Quote Engine
57 deductible options across 12 products from PSM, LifeX, Enroll Prime, UnitedHealthcare, ManhattanLife, and Allstate. Enter the client's state, age, tier, budget, medications, and health history — every product prices at its cheapest option the client can actually get, and the ones they can't knock themselves out. Use the dropdown to move up a deductible. Click any product for copays, drug costs, underwriting, and network.
Build the quote
Answer what you know. Every question below narrows the list — medications and health history knock out plans the client would be declined for, so you find that out before you build the quote instead of after.
Disqualify early
Before you build a quote, not after.
- They'd get a real subsidy on the marketplace. Send them there. Selling against a big subsidy is bad for them and bad for you.
- Type 1 diabetes. Every carrier here declines it except PSM, and PSM only on an approved suitability code.
- Any serious condition — heart, stroke, cancer, kidney, liver, autoimmune, pregnancy. Underwritten coverage excludes it for 12 months. Send them to the marketplace.
- Anything not controlled. Six months stable is the bar at most carriers.
- Brand or specialty medications — check before you present.
- Pregnancy.
- Their state. LifeX uses PHCS everywhere except NY and NJ, which use MagnaCare.
Every carrier underwrites differently
Don't carry one carrier's process onto another carrier's call.
| Carrier | How it underwrites | Cutoff | Draft |
|---|---|---|---|
| PSM | Suitability code. Client is underwritten before enrolling. | 19th | 20th |
| LifeX | Yes/no health questions on the application. That's it. | 22nd | 15th |
| Enroll Prime | Declines if pre-existing conditions will cost over $5K the first year. | — | — |
| UnitedHealthcare | Medically underwritten by Golden Rule. 12-month pre-existing exclusion. | — | — |
| ManhattanLife | Simplified issue with a published decline list and a build chart. Prescription check on every application. | — | — |
| Allstate | Short health application. Guaranteed Issue plan asks nothing at all. | — | — |
What we actually sell
Your client isn't buying an individual policy. They're joining a group and getting coverage under that group's plan — the same way an employee gets coverage at a big company. The group just isn't their employer.
Every one of these has three parts. Learn to say them separately.
Why a self-employed or high-income client wants this
No subsidy to protect
High earners pay full price on the marketplace. There's no discount to lose, so the only question is whether they can get priced better somewhere else.
Health-based pricing
Marketplace plans charge healthy people the same as sick people. These are underwritten, so a healthy client stops paying for everyone else's claims. That gap is the pitch.
Real networks
National PPOs instead of a county-limited HMO. For a client who travels or likes their doctors, this closes deals on its own.
Enroll any month
No waiting for November. A conversation in March can close in March.
The two kinds of plan
Get this right or nothing else matters.
Caps what they can lose
- BIG CLAIM Covered, up to the out-of-pocket max
- PRICE $600–800/mo
- FOR Anyone with assets or real risk
Pays set amounts for routine care
- BIG CLAIM Client is exposed
- PRICE $250–600/mo
- FOR Healthy, price-driven, otherwise uninsured
Never let a client think a limited plan is major medical. Say the words "limited plan" out loud, explain what isn't covered, and confirm they understand before you enroll.
Things that get agents in trouble
- Calling a limited plan "major medical"
- Saying "it covers everything"
- Promising an effective date before underwriting clears
- Telling a client a drug is covered without checking the formulary
- Giving tax advice — "ask your CPA" is the whole answer