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FIRSTChoice “ Guaranteed Issue ” Health Insurance Plans Underwritten by: Central United Life Insurance Company Marketed by: BMC Agency, Inc.

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Presentation on theme: "FIRSTChoice “ Guaranteed Issue ” Health Insurance Plans Underwritten by: Central United Life Insurance Company Marketed by: BMC Agency, Inc."— Presentation transcript:

1 FIRSTChoice “ Guaranteed Issue ” Health Insurance Plans Underwritten by: Central United Life Insurance Company Marketed by: BMC Agency, Inc.

2 This PowerPoint presentation is intended strictly as a training tool for licensed FIRSTChoice agents, as well as an information source for prospective agents to evaluate the product. It is expressly forbidden to be used in any sales situation or public venue, in whole or in part.

3 BMC Agency, Inc. has a “ZERO TOLERANCE” policy in which any violation of this “Agent Eyes Only” rule by any FIRSTChoice representative may result in their immediate termination WITH CAUSE!

4 FIRSTChoice Guaranteed Issue Health Plans Central United Life is a member of the Manhattan Insurance Group, whose Worksite strategy is to offer sound, affordable products that meet the demands of even the most sophisticated of Policyholders. CUL has focused on the acquisition of life, accident and health insurance for more than 20 years.

5 Since the introduction of the first “Guaranteed Issue” Health Insurance supplement for individuals in 2003, BMC Agency, Inc. has remained committed to refining and revolutionizing the individual health insurance marketplace. This is why CUL chose BMC to assist in the development and promotion of their incredible FIRSTChoice series. FIRSTChoice Guaranteed Issue Health Plans

6 Who qualifies for “Guaranteed Issue” Consideration? Individuals age who work an average of 30+ hours per week, their spouse ( if ) and their children.

7 FIRSTChoice Guaranteed Issue Health Plans Once issued, the plans are GUARANTEED RENEWABLE to age 65, so long as premiums are paid when due. It is not necessary to maintain ‘full time’ employment status once a FIRSTChoice plan is issued!

8 FIRSTChoice Guaranteed Issue Health Plans How are Pre Existing Conditions treated? Conditions for which an insured sought or received medical treatment in the 12 months prior to application date, or which manifest symptoms that would have caused an ordinarily prudent person (a person of average intelligence) to have done so will not be covered for 12 months after the effective date, whether or not they are disclosed on the application.

9 FIRSTChoice Guaranteed Issue Health Plans Are there any Ineligible Conditions or Ineligible Occupations with FIRSTChoice? NO! Individuals working an average of 30+ hours per week may apply regardless of their Occupation or Pre-Existing conditions!

10 FIRSTChoice Guaranteed Issue Health Plans Most FIRSTChoice plan designs include a unique combination of features that provide significant “front loaded” benefits when they are needed the most. There are three separate benefits designed to provide cash for the expense of the hospital room when confined. 1) The Daily Room Benefit 2) The Indemnity Benefit 3) The First Hospital Confinement Benefit

11 FIRSTChoice Guaranteed Issue Health Plans The Daily Room Benefit is paid for up to 365 days per period of confinement, currently much longer than any competitor. ( Others are usually 30 or 31 days maximum )

12 FIRSTChoice Guaranteed Issue Health Plans The Indemnity Benefit is paid on the first day of hospital confinement in any calendar year.

13 FIRSTChoice Guaranteed Issue Health Plans The First Hospital Confinement Benefit is paid during the first period of hospital confinement of any calendar year. Depending on the plan selected, it can be as much as $10,000 over the first 6 days, in addition to any and all other benefits!

14 The First Hospital Confinement Benefit in both the GOLD and PLATINUM plan designs pays as follows: FIRSTChoice Guaranteed Issue Health Plans Day 1: $1,000 Day 2: $1,000 Day 3: $2,000 Day 4: $2,000 Day 5: $2,000 Day 6: $2,000 TOTAL: $10,000 If a period of confinement lasts less than 6 days, the balance of the benefit is available for a subsequent confinement for the same condition, provided it occurs within 6 months.

15 FIRSTChoice Guaranteed Issue Health Plans There are THREE important areas that must be considered when selecting which Guaranteed Issue plans to market. We feel that the FIRSTChoice Plan Series is superior to the competition in all three! 1) PLAN DE$IGN 2) PREMIUM$ 3) COMPEN$ATION

16 FIRSTChoice Plan Design The FIRSTChoice PLATINUM Plan has 9 separate benefits, including the 4 most significant, that are equal to or superior to ANY OTHER GUARANTEED ISSUE plan currently available!

17 As of 7/27/10 FIRSTChoice PLATINUM PLAN USA+ Secure Advantage 2000 Core Value 1000 MAXeHealthStarrGetMed 360AIM Health Max Plus Daily Room Benefit $2,500 days 1,3, 4, 5,& 6 $1,500 day two $500 days $2,000/day Up to 31 days/yr $1,000/day Up to 30 days/yr. $1,000/day Up to 30 days/yr. Then 3x $500/day $1,000/day x 31 $2,000 first day + $1,000/day for 100 days per year Intensive Care $2,000/day Up to 20 days/yr. IN ADDITION to DRB $2,000 days 2-31 IN LIEU of DRB $1,000/day up to 5 days/yr., IN ADDITION to DRB X $2,000/day Up to 15 days/yr. $1,000/day Up to 15 days/yr. Surgery $10,000 Schedule Unlimited Times $100% of Medicare RBRVS 100% of RBRVS not to exceed charges $100% of Medicare RBRVS $10,000 Schedule Max of 2 Times/yr. $100% of Medicare RBRVS Anesthesia25% of Surgical benefit 20% of Surgery benefit 25% of Surgical benefit Wellness $400 mammogram, $200 PSA, $100 PAP $30 X 1 visit/yr or $20 Copay "in network" 1 X $150/yr.$100 x one visit/yr. $20 Copay X 5 in network $40 X 5 out of network $150 x 1 per year X-Ray / Labs X1 X CWE at DirectLabs$75 X 5/yr. 3 visits/yr 100% coins. to $1,000 annual max, shared with Dr. Office benefit Up to $100 x 3/yr.$400 x 5/yr. Maternity Covered as any illness 10 month wait XXXX Covered as any illness 12 month wait OP Sickness ( Doctor's Office ) 4 X $100 per insured category+ 5 X $30 or $20 Copay "in network" $75 X 5/yr. 5 X $30 Copay, 100% coins. to $1,000 annual max $20 copay X 5 in network $40 X 5 out of network $100 x 7 per year Emergency Room Increases OP Sick. benefit to $150 1 per year up to $100X $100 per visit, 1 visit per year Max of 2 visits to receive Max of $1,000.yr. $100 ded. per visit X Prescription Medicine X Companion Life RX benefit 4-Tiered Rx Discount Rx Discount ProgramX Generic Copay + Brand Name discount card Critical Illness XXXX$10,000$5,000 Private Duty Nursing $250/day for 20 days/yr. XXXXX AD&D$30,000$10,000XX$15,000X Accident % of $1,800 schedule + 4 X $200 per accident 1 per year. $ $200 ded. $5,000 annual max $100 ded, then 80% X $5,000 less $100 ded. All other benefits pay first. X Mental HealthXX 60 x $500/day Inpatient 10 x $25 Outpatient 60 x $500/day Inpatient 40 x $50 -75% Coins. Outpatient XX Substance Abuse XX 60X $500/day inpatient 20 x $25 outpatient ( Combined with Mental Health benefit above ) XX Ambulance$300/trip, one trip/yr.1 x up to $100/yr.X PRICE$241.00/mo.$370/mo.$282.72/mo.$334/mo.$329.90$349/mo.

18 As of 7/27/10 FIRSTChoice GOLD PLAN USA+ Essential Health 1000 Core Value 1000 eHealthStarr Starr 500 GetMed 360 Platinum 250 Value Health Plan Diamond Plan Daily Room Benefit $2,100 days 1,3, 4, 5,& 6 $1,400 day two $400 days $1,000/day Up to 31 days/yr $1,000/day Up to 30 days/yr. $500/day Up to 30 days/yr. $250/day x 31 $1,000/day Up to 30 days/yr. Intensive Care $1,000/day Up to 20 days/yr. IN ADDITION to DRB $2,000 days 2-31 IN LIEU of DRB! XX $1,000/day Up to 15 days/yr. $3,000/day Up to 14 days/yr. IN LEU of DRB! Surgery $5,000 Schedule Unlimited Times $100% of Medicare RBRVS 80% of RBRVS not to exceed charges $80% of Medicare RBRVS $10,000 Schedule Max of 2 Times/yr. $8,000 Schedule Anesthesia25% of Surgical benefit 25% of Surgical benefit, Max of $500 20% of Surgery benefit 25% of Surgical benefit20% of Surgical benefit Wellness $200 mammogram, $100 PSA, $50 PAP $30 X 1 visit/yr or $20 Copay "in network" 1 X $150/yr.$100 x one visit/yr. $20 Copay X 5 in network $40 X 5 out of network X X-Ray / Labs X1 X CWE at DirectLabs$75 X 3/yr. 3 visits/yr 80% coins. to $1,000 annual max, shared with Dr. Office benefit XDiscount Maternity Covered as any illness 10 month wait XXXXX OP Sickness ( Doctor's Office ) 4 X $75 per insured category+ 5 X $30 or $20 Copay "in network" $75 X 3/yr. 5 X $30 Copay, 100% coins. to $1,000 annual max $20 copay X 5 in network $40 X 5 out of network $75 X 5/yr. Emergency Room Increases OP Sick. benefit to $ per year up to $100X $75 per visit, 1 visit per year Max of 2 visits to receive Max of $1,000.yr. $100 ded. per visit X Prescription MedicineXX 4-Tiered Rx Discount Rx Discount ProgramXDiscount Critical Illness XXXXXX Private Duty Nursing $150/day for 20 days/yr. XXXXX AD&D$20,000$10,000XX$15,000X Accident % of $1,800 schedule + 4 X $150 per accident 1 per year. $ $200 ded. $5,000 annual max $100 ded, then 80% X $5,000 less $100 ded. All other benefits pay first. $75/visit X 2 visits/yr. Mental HealthXX 60 x $500/day Inpatient 10 x $25 Outpatient 60 x $250/day Inpatient 40 x $50 -75% Coins. Outpatient XX Substance Abuse XX 60X $500/day inpatient 20 x $25 outpatient ( Combined with Mental Health benefit above ) XX Ambulance300/ trip, max of 1 trip/yr.X$100/trip X 2 trips/yr. PRICE $156/mo.$245/mo.$282.72/mo.$241/mo.$ = $85/mo * =$180/mo =$266/mo. * =$288/mo.

19 FIRSTChoice Plan Design Remember that all FIRSTChoice plans are GUARANTEED RENEWABLE POLICIES, not certificates of some Group Master policy or Association Plan. This provides much greater protection for the insureds!

20 FIRSTChoice Plan Design FIRST Choice Plans are true “Defined Benefit” plans. As such, the stipulated benefit is always paid in full, regardless of the billed amount. There is no “pays UP TO $$$” language in FIRST Choice policies!

21 FIRSTChoice Plan Design Unlike the competition, many of which have no benefit for Intensive Care, or pay it “in lieu” ( instead of! ) the DRB, FIRSTChoice policies pay all Intensive Care benefits IN ADDITION TO any and all other benefits of the policy, including the DRB. This is a HUGE advantage to the policyholder!

22 FIRSTChoice Plan Design Virtually ALL Guaranteed Issue Plans address SURGERY in one of two ways. Many pay a percentage, often 100%, of the Medicare reimbursement rate ( RBRVS, or Resource Based Relative Value Scale ). What many agents and most clients do not realize is that this amount IS NOT based upon the total cost of the procedure, but simply on the amount charged by the PRIMARY SURGEON ONLY! This does not include the Operating Room, Suture Kits, dressings, etc.!

23 Another problem is this; at a time when an estimated 46% of doctors are threatening to boycott Medicare over what they feel is inadequate compensation, how will a client under age 65, and not covered by Medicare, compel their doctor to accept this discounted amount? FIRSTChoice Plan Design

24 The rest address Surgery with an established Surgical Schedule, usually with a maximum benefit of $10,000. Often, the benefit from a $10,000 Surgical Schedule will be more than for the identical procedure under a 100% RBRVS Medicare Reimbursement rate!

25 FIRSTChoice Plan Design One drawback to most plans with Surgical Schedules is that they tend to limit coverage to one or two surgical procedures per year, maximum!

26 FIRSTChoice Plan Design FIRSTChoice incorporates the best of both, with a $10,000 Surgical Schedule that can be accessed an UNLIMITED number of times each year, for either inpatient or outpatient procedures!

27 The FIRSTChoice benefit for Anesthesia is the highest percentage paid, 25% of the amount paid for Surgery. Since our Surgical Schedule will deliver more benefits and do it more often than other plans, the Anesthesia Benefit is correspondingly higher as well! FIRSTChoice Plan Design

28 Unlike the vast majority of competitors, FIRSTChoice plans provide benefits for MATERNITY, both Natural Delivery as well as Caesarian Section, effective 10 months after the policy effective date!!

29 FIRSTChoice Plan Design FIRSTChoice plans are the only “Guaranteed Issue” plans currently known to include Private Duty Nursing benefits. The Platinum Plan also has the highest levels of AD&D protection, $30,000!

30 FIRSTChoice Plan Design The total paid for an Accident will come from several different plan benefits. They are: 1)Accident Rider 2)Specific Injury Rider 3)Surgery Schedule, with Anesthesia

31 FIRSTChoice Plan Design Accident Rider: Pays a (first dollar) benefit for each accident. Specific Injury Rider: Pays as much as $1,800 per accident from a (first dollar) schedule of procedures. Surgery Schedule: Pays a (first dollar) percentage of the Surgery Schedule, plus 25%+ for anesthesia!

32 FIRSTChoice Plan Design There are benefits absent from FIRSTChoice that appear with other Guaranteed Issue plans. They include Prescription Drugs, Outpatient Labs & X-Rays, Critical Illness, and “Association Junk”

33 FIRSTChoice Plan Design Prescription Drugs tend to fall into one of two categories, Maintenance Drugs and Occasional Drugs. Let’s consider each!

34 FIRSTChoice Plan Design Maintenance Drugs are taken regularly, and are often available in generic or generic equivalents. Literally hundreds are available at discount chains, often for $4.00 each, or less! These are less expensive than when using a discount drug card!

35 Maintenance Drugs can also be very expensive. For that reason, ALL BMC Agents are provided access to a quality PPO repricing and Discount Medical benefits card. This optional benefit can reduce the cost of procedures by 30% and more! FIRSTChoice Plan Design

36 Occasional Drugs are most commonly Antibiotics, used infrequently, and Pain Medication, usually very inexpensive. We believe it is less costly over time for the client to ‘pay as you need’ these, as opposed to building in costs that drive up plan premiums. FIRSTChoice Plan Design

37 X-Rays and Lab tests are legitimate medical procedures, but have become abused as doctors increasingly practice ‘defensive medicine.’ We have chosen to avoid coverage for these elements in favor of additional coverage for expensive confinements/procedures.

38 FIRSTChoice Guaranteed Issue Health Plans Critical Illness plans normally require even more scrutiny in underwriting than Major Medical. To include CI benefits within a Guaranteed Issue program adds a disproportionately high premium cost that we feel is an ineffective use of our clients premium dollars.

39 Prior to 2003, the only option for “Uninsurable” clients was an expensive ‘state pool’ or an “Association Package” that featured “discounts” on some medical services, but mostly benefits unrelated to Health Insurance. FIRSTChoice Plan Design

40 Today, even though numerous “Guaranteed Issue” plans exist that feature solid Health Insurance benefits, most plans are still littered with movie tickets, rental cars, Disney discounts, and vitamins. With FIRSTChoice, you get quality INSURANCE BENEFITS, period.

41 FIRSTChoice Plan Design By limiting eligibility to employees who work an average of 30+ hours/week, and avoiding marginal benefits subject to abuse, we are able to provide what we believe to be the strongest package of “Guaranteed Issue” benefits available in our industry today!

42 FIRSTChoice Premiums Ranging from the HSA Supplement for less than a dollar a day, to the PLATINUM plan design with the richest benefits available in any Guaranteed Issue chassis, FIRSTChoice plan designs are available in a variety of configurations, all of which are lower in price than competitor plans with fewer and smaller benefits!

43 FIRSTChoice COMPEN$ATION Almost all “Guaranteed Issue” plans today pay a ‘levelized’ commission, and very few offer annualization. FIRSTChoice plans provide ‘heaped’ first year commission with 6 months advanced commissions available to agents that qualify!

44 The highest commission levels available from competitors for top IMO/FMO contracts is 30% First Year Commission. ********************************************************************************************************************* This same 30%, (with 8 % renewals), is what we pay AGENTS with FIRSTChoice! FIRSTChoice COMPEN$ATION

45 Higher Contracts can be earned by General Agencies and Managers with active production teams. Details are available from the BMC Marketing Partner that provided you with this PowerPoint presentation!

46 BMC Agency, Inc. and CUL FIRSTChoice STRONG BENEFITS! ************************************************************************************************************ Low Premiums! *********************************************************************************************************** High Compensation! ************************************************************************************************************** “The FIRSTChoice in Guaranteed Issue Health Plans!”


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