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WHAT’S WRONG WITH SMALL GROUP BENEFITS UNDERWRITING? 1. Employees with health issues cannot qualify for plans they need, unless other employees also buy.

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Presentation on theme: "WHAT’S WRONG WITH SMALL GROUP BENEFITS UNDERWRITING? 1. Employees with health issues cannot qualify for plans they need, unless other employees also buy."— Presentation transcript:

1 WHAT’S WRONG WITH SMALL GROUP BENEFITS UNDERWRITING? 1. Employees with health issues cannot qualify for plans they need, unless other employees also buy the same plan. 2. Participation requirements are a hassle to achieve. 3. Guaranteed-issue face amounts for small groups are too small. 4. Plans are too expensive for employer to purchase. 5. Some employers are too small to qualify for good benefits. A HOT NEW CONCEPT APPROVED FOR TEXAS OVERCOMES THESE CHALLENGES EMPLOYER’S DEFINED CONTRIBUTION PLANS FOR GROUPS 2 – 99 GUARANTEED-ISSUE (GI) WITH MINIMAL PARTICIPATION REQUIREMENTS, EVEN IF ONLY ONE EMPLOYEE PARTICIPATES PER PRODUCT* A+ RATED CARRIER IN BUSINESS SINCE 1971 AGENT / MARKETING CONTRACTS AVAILABLE *LTD REQUIRES TEN EMPLOYEES AND AT LEAST TWO PARTICIPANTS. ALL OTHER VOLUNTARY PLANS REQUIRE A MINIMUM TWO EMPLOYEES ON PAYROLL AND ONLY ONE PARTICIPANT.

2 A Defined Contribution Approach Approach to Ancillary Benefits to Ancillary Benefits This innovative “Defined Contribution” approach allows employees to select specific benefits with premium dollars provided to them by their Employer. The employee may also select additional benefits through the ease of payroll deduction Where Employees choose the benefits THEY WANT! Contribution Enrollment

3 EmployerContribution Requirements Requirements Minimum employer contribution is $15/$30 or $50 PEPM for benefits, however there is no limit. Think of it as handing the employee a gift card to use at the benefits store - most employees will spend more than the contribution from the employer. $15 minimumNo maximum The dollar amount the employer chooses for the employee’s PEPM, will become the employer’s Defined Contribution amount.

4 Benefit Options The employer may choose any combination of the following benefits to make available to employees: Base Life / AD&D* Voluntary Life Long Term Disability** Short Term Disability Dental Vision Most* products are guaranteed-issue, even if only one employee participates per product. Up to $150,000 Guarantee Issue when Basic and Voluntary Life or chosen *100% participation needed when offering Employer paid Life/AD&D ** Available for 10+ groups

5 Defined Contribution Plan Offerings Plan Offerings Employer chooses products and plan options Life / AD&D Voluntary Life Short Term Disability Dental Vision Long Term Disability

6 Life / AD&D Voluntary Life Short Term Disability Dental Basic Life / AD&D Employer Selects One of the following Benefits: Base Life AD&D 1. $25,000 $25,000 2. $50,000 $50,000 Dependent Life Insurance: Spouse: $5,000 Children : 14 Days to 6 Months: $100 6 Months & Over: $5,000 *100% participation needed when offering Employer paid Life/AD&D Employer Paid Life Vision Long Term Disability

7 Life / AD&D Voluntary Life Short Term Disability Dental Voluntary Life - Voluntary Life - AD&D Included Employee then has the Option of: up to $100,000 (age 65 and under) is Guarantee Issue if you enroll when initially eligible Spouse Coverage guarantee-issue up to 50% of Employee Amount up to $50,000 $25,000 to $250,000 of Voluntary Term Life Child(ren) Options of: $2,500, $5,000, $7,500 or $10,000 Abbreviated overview – see proposal for more details $100,000 GI Long Term Disability Vision

8 Life / AD&D Voluntary Life Short Term Disability Dental Short Term Disability Benefits Begin Employer chooses 1 from following plan designs: Accident Sickness Benefit Amount Weekly Benefit Maximum Benefit Period Maternity is covered Plan 1 Plan 2 Plan 3 8 60% $1,250 13 Weeks 8 60% $1,250 26 Weeks 15 60% $1,250 52 Weeks Guarantee Issue with 12/12 Pre-X Abbreviated overview – see proposal for more details 3 Standard Plan Optons Long Term Disability Vision

9 Life / AD&D Voluntary Life Short Term Disability Dental Long Term Disability 2 Lives Minimum Participation Abbreviated overview – see proposal for more details Groups 10 – 99 Lives Long Term Disability Vision All active, full-time employees Groups 10-99 lives / 2 lives minimum participation Benefit Replacement Percentage 10-24 eligible lives: up to $3,000 per month 25-99 eligible lives: up to $5,000 per month Benefit Duration2-years5-yearsSSNRA Elimination Period90 or 180 days Social Security Benefit IntegrationSocial Security Definition of Disability24 months own occ Work Incentive Benefit Duration12 months Minimum BenefitAdd $100 minimum or 10% LTD Benefits Partial DisabilityResidual w/12 month WIB Mental & Nervous Condition24 month limit Pre-existing Conditions12/6/24 Rate Guarantee2 Years Late EntrantsMedical underwriting Waiting Period90 days Other Standard Features Full Maternity Benefits Social Security Assistance Survivor Benefit (3 months) Vocational Rehabilitation BenefitContinuity of CoverageWaiver of Premium Workplace Modification BenefitCost of Living Freeze Abbreviated overview – see proposal for more details.

10 Life / AD&D Voluntary Life Short Term Disability Dental Dental Employer May Choose 2 of the following plan designs: Preferred Takeover on All Groups – Rates Guaranteed for 24 Months Option 1 Option 2 Option 3 Option 4 Deductible Family Limit Waived for Preventative Type I Preventative Type II Basic Services Type III Major Services Annual Maximum Type IV Orthodontia Lifetime Maximum $50 Contract year 3 Yes 100% 80% Endo/Perio 50% $2,000 50% $2,000 $50 Contract year 3 Yes 100% 80% Endo/Perio 50% $1,000 50% $1,000 $100 Lifetime No Limit No 100% 80% 50% Endo/Perio $1,000 50% $1,000 $100 Lifetime No Limit No 100% 80% 25% Endo/Perio $500 0% Not Available Abbreviated overview – see proposal for more details Dentist in Mexico are acceptable Choose Any Dentist Vision Long Term Disability

11 Life / AD&D Voluntary Life Short Term Disability Dental Vision Employer chooses 1 of the following Options: In Network Member Cost Exam Only Option Exam & Eyewear Option Vision Exam Standard Lenses Lens Options UV Coating Tint Scratch Resistance Polycarbonate Anti Reflective Coating Progressive Other Add-ons Frames Contact Lenses Conventional Disposable Standard Fit & Follow-up Premium Fit & Follow-up Medically Necessary Abbreviated overview – see proposal for more details $10 co-pay $50/$70/$105 $15 $40 $45 $65 20% off retail 35% off Retail with Eyeglass purchase 15% off retail N/A $10 co-pay $15 $40 $45 $65 20% off retail 20% off balance over $130 15% off balance over $120 allowance $0 for Fit and 2 follow-up visits 10% off Retail Charge less $55 $0 EyeMed Network Vision Long Term Disability

12 The Added Benefits are Included with every Defined Contribution Plan sold at no Extra cost. ADDED BENEFITS Hearing Services Plan Global Emergency Services Vision Discount Plan Global Dental Tourism

13 Agent and Marketing Contracts Available Marketed in Texas exclusively by: National MGA Insurance Alliance, Inc. 210-340-0470 / 956-982-3998 Simplicity ER Sets Contribution Easy Set-up Employee Choice Census Enrollment Case Setup


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