life insurance

"Follow the trail of blood"

We were at my parents' in NJ when the bleeding started. My first call to the on-call OB was met with reassurance. “One episode of bright red bleeding + clots is ok.” Except it quickly became 4-5 episodes in < 1 hour. The next call – “Go to the nearest ER.” Except that I wanted to be at my hospital with my doctors. I felt ok and the bleeding was intermittent so we took a chance and decided to head to Long Island. Google maps said it would take 1 hour. So off we went. We left Eggy home with grandma. We let my OB's office know we were on the way. I double diapered myself and brought chucks for the ride. I brought my donut pillow to sit on (3rd degree tear …). The last 20 minutes or so were scary. I started bleeding profusely and constantly. I bled through the two diapers, onto the chucks, onto the donut pillow, onto the seat and seat belt. I tell M he may get rich sooner than planned … But I feel fine. I check my pulse, seemed “normal”. We roll up to the ED entrance. The security guard immediately puts me in the wheelchair as blood is spilling out of the passenger seat. M goes to park. I get wheeled into triage and the nurse starts to do intake and looks at the blood pooling below me, “I'll register you later…” then wheels me into the ED directly into a trauma bay – “Crit B”. M parked and when he arrived at the ED entrance looking for me the guard says “Follow the trail of blood.” The usual happens. Vitals are taken. I'm slightly tachy. My BP is high as my body is compensating for the blood loss. 2 x 18 gauge IVs are placed quickly. Blood is sent. My on-call OB arrives. An ultrasound of my uterus is done. 1 unit blood was hung pretty quickly as I am whisked to the OR for emergent D&C for presumed retained parts. I wake up in recovery. I'm getting a second unit. Anesthesia did a great job as I remember nothing and have no pain. The NP examining me notices my engorged breasts and gets me a breast pump. I'm not sure how I managed to pump but I did (with assistance from M). I end up in recovery for several hours since a 3rd unit of blood is given. I finally get wheeled into a room at ~ 4am. Two weeks prior to this, Eggy was born. This sweet moment only lasted a few minutes as I started hemorrhaging after the placenta was delivered (yes I've had not one, but two hemorrhages). After a few minutes of skin to skin with Eggy, I suddenly feel very cold and shiver uncontrollably. Things are a bit of a blur but I remember the room being suddenly full of doctors and nurses – the “OB crash team” so to speak. Another IV is placed. I see M in the corner holding Eggy. I'm getting shots to stop the bleeding. M later tells me blood was pouring out and was all over the floor. I turned white including my lips. I received two blood transfusions. After 5 blood transfusion in two weeks, it seems like more blood is foreign than mine. A 10lb sand bag is placed over my uterus to contract it. These recent experiences taught me that life is precious. I'm grateful I didn't have a home birth (was never a “dream” of mine). I'm grateful for the doctors (shout out to my OB – good friend from medical school) and nurses that took care of me.]]>

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Finding the Best Independent Insurance Broker

This is a post about independent insurance broker Lawrence Keller, CFP®, CLU, ChFC, RHU, LUTCF. He is a sponsor of Wealthy Mom MD. Lawrence Keller


Besides disability insurance, do you sell other insurances?

Yes, besides disability insurance, I also sell term life insurance.

Are there any particular insurances that you think us physicians should be aware of?

When purchasing term life insurance, as you discussed previously, carriers look many factors. These may include height, weight, blood pressure, pulse, personal medical history, and family history. Ideally, you want to apply to for your life insurance with a company in which you have the best chance of receiving the most favorable underwriting classification and, thus, the lowest premium rate.

For example, if one has an immediate family history of Coronary Artery Disease (in a parent prior to age 65), they should consider which company they apply to. For instance, a company may not care if the family member was diagnosed with CAD; instead, they focus on if the individual passed away as a result. If they are alive and the proposed insured meets all of the other criteria, they would typically still qualify for the best underwriting classification. The same is true for cancer. Some carriers will take this family history into consideration and others will not.

While I do not sell Property & Casualty Insurance, physicians, in most cases, should have more coverage here. Specifically, they should carry an Umbrella or “Excess Liability” policy – especially if they drive a car. This extends the liability limits of your automobile and/or homeowner's insurance policies. You would likely want to purchase all of these from the same insurance company. In doing so, you can have them integrated and coordinated with each other, as well as, qualify for discounts.

How do you differ from other brokers?

I'm an academic at heart and understand the nuances of each policy available in the marketplace. I also have access to discounts, in many cases, including unisex rates for females. However, unlike other brokers, I don't advertise this or use it as a way to bring me new clients. If I find myself in a situation where I know that the potential client needs a product or discount that is “exclusive” and I cannot provide it, I will refer them to the “endorsed” agent. I do this knowing that I will not be compensated.

You never have a second chance at a first impression. I have found that the “goodwill” that this provides has done more for me than any commissions that I could have earned selling a product that was not in the best interest of the potential client.

Do you have any advice on how to choose an independent insurance broker and what makes someone a good broker?

I think a “good broker” possesses certain qualities. A good broker:

  • has a deep understanding of the marketplace,
  • represents several companies,
  • provides illustrations of coverage from each of them,
  • and takes the time to thoroughly review the differences.

An independent insurance broker who does these things helps clients make a decision that best meets their individual needs, goals and budget.

Beware of agents that are “captive” and can only offer policies to you from one company or have a strong financial incentive in to do so. The client should never feel that they were “sold” something or pressured to make a buying decision. The client should feel that their broker was a resource throughout the process. They should feel that they had their best interest in mind and made the process as enjoyable and informative as it could be.

I would also look an independent insurance broker with credentials and/or certifications in the insurance and/or financial planning industry. This shows dedication to the industry and the desire to learn. More so, these brokers usually have a good understanding of the financial planning process, not just disability and life insurance policies.

Finally, you will not be paying more for purchasing your policy from an experienced insurance agent than you would from an inexperienced insurance agent.

What are the top 3 things you see that physicians don’t understand about disability insurance?

Understanding Premium Pricing

If policies are structured the same way and all agents are showing policies with the same discounts, the premium rate will be the same. This industry is heavily regulated and the premium rates and contractual language must be approved by each state. Therefore, if the plan parameters are the same, the only way that one agent can provide a lower price to the consumer is by having access to or knowing of a discount plan that another agent does not.

Association Plans v. Individual Policies

Association plans (not individual policies that include an association discount) are inferior compared to individual policies. Typically, the policy can be cancelled by the association or insurance company. Also, premium rates can increase every five years (generally when your age ends in a “0” or a “5”). Plus, the definition of total disability is not “Own-Occupation” and you don't receive a policy. You simply receive a certificate that evidences that you are part of a larger group.

Understanding LTD Plans

When it comes to group LTD plans and individual policies, there is no such thing as a “primary” or “secondary” company. If you meet the definition of total disability under both policies, you can potentially collect full benefits under both policies.

Additionally, with the exception of those eligible to purchase coverage under “New In Practice” limits, generally, if you are going to be eligible for group LTD coverage with a new employer, it must be taken into consideration when determining the amount of individual coverage available and deferring enrollment into a mandatory group LTD plan to potentially allow you to purchase a larger amount of individual coverage does not work. If you submit a copy of your employment contract in order to purchase coverage based upon your “new” salary and it mentions that you will be provided with Long-Term Disability insurance, the underwriter will ask about this and, again, it will be taken into consideration when determining the amount of individual coverage available for purchase.

Finally, it does not matter if the group plan's definition of total disability is “Own-Occupation” or not. Instead, the insurance company must assume that if you are disabled, you can potentially collect under the group LTD plan. After all, the insurance companies to not want to give you an incentive not to work. That would allow you to make more money not practicing than if you continued to practice medicine.

Is there anything else you would like to tell us as an independent insurance broker?

The time to ask your questions is when you are researching the policies available. You don't want to find out that you purchased the wrong policy and then start doing your homework.

All too often, I see physicians in this situation that could have easily been avoided if they took the time to really understand what they were purchasing. Unfortunately, they don't have the ability to make changes based upon medical or financial issues that arise subsequent to the purchase of the policy or policies they no longer feel to be adequate.

I hope you enjoyed learning a bit more about Lawrence and independent insurance brokers!

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Insure against death

This post is sponsored by Lawrence Keller, CFP®, CLU®, ChFC®, RHU®, LUTCF,  an independent agent for several insurance companies. He has earned his reputation as the “go-to” agent for life and disability insurance for doctors and other highincome professionals.  If you wish to contact him you can call (516) 677-6211 or email [email protected]

Do you have life insurance? You need to unless you'll never have dependents – children, a spouse, parents perhaps. One of my mantras is to insure yourself against the top 4 financial catastrophes – death, disability, divorce, and liability.

There's a lot of confusion as to what life insurance product to buy, how much to buy, and for how long. For the overwhelming majority, term life insurance is the right product. Term life insurance is a product where you buy a certain amount for a certain amount of time (or term). If you die during the term, your beneficiaries receive the amount purchased tax-free. Typical terms are 10, 20 or 30 years.

You can also “ladder” policies meaning that you stack multiple policies with varying terms. For example, you purchase three policies: $1 million x 10 years, $1 million x 20 years, and $1 million x 30 years.   If you die in the first 10 years, your beneficiaries receive $3 million, if you die in the 2nd 10 years they get $2 million(as the $1 million x 10 years policy has expired), and if you die in the 3rd 10 years, they get $1 million.

You could just buy one $3 million x 30 year term but this is a lot more expensive and likely not necessary. The reason to decrease the payout amount over time is because your wealth will build and you will have enough to self-insure (retirement accounts, cash savings, debt elimination). Many factors determine your rate, here are a few:

  • Gender
  • Age
  • Health – personal and family medical history (cardiac disease, cancer)
  • Smoking status
  • Activities – rock-climbing, skydiving enthusiast, etc

How to buy term life insurance:

1. Determine how much you need and for how long The amount you need depends on what you want the life insurance money to be used for. If you die, you want enough money to cover funeral costs, any debts (mortgage, student loans, etc.), kids' childcare and college costs, or any other dependents that rely on your income. If you're married, do not underestimate the toll your death will take on your partner and other dependents; they may need to take some time off and get things in order. Wouldn't you want to give your partner (and kids) the time and freedom to do that? Also keep in mind that inflation will eat away at the amount as well. A good starting point is 7-10x of your income. For those who are divorced and have to cover multiple family interests please consult any divorce decree requirements and factor those requirements in as well. A sample calculation for someone who makes $250K:

  • $500K mortgage
  • 2 kids, $250K each for college
  • Funeral costs $10K
  • Income loss for remaining partner: depends if they work or not. Even if they work, their lifestyle and budget likely included your income too. So let's say you'll want $100K per year to reflect that (remember this money is tax-free). So this comes out to $1 million for every 10 year term.

This comes out to just over 2 million for a 10 year term. This amount may decrease as you build up retirement and other savings, 529 accounts, etc. Using the 7-10x rule of thumb this amount falls in that range ($1.75 to 2.5 million). A stay at home spouse needs to be insured as well. You may have heard that life insurance is only needed for those that make income. But a stay at home spouse is providing childcare and likely other household duties. You'll want to account for how much childcare would cost in the event of their death.

2. Get an idea of how much it will cost on You'll see that the price of the policy will differ widely depending on whether you are female or male, the term amount, the dollar amount, and health class.

3. Talk to a broker or agent You want to work with an independent agent or broker vs. an agent that only represents one company.  If you are working with a financial advisor it is wise to reach out and receive their input as well.

4. Seriously consider purchasing disability insurance if you don't have it already to save you another work-up. You will likely need medical underwriting to determine your health class. This involves blood work and a physical exam. These can also be used for disability insurance so that you don't need to repeat this again if you apply for it within a year (generally speaking).

Other caveats:

  • If you're a woman, I strongly recommend purchasing some as early as possible if you know you'll want children. If you wait until you're pregnant you may get dinged with a rider that any pregnancy related death won't be covered (same applies for disability insurance), or you may develop a pregnancy related condition such as gestational diabetes that will ding your health rating from the top class to the 3rd or 4th class. This will result in a significant increase of your annual premium. For example a 35 year old who applies for a $2 million x 30 year term would go from an annual premium of $1,265 to $2,105 if she develops gestational diabetes (numbers for Prudential).
  • Same advice applies to men since life insurance premiums are higher for men. This stuff is already cheap and cheaper the younger and healthier you are. You'll never be as young and healthier than now.
  • Banner (William Penn in NY) offers laddering within one policy vs. buying multiple policies to form a ladder. This saves you about $60 per policy bought.
  • You may hear of a “Waiver of Premium Rider”. This waives the premium on a term life insurance policy if the insured is disabled. Unless the insured plans on converting their term policy to Whole Life (and most insureds won't), one should not consider this rider as it can, generally, add 10-25% to the cost of the annual premium. I would recommend just getting enough disability insurance instead.

I've purchased 2 policies: $1 million x 20 year term, bought at age 38 (Banner, $496/year) with preferred health plus rating (the highest health rating). I also have $1 million x 15 year term bought at age 39 (William Penn, $382/year). And yes, I bought both from Lawrence Keller.

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