Insurance ep 2 with disclosure

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Okay, and welcome back to Behind The Knife. Uh, today we're doing part two of disability Insurance with Larry Keller, and today we are going to discuss guaranteed standard issue. A lot has changed in the past few years with this, and, uh, Larry's here to guide us through guaranteed standard issue to make sure you make the right decisions when choosing your disability insurance.

So, Larry, let's just start with what is it and what has changed in, in, in, since we talked last about this. So, I mean, this is really, really big. I mean, guaranteed standard issue or GSI disability insurance is really the same individual

disability insurance policy that we see residents and fellows commonly purchasing, sometimes really early in their career.

Other times it might be towards the end of residency or even at the end of fellowships. And part of buying an individual disability insurance involves what's known as medical underwriting. This means that you're applying for coverage, you're answering medical questions behind the scenes, the underwriter is doing a prescription drug canvas, so when you go to the pharmacy and do sign off saying, you know, yes, I was counseled.

That's going right to a database that the underwriters can access so they can see what prescriptions you filled. They can see typically the name of the physician that wrote the prescription. They could see the number of refills. If you didn't tell us about this, we're gonna come back and we're gonna ask you, uh, what did you fill this for?

What symptoms were being treated? What's the current status of the symptoms?

And this can potentially be used against you, depending upon the severity of the condition. Uh, it could lead to a decline. Like we're not willing to give you coverage at all. It could lead to an exclusion rider, like, we're willing to give you coverage, but we're not willing to cover, uh, medical conditions or specific body parts.

It could potentially lead to a more expensive policy. So we call this a, a rating, which is a, a term for an additional premium charge to make up for increased risk. Then we could start to maybe reduce things. Instead of paying your benefits until your 65th birthday, we're only gonna pay benefits for five years or 10 years.

Now, there was a study done back in 2021, and this is called the Individual Disability Insurance Market Survey, and it was done by a company called Milliman. And what they found is that of all the disability

insurance applications that came in 50%. Half of the people that applied for long-term disability coverage on an individual basis were either declined, like, sorry, we cannot offer you coverage at all.

That was 16%. Or We can offer you coverage, but it's gonna require one or more modifications, like what I described, and that was 34%. So if you happen to be. Sitting somewhere, you know, maybe you're listening to this, but you're, you know, in a classroom with a bunch of other, you know, residents or, or fellows.

I happen to be an insurance guy. I'd like to think I'm a pretty cautious guy. When I go to cross the street, I literally look both ways. I look to my right, I look to my left, and when I see that it is safe to cross, that's when I go, well, as a resident or fellow, what this study tells me is if I look to my right.

Or my left.

I don't have to look to both, either me or the resident or fellow that's to my right or to my left. One of us is either not gonna get a policy at all, or we're not gonna get the policy the way we actually did apply to buy it. So a guaranteed standard issue plan is the same individual disability insurance policy that you buy in the open market.

It's the same discounts that you'll have in the open market as a resident or a fellow, but medical underwriting is taken out of the equation. There's either no medical questions at all, or you might find a couple of gatekeeper questions like, we wanna make sure that you've been working full time for the last three or six months without a break in the action due to an act center sickness.

It's very reasonable. By the same token, if we're asking you gatekeeper questions and you tell me that you were hospitalized, but you had covid for two weeks.

That's really not gonna necessarily impact your ability to buy at least one company's GSI plan. Other companies are gonna say, well, just the fact that you were outta work for that two weeks, you really need to be back full-time working for six months prior to purchasing this policy, and you cannot be receiving disability insurance benefits currently or in the past.

So if you happen to be active duty, you're really not gonna find a guaranteed standard issue plan. 'cause they're typically tied to resident and fellow programs that are not active duty. But let's say you're a resident now, but previously you were military and you were active duty and you filed a VA disability claim and you were given a rating.

Well now if you are receiving VA disability benefits. For at least one of the companies, you no longer are eligible to buy the

GSI plan. Wow. Almost everyone in the military ends up on VA disability to some degree. Yes. Wow, that's crazy. Yeah. So one of the big things with, uh, military members, whether they're residents, fellows, or practicing is, aside from like this GSI, 'cause it's really not applicable to them, is you wanna buy your policy early.

Your training before you develop any conditions, because then if you get to the point that you develop something and you are filing for a VA rating for any number of conditions, if your policy has an increase option, it's not going to cause an exclusion rider or exclusion riders or cause you to be declined because you're first looking for coverage after the fact.

So very important that you can buy coverage as an active duty military physician or military dentist. Very few companies offer it, but once you have it, you can make

increases to it. So if we look at guaranteed standard issue on a resident or fellow, um, in a civilian program, it happens to be that my institution has a guaranteed standard issue.

Offer available to me, either from the institution, with the insurance company backing it, or maybe it's given by the insurance company to a specific agent that can make it available to the residents and fellows training at that institution, so the ones that make it available through an agent. The insurance company gives it to the agent.

I'm gonna call this a non-used program, like literally if you called up GME, they would not even know that it's there. If it's an endorsed offer, generally the GME is gonna know that it's there. They're going to try to promote the availability of this to the residents or fellows, and then they know that they can buy it.

Well as good as guaranteed.

Standard issue is. We have to know the most important thing is if you take a misstep, you can become ineligible for a guaranteed standard issue plan pretty quickly. So a couple of general rules is if you apply for medically underwritten disability insurance where you're answering medical questions, they're doing the prescription drug check, they're reviewing your medical records, and your application is declined.

For the most part, you are now ineligible for A GSI offer. If your policy is approved, but it's approved with a modification, like I said before, an exclusion rider, a reduction in the number of years that they're gonna pay an extra premium charge, maybe they remove the increase options. General rule, you become ineligible for the GSI plan.

Some

companies, if you put in an application, even if you withdraw the application 15 minutes later, most of the insurance companies have the ability to get electronic health records, and at that point they can tell pretty quickly whether your policy is going to have an exclusion rider, a modification, or you're going to be declined.

Putting in an application and withdrawing your application also generally makes you ineligible for A GSI plan. So the first thing that you should do as a resident or fellow thinking, even thinking about buying disability insurance is find out if there is a guaranteed standard issue offer available to you by your affiliation with the institution in which you are doing your training.

Now different institutions might have different insurance companies that make the GSI Plan available, and it's

only available with specific companies at specific institutions. I will tell you today, it's more likely that you're going to find a GSI Plan available to you. You're not going to find a GSI plan available to you.

So I can tell you I get a lot of calls and emails from people that tell me, Larry, I found you online. I applied for insurance previously. I was declined. And I'm like, oh, I'm so sorry to hear that. Can you tell me a little bit more about what caused your decline? I had a vasovagal episode. It was within the 12 months prior to me applying for disability insurance.

I really didn't think much of it. I didn't even really think I had to mention it, and I got declined, and I'm like, well, did the agent that you were working with, did they really ask you to think about what might be in your medical records? What's transpired over the last,

let's say, five to 10 years? If they didn't and they put you right into medical underwriting and they didn't even bring up the guaranteed standard issue plan being available, they did you a disservice.

So one thing that we need to know is guaranteed standard issue plans are not available to all insurance agents. A guaranteed standard issue offer, whether it's an endorsed offer or a non-used offer. Those are only available to specific agents that are really the ones that are endorsed for that specific GSI program at that specific institution.

So what happens here, this causes a tremendous conflict of interest because if you went online or you met someone that's an insurance agent and you requested quotes, and they are not the endorsed agent. Or the endorsed

agent will not give them the ability to use that program. They are going to try to tell you even if you know it exists, that you should not buy the GSI plan.

And the reason that they're telling you this is because they either cannot be compensated by selling it to you, or their compensation is not going to be as high as it would normally be because they have to cut in. The endorsed agent because that endorsed agent is the one that set up the GSI plan either with the institution or directly with the insurance company.

So you need to know first and foremost is there a GSI plan available to me. So how do I know you either ask GME and if it's endorsed, they will know. Or you ask your friends and colleagues, do you have disability insurance? If you do, who is the agent that you dealt with? Uh, do you know? Is it a GSI plan?

But

most of the people that are in the medical market that are actively working with residents and fellows, we're going to know. That's really what it's gonna come down to. So you need to ask, the very first thing you need to do is to explore, is this an option? For me. The second thing that we wanna know is because you're bypassing all of the medical underwriting, who does this work well for?

And a lot of people say, well, it only works well for people that are not healthy, or it only works well for people that do crazy things. They rock climb, they hang glide, they do motorcycle racing. That's not exactly true. It can work very well for someone that's perfectly healthy. Uh, so let's look at some common reasons for a modification or a decline.

And this would lead me to the GSI plan should

be really, really important to me. So I'm self prescribing, or I'm peer prescribing, or my spouse is a healthcare professional and they're writing a script for me. And there's no medical records that exist that go along as a third party with the prescriptions that I'm writing or I'm having filled.

For me, that's pretty much gonna be an instant decline other than something like a Z-pack or something pretty innocuous. Right. And I, Kevin, I gotta imagine in residency you probably saw a bunch of friends writing scripts. Hopefully not for themselves, but maybe for other residents and fellows. Maybe mainly Zofran.

Mainly Zofran, yeah. Yeah, that could be an issue, right? Uh, if you're currently pregnant or you have a history of pregnancy complications or you're doing IVF, you know, that's gonna be an exclusion rider for pregnancy or complications. Uh, GSI plan is going to generally cover

pregnancy and complications.

'cause we're not really, you know, asking. A big one for residents and fellows today. Diagnosed or being treated for stress, anxiety, depression. A-D-D-A-D-H-D. Tremendous number of residents and fellows, especially post covid. I'm a diabetic or I'm a pre-diabetic. I had a recent needle stick, but I don't have a negative HIV, hepatitis B or Hep C test, six months post exposure.

I can't, it just happened two months ago. I'm gonna get an exclusion rider for bloodborne pathogens. So what happens if I get the exclusion rider and I actually convert to HIV positive? I wouldn't receive any benefits. A GSI plan you are going to be covered and generally benefits will be payable unless it fools under what's called a preexisting condition limitation.

And we'll talk a little bit about that. Uh, I recently

had surgery or I had surgery where hardware was placed a history of cancer. I'm being treated by a chiropractor. Surgeons will tell me it's prophylactic. I get it. I will tell you your medical records from the chiropractor will say otherwise, uh, you've been diagnosed with psoriasis or psoriatic arthritis, and if you're using like a third line medication.

This is a big problem. Now, if it's more than just the skin and it's gone to like the bones and the joints, you're typically gonna look at not only an exclusion writer for psoriasis or complications, but a 50% five zero extra premium charge benefits payable for only five years, and no increase options on your policy.

But A GSI plan no issue at all. Very popular one seems to be today. I was recently diagnosed with sleep apnea. I was given A-C-P-A-P machine. I

haven't even started using it. You're probably not gonna be insurable for a year or two years, especially if it's obstructive sleep apnea. Another big one. I see a lot diagnosed with ulcerative colitis or Crohn's disease.

That's gonna usually get you a limited policy, uh, five years worth of benefits, an exclusion rider for the large intestine, the small intestine. No increase options and an additional premium charge. Uh, BMI, believe it or not, like a BMI, that's too low in the eyes of the insurance company is equally as bad as A BMI.

That's too high. A GSI plan, we do not even ask about your height and weight. So that alone could be a reason to buy A GSI plan. Otherwise. A GSI plan literally is the same individual policy that you would buy in the open market with the same

riders that you would look for in the open market. But typically the maximum is limited to $15,000 a month between the base policy and the increase option.

All of the GSI plans come with a 24 month limitation for claims resulting from anxiety, depression, stress, chemical dependency, drug addiction, or burnout. So let's say you were diagnosed with A-D-D-A-D-H-D, and you're using Vyvanse or Adderall, instead of getting no coverage for these things, A GSI plan will actually give you two years of coverage and benefits for these things like.

That's actually really good. Like no one likes to think that they're the one that's gonna go out for it. But given the choice of an exclusion rider, which gives me no coverage or some coverage for a condition, I'd rather have some coverage for the condition. Makes sense. Right, right. Yeah, no it does. And definitely

see the benefit of, uh, getting GSI.

Yeah. Another big thing is you're just a busy resident. You're like Larry, in between clinic and the or, I don't really have time to answer a bunch of medical questions. You know, if the insurance company wants to send someone out and they typically don't, but they want me to do labs and vitals, I don't have the time for this.

So if we look at it to get $15,000 a month, assuming you had no other coverage. Your income needs to be approximately $350,000 annually. So the GSI plan alone really is gonna be very, very effective to cover a good amount of income for most of the medical specialties. But let's say it's not, let's say you're a surgeon, you're really, really busy.

You just want to get your policy, and typically you can be applying for this and approved in 24 to 48 hours. Generally the medical

underwriting policy, I don't know, that's anywhere from a couple of weeks to a couple of months, and at the end of it all, you might not even walk away with a policy or at least something that you thought you wanted to buy.

So if you're a high income surgical specialist or you're a high income medical specialty, you can always buy a combination of the GSI plan. And a medically underwritten plan. So go back to my example. I'm an orthopedic resident. I had shoulder surgery, I have pin screws and anchors in my shoulder. I know I'm gonna get an exclusion rider if I apply medically.

So what I might do is just buy two policies, one that's A GSI. I am not gonna have an exclusion rider that can get to 15,000 a month. And I'll buy another really small policy that has an increased option that will have the exclusion rider. Now I can get to $30,000 a month. Half of my coverage is gonna

have no exclusion rider, and the other half will have the exclusion rider.

I've done about as well as I could do. So a lot of times A GSI plan is just great for those that wanna bypass the system, get their coverage quick. It's not that the policy is any less high quality, it's the same policy except it's gonna have a two year mental nervous limitation, and the maximum monthly benefit is typically going to be $15,000.

It does not necessarily mean this is the only disability insurance policy that you're ever going to own, so just know. It does not mean that if you have a medical problem, the only policy that you should buy. GSI, you could be perfectly healthy and you just wanna speed up the process. You should be looking at GSI too.

The biggest issue that I have is there is a really bad message going out around the physician blogosphere.

And because I said you can easily become ineligible for A GSI plan. There are websites telling people to apply for A GSI plan. Lock it in. So now you know you've got it. And once you have it, you could shop and go try to buy a cheaper policy or a better policy.

And if you think about this message, it's really terrible. Like the insurance company is making guaranteed standard issue plans available to residents and fellows at these institutions knowing that they're going to be taking in both. Bad risks as well as good risks. And this message basically tells the doctors Go lock in what's guaranteed.

And once you have that, you can go shop and get a better policy or a cheaper policy and get rid of the GSI policy. Well, insurance companies are

all about risk management, and I can tell you if people do this, what's going to be left. In the hospital under the GSI plan is only going to be people that are uninsurable, people that would be chockfull of exclusion riders and other modifications and guaranteed standard issue Coverage is going to disappear and no longer be available in a very, very quick matter.

So I'm going to go out on a pretty big limb and I'm gonna say Kevin. If there is a guaranteed standard issue plan available at the hospital in which you are doing your training, with very few exceptions, that is what you should buy. And if it's not enough, you can buy a supplemental policy from the same company to get to a higher level of coverage should you feel you need it based

on your future earning potential.

But should you decide to do that, you want to get the GSI first, correct? Yes. You wanna make sure that you lock into the GSI first that's gonna come back clean. 'cause if you go the other direction and you buy the policy that has the exclusion rider, now you might have made yourself ineligible for the GSI plan, even if it's the same company that you applied to medically, that you'd be buying the GSI plan from first.

So you gotta go with the GSI plan first, and again, I probably go to the same company for the additional coverage to supplement it. That makes the GSI plan available. Now, there's two other things to look at. So certain companies on their GSI Plan, they have what's called a preexisting condition limitation.

Basically what they're afraid of is that you are buying this policy after you've been diagnosed with something or you've got a preexisting condition and you're gonna look to

file a claim very quickly thereafter. So again, like I said, you gotta be working full time, you know, not taking time off due to an accident or sickness.

You can't be receiving generally disability insurance benefits. So now we're gonna look back and of the companies that have a preexisting condition limitation. I'm gonna make this up. Let's say you applied for your policy and it was approved on February 1st, 2025. Most of these have what's called a three slash 12 pre-existing condition limitation, and what they're really gonna do is they're gonna look back three months prior to your policy's start date.

So if you bought it in February, we're gonna say in January, December or November. Did you see a physician? Did you take a prescription medication? Did you have a diagnostic test done? Were you experiencing

symptoms that a prudent human being would've gone to see a physician for? If the answer is yes, that's going to be called a pre-existing condition.

If you file a claim as a result of that pre-existing condition within the first 12 months of owning that policy. That is not going to be a claim that is paid because it falls under the preexisting condition limitation. Some companies have this currently, guardian does not even have a preexisting condition limitation.

So you can be someone that bought a policy as a type one diabetic, you're using insulin, you buy your policy. Three months after you buy the policy, you have a severe diabetic complication. If you have a guardian GSI plan and you receive, uh, benefits because you've met the definition of disability, you're fine.

Even though it was a pre-existing condition

in the other two, if it fell in that limitation, it's within that first 12 months of owning the policy. That plane would not be paid. Kind of interesting the way Yeah, no, that is, that is quite interesting. And so it, so it's just if you've recently been diagnosed with something that is the one exclusion, but not if you've kind of had something going on your whole life.

Uh, well, even if you've had it going on. So let's say you were a type one diabetic, you were diagnosed as a kid, you're using insulin. You're gonna be using insulin for the rest of your life. You bought your policy, you know, February 1st, they look back November, December, January, oh yes, he was using insulin.

You become disabled in that first 12 month of ownership due to a diabetic complication. If there's a preexisting condition limitation there that's not paid. If there's no pre-existing condition limitation like Guardian currently has,

that claim would actually be paid. I'll leave you with. The last thing is gonna be some unique rules that Guardian has.

So number one is if you don't apply elsewhere, so you don't apply to a company other than Guardian and you are willing to go through medical underwriting and things don't work out the way you expected. You were approved, but you were approved with an exclusion rider, or you were approved with a higher premium or some modification, or maybe you were even declined.

If you only went to Guardian, you are still eligible for the Guardian GSI Plan. They do not punish you because you went somewhere else. If you went to Guardian, you're always gonna be eligible for the Guardian GSI Plan number two, I'm gonna call the Vegas rule. So let's say you're really on top of things.

You know you're

finishing medical school, you're an MS four. You matched, you know where you're going for residency. Uh, you wanna buy a disability insurance policy 'cause now you know what your life is going to look like. You apply for disability insurance with any company. Worst case scenario is you are the client.

You now start your residency and you find out at your residency program. Lo and behold, there is a guaranteed standard issue plan with guardian. Because you applied for disability insurance before your hire date or your start date at the residency program where the GSI plan lives, the fact that you were declined, even if it was a company other than Guardian, it does not count.

You're still eligible. So I say the Vegas rule, 'cause what happens in Vegas stays in Vegas. You're still good. The last rule.

Is, let's say you started your residency. You didn't even know that there was a GSI plan there. You met with a local agent. They didn't know that there was a GSI plan. You went into medical underwriting and you got declined.

And you got declined four months into your residency. You started in July 1st, you were basically declined, you know, sometime November, December. Because your knowing of the modification or decline took place within the first nine months of your hire date. So if you started July 1st, you literally could be declined, modified, postponed through March.

You're still eligible for the GSI plan throughout the entire time that you do your residency at that institution. Or up to 90 days after you graduate. So they don't

really punish you for trying to get coverage because you really were unaware. You didn't have enough time to know that there was a GSI plan, and now you've come to find out about it.

You are still eligible, but those are guardian specific rules, not other insurance company rules. And using the other company rules. You would be ineligible for the GSI plan. So you really have to be careful. I use a punt as a military doc to not step on a landmine, and it's very easy to do if you're not doing your homework or you're not speaking to the right agents or brokers that are going to let you know what's available to you, whether they can offer it and be compensated, or whether they cannot be compensated, but they're happy to tell you.

Where it is and who the agent is, and you can go ahead and buy that policy. And then if you wanna work with that agent, you could basically sign a

broker of record letter and the agent you'd like to work with can become your servicing agent, work with you going forward. So you have to buy it from the endorsed agent.

It's basically like having no keys to the castle, but once the castle's open, I've been in there enough times I could show you around. If the endorsed agent is still gonna get paid for selling that policy, the new agent that takes over, they're just gonna get paid for helping you make increases in selling additional coverage.

Okay. Uh, so let me see if I can sort of summarize a few things as a simple surgeon here and not an insurance expert. I'm gonna do broad strokes, 'cause obviously there's lots of exclusions, but as we talked about in our first episode, it's really important. Maybe the most important thing you can do as a resident or fellow is to leave with a disability policy, um, and particularly in own occupation and disability policy.

Um, what we discuss now is that

your default. A resident or fellow should be to get a guaranteed standard issue, disability insurance policy at your institution, uh, which is above and beyond whatever sort of baseline disability is included in working there, and the only major reasons you would need an additional insurance policy.

Would be, um, you want more mental health, uh, support or you want more money, um, coverage. And, um, other than that, the GSI is a very good option, um, for residents and, and that's why it's so important. It doesn't have medical underwriting to take advantage of this while you have access to it. 'cause as soon as you're an attending, um, you know, after a few months, you're not gonna have access to these types of plans.

Yeah, that's a hundred percent right. I mean, GSI really is where it's at and

short of wanting unlimited mental nervous coverage, if you qualify for that short of wanting a benefit that exceeds $15,000 a month. Yeah, the GSI plan is great and, and I've had a lot of people, and I think Kevin, this is really important is you've got a lot of residents that say, well, if the plan is guaranteed, and I know I could buy this regardless of my health, if I'm a PGY one or a PGY two, like, why don't I wanna buy this now?

I'll just wait until I'm done with my training because I know it's guaranteed. I cannot emphasize this enough. I'll say that again. I cannot emphasize this enough. If you are early in your training and there is a guaranteed standard issue plan available to you now in no way, shape or form, does that mean that that guaranteed standard issue plan may be available to you in the future?

The guaranteed standard issue plans that are offered by the insurance companies are

predicated on a percentage of graduating residents or fellows buying this plan. If the numbers are not being met, the insurance companies will terminate these guaranteed standard issue plans with no advance notice, and at that point you are simply out of luck.

So your most valuable asset, even though we don't think about it like this, is our ability to get up day in and day out, use our education training experience to do what we love. Ideally to earn a lot of income, to build a lifestyle for ourselves and our family. And if an accident or a sickness was to take all of that away, even the best laid financial plans may come to a screeching halt.

So Larry, thank you for all the information you've given us, uh, on both these episodes. Um, if someone wants to use your 30 plus years of expertise, how can they

find you? Yeah, so I'm pretty easy to find. I mean, you can always Google. Lawrence Keller Insurance or Larry Keller Insurance, but my email address is l Keller L-K-E-L-L-E-R, at physician financial services.com, all spelled out.

You can always call 5 1 6 6 7 7 6 2 1 1. If you have disability insurance and it has a modification and you're still a resident or a fellow, and you'd like to see if a guaranteed standard issue plan. Is still an option for you. Do not hesitate to reach out. If you're exploring disability insurance and you're trying to figure out like, is there a guaranteed standard issue offer available to me at my institution, feel free to reach out.

I know where they are. If I can't do it, I can certainly put you in touch with the endorsed agent that can provide that for you. So. Do not be

fearful. Reach out, use me as a resource. I'm certainly happy to help as best I can. I can. Val, you're always a pleasure to talk to, uh, both on the podcast and as a client.

So, uh, thank you, Larry. Hey, I appreciate it, Kevin. Thanks so much for your time, everybody listening. Thank you. Have a great day. This podcast is intended for general public use and is for informational purposes only. The Behind The Knife Podcast is not affiliated with or endorsed by Park Avenue Securities Guardian, or Physician Financial Services and opinions stated are their own.

Please note that individual situations can vary. Therefore, the information should only be relied upon when coordinated with professional advice. Lawrence B. Keller is a registered representative and financial advisor of Park Avenue Securities, LLC, PAs, osj. 3 5 5 Lexington Avenue. Ninth Floor, New York. New York, 1 0 0 1 7.

2 1 2 dash 5 4 1 dash 88 0. Security products and advisory services are offered through PAS member Finra, SIPC, financial representative. The Guardian Life Insurance Company of America, guardian, New York. New

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