

TIER 1Manhattan — Package of Protection▶ PRIMARY
TIER 2IronHealth — PSM Thrive PPO $2,500
TIER 3LifeX — $500 Co-Pay Plan
TIER 4USA Health (Cigna Triad) — $7,350 Deductible
TIER 5Last Resort — UHC Short-Term / Guaranteed Issue