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LIFESHIELD STM LIFESHIELD STM.

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Presentation on theme: "LIFESHIELD STM LIFESHIELD STM."— Presentation transcript:

1 LIFESHIELD STM LIFESHIELD STM

2 Underwritten by LifeShield National Insurance Co.
Do Not Distribute For Training Purposes Only

3 Product Notes Affordable
Low out-of-pocket costs, including $30 or $40 copays for doctor’s office visits and $50 wellness care Reliable PHCS Network, giving members their choice of any doctor Valuable Variety of non-insurance benefits provide more than just great health coverage Exclusive New standard in STM coverage with exclusive partnership with LifeShield National Insurance Co., an A. M. Best B++ carrier ••Office visit should also include $40 copay Do Not Distribute For Training Purposes Only

4 Product Highlights Eligibility 18-64; child-only coverage age 2-25
Coverage Effective Date Next day coverage; later effective date available, but not to exceed 60 days from date of processed application Waiting Period 5 days for sickness; 30 days for cancer Do Not Distribute For Training Purposes Only

5 Product Highlights Deductible Options
$1,000, $2,500, $5,000, $7,500, $10,000 Coinsurance Options 100%/0%, 80%/20%, 70%/30% or 50%/50% Choice of Coverage Period Length 6 months or up to 364 days (may vary by state) Out-of-Pocket Maximum Amount $2,000, $3,000, $4,000 or $5,000 ••Need to add $10,000 ded ••Need to add 50% coinsurance ••Need to add $5,000 Out-Of-Pocket Max amount Do Not Distribute For Training Purposes Only

6 Plan Benefits Plan 1 w/ Pre-Ex Rider Plan 1 Plan 2 Coinsurance
70/30, 80/20, 100/0 50/50, 70/30, 80/20, 100/0 Deductible $1,000, $2,500, $5,000, $7,500 $1,000, $2,500, $5,000, $7,500. $10,000 Out-Of-Pocket Maximum $2,000, $3,000, $4,000 $2,000, $3,000, $4,000, $5,000 Coverage Period Maximum $250,000, $750,000, $1,000,000 Unless specified otherwise, the following benefits are for Insured and each Covered Dependent subject to the plan Deductible, Coinsurance Percentage, Out-Of-Pocket Maximum and Policy Maximum chosen. Benefits are limited to the Maximum Allowable Expense or each Covered Expense, in addition to any specific limits stated in the policy. Doctor Office Consultation  Copay $30 Copay, maximum 3 $40, unlimited Wellness Benefit Copay $50 Copay, maximum 1 $50 copay, maximum 1 Inpatient Hospital Services Average Standard Room Rate $1,000 per day Hospital ICU $1,250 per day Doctor Visits $50 per day, maximum $500 Subject to Coinsurance and Deductible Outpatient Services  Surgical Facility Outpatient Surgery Deductible N/A $500 Additional deductible applies, maximum 3 Emergency Room - deductible $500 Additional deductible applies Emergency Room - benefit $250 per visit Advanced Diagnostic Studies Deductible $500 per occurrence Ambulance Injury and Sickness: $250 per transport Injury and Sickness: $250 per transport Injury and Sickness: $250 per transport Extended Care Facility $150 per day, maximum 30 days Home Health Care $50 per visit, maximum 30 days Physical, Occupational and Speech Therapy $50 per day, maximum 20 visits Mental Disorders Inpatient $100 per day, maximum 31 days Outpatient $50 per day, maximum 10 visits Substance Abuse

7 What is Covered Benefits are limited to the Maximum Allowable Expense for each Covered Expense, in addition to any specific limits stated in the policy. Preventive / Wellness Care Doctor’s office consultation in excess of a $30 or $40 co-pay. This benefit is not subject to the Plan Deductible or Coinsurance Percentage Outpatient and Inpatient Treatment for Mental and Nervous Disorders Outpatient and Inpatient Treatment for Substance Abuse Organ and Tissue transplants Inpatient prescription drugs Physical, Occupational and Speech Therapy $50 per day and 20 visits combined Ambulance Transportation maximum benefit $250 Outpatient Hospital or Emergency Room Care Inpatient Room & Board, including Intensive Care Outpatient Miscellaneous Medical Services, doctors medical care and treatment performed in a hospital Home Health Care benefit $50 per visit for a maximum of 1 visit per day and 30 Home Health Care visits. Extended Care Facility up to $150 per day for a maximum of 30 days Outpatient Surgical Facility Surgeon services in the hospital or outpatient surgical facility ••Need to add $40 copay for office visits This is a brief description of the plan benefits, which may vary by state.

8 What isn’t Covered Loss caused by, contributed to or resulting from the following is excluded or otherwise limited as specified: 1. Pre-existing Conditions: a. Charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice, including diagnostic tests or medications, within the 60 month period immediately preceding such person’s Certificate Effective Date are excluded for the first 364 days of coverage hereunder. b. Pre-Existing Conditions includes conditions that produced any symptoms which would have caused a reasonable prudent person to seek diagnosis, care or treatment within the 60 month period immediately prior to the Covered Person’s Certificate Effective Date of coverage under the Policy. This exclusion does not apply to a newborn child or newborn adopted child who is added to coverage in accordance with PART II – ELIGIBILITY AND EFFECTIVE DATE OF INSURANCE. 2. Waiting Period: a. Covered Persons will only be entitled to receive benefits for Sicknesses that begin, by occurrence of symptoms and/or receipt of treatment, more than 5 days following the Covered Person’s Certificate Effective Date of coverage under the Policy. b. Covered Persons will only be entitled to receive benefits for Cancer that begins, by occurrence of symptoms or receipt of treatment more than 30 days following the Covered Person’s Certificate Effective Date of coverage under the Policy. 3. Charges during the first 6 months after the Certificate Effective Date of coverage for a Covered Person for the following: a. Total or partial hysterectomy, unless it is Medically Necessary due to a diagnosis of carcinoma; b. Tonsillectomy; c. Adenoidectomy; d. Repair of deviated nasal septum or any type of surgery involving the sinus; e. Myringotomy; f. Tympanotomy; g. Herniorraphy; or h. Cholecystectomy. However, if such condition is a Pre-Existing Condition, any benefit consideration will be in accordance with the Pre-Existing Conditions limitation.

9 What isn’t Covered 4. The benefits payable for the following conditions or procedures are limited to the specified amounts shown in the Schedule of Benefits: a. Kidney stones b. Appendectomy c. Joint or tendon Surgery d. Knee Injury or disorder e. Acquired Immune Deficiency Syndrome (AIDS)/ Human Immuno-deficiency Virus (HIV) f. Gallbladder Surgery 5. Charges which are not incurred by a Covered Person during his/her Coverage Period. 6. Charges which exceed any limits or limitations specified in this Certificate, including the Schedule of Benefits. 7. Charges for services of supplies in excess of the Maximum Allowable Expense. 8. Charges for services or supplies which are not administered by or under the supervision of a Doctor. 9. Mental, emotional or nervous disorders or counseling of any type, except as specifically covered as an Eligible Expense. 10. Marital counseling or social counseling. 11. Treatment for Substance Abuse, unless specifically covered under the Policy as an Eligible Expense. 12. Prescription Drugs, except those administered by a Doctor in an Inpatient or Outpatient setting covered under this Policy as an Eligible Expense. 13. Medications, vitamins, and mineral or food supplements including pre-natal vitamins, or any over-the-counter medicines, whether or not ordered by a Doctor. 14. Any drug, treatment or procedure that either promotes or prevents conception including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal of sterilization. 15. Any drug, treatment or procedure that corrects impotency or non-organic sexual dysfunction. 16. Modifications of the physical body in order to improve the psychological, mental or emotional well-being of the Covered Person, such as sex-change surgery. 17. Cosmetic Treatment, except for reconstructive surgery where expressly covered under the Policy. 18. Weight modification or surgical treatment of obesity. 19. Eye surgery, including LASIK, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism. 20. Dental Expenses, except as necessary to restore or replace sound and natural teeth lost or damaged as a result of an Injury. The Injury must be severe enough that the contact with the Doctor occurs within seventy-two (72) hours of the Accident, unless extenuating circumstances exist due to the severity of the Injury that prevent you from contacting the Doctor. This is a brief description of the plan limitations and exclusions, which may vary by state.

10 Product Notes KNOCKOUT QUESTIONS Colorado
1. Have you or any other person to be insured been covered under two or more nonrenewable short-term policies during the past twelve months? If “yes”, then this policy cannot be issued. You must wait six months from the date of your last such policy to apply for a short-term policy. 2. Is the Applicant or any Proposed Covered Person eligible for Medicaid or Medicare? 3. Is the Applicant or any Proposed Covered Person; a. Now pregnant, an expectant parent, in process of adoption or undergoing infertility treatment? b. Over 325 pounds if male, or over 275 pounds if female? 4. Will the Applicant or any Proposed Covered Person have any other group major medical health insurance or individual major medical health insurance in force on the requested effective date? 5. Within the last 5 years has any applicant been diagnosed with, received treatment, abnormal test results, medication, consultation for, or had symptoms of: Insulin or medication dependent diabetes except gestational, stroke, transient ischemic attack (TIA), cancer or tumor except basal cell skin cancer, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, systemic lupus, chronic obstructive pulmonary disease (COPD), emphysema, cystic fibrosis, hepatitis C, multiple sclerosis, muscular dystrophy, alcohol or drug abuse; bipolar disorder or schizophrenia; hospitalization for mental disorder, an eating disorder; or any diseases or disorders of the following: liver, kidney, blood, pancreas, lung, brain, heart or circulatory including heart attack or catheterization? 6. Within the past 5 years, has the Applicant or any Proposed Covered Person been diagnosed or treated by a physician or medical practitioner for Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or tested positive for Human Immunodeficiency Virus (HIV)? If the Applicant and all Proposed Covered Person(s) are United States citizens, please answer “No” to this question. If the Applicant or any Proposed Covered Person is not a United States Citizen, has that person resided outside the United States for more than 4 weeks over the last 364 days?

11 Product Notes KNOCKOUT QUESTIONS The Applicant or Proposed Insured is not eligible for this coverage if any question is answered “Yes.” Virginia Is the Applicant or any Proposed Covered Person; a. Now pregnant, an expectant parent, in process of adoption or undergoing infertility treatment? b. Over 325 pounds if male, or over 275 pounds if female? Will the Applicant or any Proposed Covered Person have any other group major medical health insurance or individual major medical health insurance in force on the requested effective date? Within the last 5 years has any applicant been diagnosed with, received treatment, abnormal test results, medication, consultation for, or had symptoms of: Insulin or medication dependent diabetes except gestational, stroke, transient ischemic attack (TIA), cancer or tumor except basal cell skin cancer, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, systemic lupus, chronic obstructive pulmonary disease (COPD), emphysema, cystic fibrosis, hepatitis C, multiple sclerosis, muscular dystrophy, alcohol or drug abuse; bipolar disorder or schizophrenia; hospitalization for mental disorder, an eating disorder; or any diseases or disorders of the following: liver, kidney, blood, pancreas, lung, brain, heart or circulatory including heart attack or catheterization? Within the past 5 years, has the Applicant or any Proposed Covered Person been diagnosed or treated by a physician or medical practitioner for Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or tested positive for Human Immunodeficiency Virus (HIV)? If the Applicant and all Proposed Covered Person(s) are United States citizens, please answer “No” to this question. If the Applicant or any Proposed Covered Person is not a United States Citizen, has that person resided outside the United States for more than 4 weeks over the last 364 days?

12 Product Notes KNOCKOUT QUESTIONS The Applicant or Proposed Insured is not eligible for this coverage if any question is answered “Yes.” All other states 1. Is the Applicant or any Proposed Covered Person eligible for Medicaid or Medicare? 2. Is the Applicant or any Proposed Covered Person; a. Now pregnant, an expectant parent, in process of adoption or undergoing infertility treatment? b. Over 325 pounds if male, or over 275 pounds if female? 3. Will the Applicant or any Proposed Covered Person have any other group major medical health insurance or individual major medical health insurance in force on the requested effective date? 4. Within the last 5 years has any applicant been diagnosed with, received treatment, abnormal test results, medication, consultation for, or had symptoms of: Insulin or medication dependent diabetes except gestational, stroke, transient ischemic attack (TIA), cancer or tumor except basal cell skin cancer, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, systemic lupus, chronic obstructive pulmonary disease (COPD), emphysema, cystic fibrosis, hepatitis C, multiple sclerosis, muscular dystrophy, alcohol or drug abuse; bipolar disorder or schizophrenia; hospitalization for mental disorder, an eating disorder; or any diseases or disorders of the following: liver, kidney, blood, pancreas, lung, brain, heart or circulatory including heart attack or catheterization? 5. Within the past 5 years, has the Applicant or any Proposed Covered Person been diagnosed or treated by a physician or medical practitioner for Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or tested positive for Human Immunodeficiency Virus (HIV)? 6. If the Applicant and all Proposed Covered Person(s) are United States citizens, please answer “No” to this question. If the Applicant or any Proposed Covered Person is not a United States Citizen, has that person resided outside the United States for more than 4 weeks over the last 364 days?

13 Reapply Rules Arizona – 1 reapply of 180 days or less in any 12-month period Colorado – Cannot exceed 2 STM polices (any carrier) in a 12-month period West Virginia – Reapplies are not allowed

14 Disclaimer THIS IS A SHORT-TERM LIMITED DURATION HEALTH INSURANCE POLICY THAT IS NOT INTENDED TO AND DOES NOT QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A POLICY THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH INSURANCE POLICY THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES.

15 The Med-Sense Guaranteed Association (MSGA), is a not-for-profit organization that provides memberships to individuals. Members enjoy access to a variety of health, travel, consumer discounts and business services. Do Not Distribute For Training Purposes Only

16 Med-Sense Guaranteed Association
You can count on MSGA to continuously and aggressively seek out new discounts to add further value to memberships in the association. Services and discounts you will enjoy as a member may include a collection of the following: 1800Flowers.com Savers Book Club UPS Express Delivery Services Office Depot Office Supplies and Furniture Hop The Shops True Car Auto Buying Service Vitamin Discount GymAmerica.com Scholarships ID Resolutions Identity Theft Service Sprint Cell Phone Service Lenscrafter Vision Club 24 Hour Nurse Helpline Plan Gateway Medicard Discount Hearing Service Travel Assistance Benefits Hewlett- Packard Computer and Digital Equipment

17 Get Even More It’s Smart It’s Easy
There are no fees or charges to enroll, and it never expires It’s Smart Save an average of 46%*. You can use this card for the whole family, including pets. It’s Easy Save at more than 60,000 pharmacies nationwide, including Walmart, Target, Walgreens and more. Find participating pharmacies here. ScripPal Disclaimer: DISCOUNT ONLY - NOT INSURANCE. Discounts are available exclusively through participating pharmacies and providers. The range of the discounts will vary depending on the type of provider and services rendered. This program does not make payments directly to providers. Members are required to pay for all health care services. You may cancel your registration at any time or file a complaint by contacting Customer Care. This program is administered by Medical Security Card Company, LLC of Tucson, AZ.** Based on 2013 national program savings data.

18 What is Teladoc? When can use Teladoc? What can I use it for?
Benefit that gives you 24/7/365 access to U.S. board-certified doctors who can resolve many of your medical issues via phone or online video When can use Teladoc? When you need care now If you’re considering the ER or urgent care center for a non-emergency issue On vacation, on a business trip, or away from home For short-term prescription refills What can I use it for? Cold and flu symptoms Bronchitis Respiratory infection Sinus problems Allergies Urinary tract infection Pink eye Ear infection Visit: | Call: Tel-adoc

19 We make healthcare work.
WW Save time and money Real Results We make healthcare work. Providing personalized service, Karis360’s team of expert Patient Advisors work with members to assist in navigating the confusing and expensive world of healthcare. With a suite of dedicated services, Karis360 will help you take the hassle out of health care saving you valuable time and money. Simple. Comprehensive. Enjoyable. Karis360 helps resolve healthcare needs from start to finish Karis360 saves time and frustration - rescuing members from overwhelming situations Karis360 provides unlimited assistance from a skilled Advisor

20 Start Selling Become a licensed agent to sell LifeShield STM.
HOW TO GET STARTED Become a licensed agent to sell LifeShield STM. Pre-appointment in KS and SD “Just in time” appointments in all other states Begin quoting immediately. Links are available in your Agent portal. Need to get appointed? Contact Sales Support at to complete your appointment forms to start selling. Sales verification: All agents selling through HII are required to use one of the following verification options. 1. Agent s the link to the client. Client Self-Enrolls on home computer; or 2. Agent completes a full voice verification using the approved carrier script, or 3. Client uses Ink

21 Low cost options for preventative care with $50 wellness copay
Start Selling WHY YOUR CUSTOMERS WILL BUY Low cost options for preventative care with $50 wellness copay Flexibility on provider network, letting them choose who they want to see Do Not Distribute For Training Purposes Only

22 Start Selling WHY YOU SHOULD SELL Exclusive plan with A.M. Best B++ rated carrier, paying you top commissions Low cost plan options gives you flexibility to sell to wider demographic Do Not Distribute For Training Purposes Only


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