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Assurant Health. 2 Charging Face of Health Care There have been many economic and political changes in the last year – Health Care Reform – Increase in.

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Presentation on theme: "Assurant Health. 2 Charging Face of Health Care There have been many economic and political changes in the last year – Health Care Reform – Increase in."— Presentation transcript:

1 Assurant Health

2 2 Charging Face of Health Care There have been many economic and political changes in the last year – Health Care Reform – Increase in major medical insurance premiums – Confusion in the marketplace Despite these changes, the basic consumer need HAS NOT changed – Affordable health care – Access to care – Network discounts – Great customer experience – Reputable “A” rated carrier

3 3 Access to Health Care Asset Protection 1 st Dollar Benefit Fixed Benefit Wellness / Rx Lower Premium Deductible Unlimited Benefit Wellness / Rx Higher Premium Assurant Health Access SM Supplemental Coverage Major Medical Products Supplemental Coverage Health Savings Accounts Broad portfolio to meet spectrum of needs 3

4 Having Access Pays SM Assurant Health Access SM

5 5 Alternative to traditional medical insurance Assurant Health Access is suite of limited benefit plans Value Plan Fundamentals Plan Enhanced Plan Pays a fixed benefit for each service, regardless of actual charges

6 6 Assurant Health Access √ Value √ Access to immediate medical care √ Benefits for hospitalization √ Benefits for surgery √ Outpatient services √ No deductible, co-pay or coinsurance √ National network discounts

7 7 Consumer Value and Education Patient Care – Independent health care advocacy for routine or non-emergency care – Recommends quality doctors/facility that cost you the least Network Discounts Medco Pharmacy Retail Clinics – Negotiated fee of $65 at Walgreen’s Take Care Clinic Health Payment Advocates (HPA) – Use professional negotiators at HPA to reduce any outstanding bills or set up a payment plan

8 8 Looking for affordability Don’t see value in traditional medical plans – Meeting a high deductible is not an option Place highest value on access to basic health care – They need to stay healthy to keep working – If something really bad happens … they’ll deal with it Haven’t had coverage or cannot afford traditional plans Dropping an IM or Group plan Child-only major medical is unavailable

9 9 Everyday needs Plan Feature ValueFundamentalsEnhanced Office visits $50 each for 2 visits$50 each for 4 visits$75 each for 4 visits Prescriptions Rx Discount Discount plus: $10 for generic / $25 for brand/ $750/CY Discount plus: $10 for generic /$35 for brand/$750/CY Immunization Allergy Shots $10 per immunization $10 per allergy shot $100/CY combined

10 10 ER, Hospitalization and Surgical Benefits Plan Feature ValueFundamentalsEnhanced Inpatient hospitalization $1,000/day for sickness $2,000/day for injury; $200,000/CY $2,000/day for sickness $4,000/day for injury $500,000/CY $3,000/day for sickness $6,000/day for injury $1million/CY Inpatient and Outpatient Surgery Plan pays 100% of the 2010 Medicare physician surgical schedule Plan pays 150% of the 2010 Medicare physician surgical schedule Anesthesia $200 / 1 per year$200 / 2 per year$200 / 3 per year Ground and Air Ambulance $100/ground; $1000/air 2 trips/yr $100/ground; $1500/air 2 trips/yr Emergency Room /Urgent Care 1 urgent care or ER at $150/visit 1 urgent care or ER at $250/visit 1 urgent care at $100/visit and 1 ER at $400/visit

11 11 Outpatient Events Plan Feature ValueFundamentalsEnhanced Outpatient lab & other $100 Surgical pathology lab $15 All lab except surgical pathology $25 Other OP Svc Outpatient PT/OT/SP $25/session Outpatient radiology services $50 x-ray or ultrasound $130 mammogram $250 PET scan $300 CT scan $450 MRI Outpatient Calendar Year Max $1,000/year $3,000/year

12 12 Product differentiators Heath Access product differentiators – Higher level of inpatient hospital confinement than many competitors – $1,000-$3,000 on sickness and $2,000-$6,000 for injury – Doctor visits are not limited to wellness, can be used for sickness – Inpatient is not limited to one visit per year – Lifetime maximum is large $1M-$3M – Medco pharmacy discounts typically 14-40% – Save up to 60% on outpatient laboratory services – Network discounts apply even after calendar year maximum is reached – Discount card is included with discounts for vision care, chiropractic care, alternative health and wellness, and more

13 13 At the point of service How it all works Providers – No claim forms when client assigns benefits – Providers paid directly when client assigns benefits – Clients can find participating network doctors at multiplan.com/assurant or by calling Patient Care Pharmacy – All plans -- client pays discounted rate at pharmacy – For Fundamentals and Enhanced Medco informs us of claim Client receives check 2-4 weeks later Benefit can more than cover out-of-pocket expense

14 14 Circle of care Consumer Needs health coverage Applies for Health Access Visits doctor using insurance card Lab work using discount network Visits pharmacy to receive Rx Discount Network discount applies Benefits are applied Customer receives EOB with balance due, if any Can contact HPA if balance over $500

15 15 Health Payment Advocate Capabilities External advocate that customer contacts directly Negotiations to reduce amount owed by policyholder Review final bill for accuracy of charges (including verifying PPO discounts, questionable charges) Establish payment plan to ease financial burden HPA Contact Number 877.277.0080

16 16 Patient Care Can Help In welcome packet customer receives a Patient Care HIPAA release which they return to Patient Care to begin the process Customer calls Patient Care to: – Find a doctor – Find doctor/hospital for non-emergency medical services, Common examples: Colonoscopies, MRI’s, Knee Surgery Provide cost and quality information on doctors and hospitals Identify lower-cost drug options Explain and educate how to manage health care benefits Patient Care does not provide clinical or legal advice.

17 17 Support your sales Assurant Health helps support your sale by offering – Welcome Call to customer to go over key value proposition Sends Customer a Benefits Guide post sale – Explains to the customer how to maximize their benefit dollar – Details of HPA and Patient Care with Contact Information – Information on Discount card

18 18 Wellness benefits to help keep you healthy Routine gynecological exam with labs $175Office visit $90Lab test $265Total visit - $116Network discount $149After discount Medical costs: Customer must assign benefits to provider to get network discount Discount amounts based on Assurant Health claims data. Results may vary. Save money by asking Patient Care to recommend a high- quality but lower cost doctor and facility ValueFundamentalsEnhanced Total related charges$149 Fixed-benefit office visit$50 $75 Fixed-benefit lab$15 Total fixed benefit paid$65 $90 Customer pays balance$84 $59

19 19 Sickness benefits to get you healthy again Take Care Clinic for strep throat $65Negotiated rate, including lab $5Generic Amoxicillin $70Total related charges Medical costs: ValueFundamentalsEnhanced Total related charges$70 Fixed-benefit office visit$50 $75 Fixed-benefit generic Rx-$10 Total fixed benefit paid$50$60$85 Customer pays (receives) balance $20$10($15) Customer must assign benefits to provider to get network discount Discount amounts based on Assurant Health claims data. Results may vary. Visit walgreens.com for store locator

20 20 Injury Benefits to keep you moving Broken Arm (radius) ValueFundamentalsEnhanced Total related charges $1,790 Benefits Paid ER /Physician Charge $150$250$400 Cast Application$85 $127 Follow-up office visits (4) $100$200$300 X-rays (5)$250 Total fixed benefit paid $585$785$1077 Remaining Balance$1205$1005$713 HPA @ 20%$241$201$143 Customer Pays$964$804$570 Medical costs: Customer must assign benefits to provider to get network discount Discount amounts based on Assurant Health claims data. Results may vary. $1,440ER /Physician Charge $300Cast Application $465Follow-up office visits (4) $475X-rays (5) $2,684Total Expenses $894Network discount $1,790After discount

21 21 0-1718-3031-4041-5051-64 Value$54$67$74$94$144 Fundamentals$89$109$119$159$249 Enhanced$139$169$189$249$386 Sample monthly premiums Primary policyholder Premiums and fees may vary by state. Assurant Health Access Affordably priced within reach + One-time, non-refundable application $25 processing fee

22 22 Easy selling process Only 3 medical questions asked Simplified rating – Not gender rated – Not area rated – No height or weight restrictions – Not rated for risk class – No smoker status – Has very broad age bands – Based on age of primary applicant One-time, $25 processing fee Simplified underwriting process improves placement Effective date is either the 1st or 15th of the following month

23 23 DemoValueFundamentalsEnhanced AgeFam 31-40 (35%) Ind 41-50 (28%) Ind 41-50 (30%) Ind 31-40 (29%) Ind 31-40 (30%) Ind 41-50 (18%) Marital Status Not divorced or widowed Single Not married Ind/FamIndividual or FamilyIndividual Income$27-76K individual $55-154K family of 4 $27-76K individual $55-154K family of 4 $43-76K Employment status Full time Demographic Trends Even split between men and women Also appealing to older age groups due to cost of traditional medical insurance

24 24 New EASE layout with all three plan levels

25 25 Choosing words carefully What Assurant Health Access is - and isn’t What it is: Excepted-benefit, fixed-indemnity plan Known benefit amount for each type of care First-dollar benefits: no deductible, copay or coinsurance What it isn’t: Medical expense coverage Major medical Covered charges Reimbursement Creditable coverage 25

26 26 Key differences of Assurant Health Access Strong history of major medical knowledge – Pass along network, lab, and pharmacy discounts – Conducts research to know what consumers use/need Meaningful hospitalization and inpatient benefits Includes benefits for outpatient to meet changing market Consumer Focused Education – Package of Patient Care and Health Payment Advocates Alternatives to traditional medicine – Negotiated discounts to walk in clinics Dedicated service team

27 27 Integrated Selling with Health Access Online process makes it easier to bundle Accident, CI and Dental 72% of apps have at least 1 ASC product 41% of apps have 2 or more ASC products

28 28 Assurant Health Access State Availability May 2011 Rev. 3/17/11 Product Not Yet Available New AHA Portfolio Available ( Value, Fundamentals & Enhanced Available) Current Fundamentals Product Available

29 29 Accident Insurance

30 30 Accident Insurance An indemnity scheduled accident policy which pays a flat benefit for each covered benefit under the plan Pays regardless of other coverage in place, no coordination of benefits Premiums can not increase based on usage No co-pays or deductibles Visit any hospital or doctor Rates are designed to remain stable Consumer can own this policy for as long as they live!

31 31 Accident Enrollment Two enrollment decisions – Level 1 or Level 2 benefits – 24-hour or off-the-job coverage Simplified issue — a few health questions Coverage is guaranteed renewable for life Coverage cannot be canceled based on the number of claims filed

32 32 Accident Key Benefits Benefit SummaryLevel 1Level 2 Accident Emergency Treatment (ER or doctor’s office) $100 Adult/ $50 Child Initial Accident Hospitalization (ICU)$1,000 ICU Confinement$500/day Accident Hospital Confinement$250/day$300/day Accident Specific–Sum Injury - Burns Up to $2000 (2 nd degree) / $20,000 (3 rd degree) Up to $2500 (2 nd degree) / $25,000 (3 rd degree) - Coma 7 days unconscious$15,000$20,000 - DislocationUp to $1000/$4000Up to $1250/$5000 - FracturesUp to $3000/$4000Up to $3750/$5000 - Lacerations$100-$800$130-1000 - Surgical RepairScheduled amounts up to $2000 Scheduled amounts up to $2500 Accidental-Death$30,000 $50,000 Ambulance (ground/air)$150/$1000$200/$1500 Lodging$100/night$125/night Major Diagnostic Exams$200 Rehabilitation Unit$100/day$150/day Accident Follow-up Treatment$25$35

33 33 Accident Example If insured was in an auto accident, he/she could receive the following benefits, which are paid in addition to any coverage provided by auto insurance or major medical. Transportation to hospital$150 Hospitalization$1,000 Hospital stay$250 ER treatment$100 Fractured hand$1,000 Stitches$400 3 Physical Therapy treatments $75 Benefits paid directly to consumer $2,975 Based on benefits of level 1 coverage

34 34 Eligibility for Accident Insurance Eligibility – Adult issue ages: 18 through 64 – All unmarried children through age 18 (through age 22 if full-time student, may vary by state) – Height/Weight chart – Accident Policy can cover all family members Rates – DO NOT vary by age or preferred/standard health class Monthly Accident Premiums Individual1 Parent FamilyPrimary/Spouse2 Parent Family $22.90$31.10$32.30$39.80

35 35 Value of Access and Accident By laying Access and Accident the value to the consumer is clear. Example of consumer with a broken arm and how the plans would pay Charged Discounted ratePlan Pays Accident Pays Customer Pays ER fee19001805250 0 1555 ER doc2001150 100 15 Surgery / Application of cast (broken arm)300150 1250+1250 Office visit follow-ups (4)465300200 140 +60 X-ray follow-ups (5)4752401250115 $3340$2610$725$1490$375 Customer saves $1455 on this one incident by having Health Access vs. being uninsured By adding an accident plan, the customer’s out of pocket would be reduced to only $375. Accident is level 2, open reduction of broken arm. Actual amounts would vary, for illustrative purposes only.

36 36 Dental Insurance

37 37 Dental Coverage Dental is an indemnity based scheduled benefit Describe product as a supplemental dental plan that helps offset dental expenses Plan pays a fixed amount for a covered dental service, regardless of the actual cost from the dentist This is not dental insurance tied to a PPO

38 38 Dental Advantages Clients can keep their dentist or choose a new one — no network restrictions Benefits available the next day for Preventive and Basic services Three affordable and convenient plan designs to meet client needs and budgets Great incentive to foster good oral care

39 39 Sellable features No ZIP code or industry for rating Coverage is portable Sold ages 0-64, 63 integrated Guaranteed renewable to age 70 Can sell a stand alone dental policy to a child No underwriting, only dental professionals are prohibited Basic and Intermediate plan are not age banded

40 40 Dental Insurance If sold with Individual Medical or Assurant Health Access, only Basic Plan and Plus Plan are available If sold stand alone, all three plans are available Preventative benefits do not count toward calendar year max Basic Plan (Level I) Intermediate Plan (Level II) Plus Plan (Level III) Preventive Separated by 150 days $75 per visit$100 per visit Basic Services$25 - $200 based on procedure $50 - $400 based on procedure $50 - $400 based on procedure Major Services None $20 - $1,000 based on procedure Calendar Year Max $500$1,000$1,500

41 41 Covered Services Preventive Services, must be separated by 150 days: Basic Services: – Includes cleanings, x-rays, fluoride and sealants – Benefits are available immediately – Pays $75 or $100 per visit (insured liable for balance) Intermediate Services: – Includes fillings and tooth extractions – Payments are 50% of the benefit for the first policy year Major Services (Plus Plan): – Includes crowns, root canals, periodontics and oral surgery – Only available on level-three plan – 180 days waiting period*, then 50% for the next 180 days * Waiting period does not apply in all states

42 42 Dental Waiting Period Applies to the Major Services of the Plus Plan ONLY! Applies if Stand Alone or Integrated Dental The two new Dental states (MD and CA) will include the 180 day waiting period with first a effective date of 5/15/2011. The change to 180 waiting period will be implemented in an additional 21 states (AL, AR, AZ, DE, GA, ID, IA, LA, ME, MI, MS, MO, NE, NC, OK, SD, TN, TX, UT, WI and WY) with the May release, and will have a first effective date of 7/1/2011. We will continue to sell old integrated dental in NH - it will be the only remaining state for old dental. This waiting period will not apply to any inforce policies. Premium remains the same

43 43 Preventive Services The customer will receive a flat benefit (Basic is $75 and Intermediate and Plus are $100) for each preventive visit Customer is responsible for any additional costs A standard preventive visit example Oral Exam $ 65 Bitewing X-rays$ 55 Dentist charges for preventive visit$120 Plus Plan pays $100 preventive benefit$100 Customer balance$ 20

44 44 Dental Rates Rates are age banded Discount when 2 or more people apply 40% discount is passed along to the consumer when purchased at the same time as Health Access Monthly Integrated Dental Premiums Primary age 50IndividualPrimary/Spouse2 Parent/2 Kids Basic Plan$9.30$16.74$32.58 Plus Plan$30.65$55.08$89.04 Monthly Stand Alone Dental Premium Basic Plan$15.50$27.90$54.30 Plus Plan$51.00$91.80$148.40

45 45 Critical Illness Insurance

46 46 Critical Illness Insurance Provides a one-time lump sum payment of up to $100,000 upon diagnosis of 15 life threatening conditions, such as cancer, stroke and heart attacks Payment may be used to help fight the disease while allowing the individual to focus on recovery Funds pay in addition to any coverage in place, including major medical No deductibles or co-pays to meet

47 47 Critical Illness (CI) Overview Policy term – 10 or 20 years Policy terminates at the earliest of: – Policy term – Age 65, the CI benefits expire – The full life face amount is paid Add-ons: – Spouse coverage — same amount as policyholder – No dependent coverage – Waiver of Premium – Accidental Death Benefit

48 48 Critical Illness (CI) Overview Select the amount of CI coverage first, ranging from $5,000-$100,000 in $1,000 increments Select the life benefit amount which will be presented as 50%, 100% or 200% of the CI amount If an individual selects $50,000 of CI insurance, the term life options will be: 50%$25,000 100%$50,000 200%$100,000

49 49 Critical Illness Plan Summary Covered Conditions 100% benefit: – Cancer (~invasive) – Heart Attack – Stroke – Kidney Failure – Major Organ Transplant – Burns Covered Conditions 25% benefit – Coronary Artery Bypass – Advanced Alzheimer’s —Blindness —Paralysis —Coma —Deafness —Loss of Limbs —Cancer (~in situ) —Heart Valve Surgery

50 50 Overcoming objections If I have medical coverage, why do I need additional coverage? – You will be responsible for any costs prior to deductible, plus co- pays and any other non medical costs associated with the disease Will your family be impacted? If you have a life threatening disease which requires prolonged treatment will it cause financial stress? Will you have to take an extended absence from work that will reduce your wages? Will you be able to afford the best treatment available?

51 51 Where will I get the money? Drain savings account – 61 percent of Americans could only live three months or less on their savings, with 38 percent stating they don't have enough saved to cover one month's expenses 1 Borrow on credit cards and pay high interest rates – Credit card balances averages are $5,100 and projected to be $6,500 at the end of the year 2 Borrow against 401k and pay fees – Percent of people who have taken a loan on their 401k is 22%, highest figure in a decade 3 File for bankruptcy – 15 million Americans will file for bankruptcy up to 60% of people are actually capsized by medical bills Sources: 1.http://www.ehow.com/facts_6777245_average-american-savings-account.htmlhttp://www.ehow.com/facts_6777245_average-american-savings-account.html 2.http://www.hoffmanbrinker.com/credit-card-debt-statistics.htmlhttp://www.hoffmanbrinker.com/credit-card-debt-statistics.html 3.http://beginnersinvest.about.com/b/2010/08/22/401k-loans-hit-10-year-high-and-average-401k-balances-up-15-over-last-year.htmhttp://beginnersinvest.about.com/b/2010/08/22/401k-loans-hit-10-year-high-and-average-401k-balances-up-15-over-last-year.htm 4.http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance?_s=PM:HEALTH

52 52 Critical Illness Insurance Critical Illness/Life Insurance – Select coverage of $10,000, $20,000 or $30,000 – Benefits are paid in a one time lump sum payment directly to you – Allows consumer to focus on getting the best treatment without worrying as much about how to pay for treatment – Coverage is available for spouse as well – Term of coverage is 10 years – Term Life benefit is part of the plan $20,000 in coverage for a 40-year old male is less than $24 a month

53 53 Make sure you touch on Customer will receive: – Separate policy and premium withdrawal per product – Coverage is portable – Supplemental benefits automatically renew – Supplemental rates are designed to be stable for the duration Make sure to fill out claim form for accident and assign benefits for dental Customer will receive a welcome call for Health Access

54 54 Assurant Supplemental Coverage May 2011 Product Availability Accident, Critical Illness & Dental Accident & Critical Illness Only Accident & Dental Only Critical Illness & Dental Only Accident Only Critical Illness Only Dental Only No ASC Product Available *FL-Dental is available integrated only

55 Individual Medical Portfolio Update

56 56 Valued features included in every plan Preventive Care Choice of doctors and hospitals Patient Care Teladoc — 24-hour access to physicians by telephone* HealthyDiscount* Reduction of CSD’s *Availability varies by state and plan design.

57 57 Deductible 1 $2,000, $3,500, $5,000, $7,500, $10,000, $15,000, or $25,000 Coinsurance100%, 80/20, 70/30, or 50/50 (Georgia: 60/40 vs. 50/50) Coinsurance Out-of-Pocket Maximum 1 $0 to $7,500 depending on Coinsurance Office Visit Copay Option 1: Office visits subject to deductible and coinsurance; 3 Free Teladoc visits included Option 2: $35 – 4 visits per person, per year Prescription Drug Coverage Option 1: Subject to plan deductible and coinsurance Option 2: Generic: $15 copay; Brand-name: $500 prescription deductible 1, then $25 copay with 50% coinsurance Facility Fees Option 1: $750 per day for the first three days as inpatient, $200 per outpatient surgery Option 2: $200 per day for the first three days as inpatient, $200 per outpatient surgery Option 3: No inpatient or outpatient facility fees CoreMed Plan Design Options 1 Family deductible and coinsurance out-of-pocket maximums are two times the individual amounts listed and are met collectively by two or more persons

58 58 Teladoc ® - Medical Care Option for Today Access 24 hours a day, 365 days a year — by telephone Affordable – CoreMed — three for FREE – OneDeductible — Consultations are only $38 Physicians are licensed, board certified, U.S. based, and experienced You call or go online anytime, from anywhere – Home, work, or the road – Let the doctor come to you – A great option when you just don’t have time to sit in the waiting room! Availability varies by state and plan design.

59 59 OneDeductible Plan Design Options Deductible Family shares one deductible No separate deductibles Individual plan options: $1,200, $1,600, $2,100, $2,850, $3,750, $5,000 Family plan options: $2,400, $3,200, $4,200, $5,700, $7,500, $10,000 Coinsurance100%, 80/20, 50/50 Coinsurance Out-of-Pocket Maximum $0 to $2,500 — depending on coinsurance Prescription Drugs Applies to your plan deductible and coinsurance One Decreasing Deductible: Reduce your deductible exposure - up to 70% Availability varies by state

60 60 One Decreasing Deductible ® You may never pay your full deductible again! OneDeductible plans with: – Plan deductible of $2,850 individual / $5,700 family or higher – 100% coinsurance Earn 10% deductible credit – January 1 and July 1 – Credits accumulate and roll over year to year Until One Decreasing Deductible is satisfied If satisfied, new credits begin the next January 1 Decrease the amount you pay to: – $1,500 for an individual / $3,000 for a family Eligibility requirements apply Availability varies by state

61 61 EASE Quoting Screen

62 62 No Prior Coverage: 30 Day Effective Date Delay The first effective date available for customers that do not have prior coverage will be 30 days past the date the application is submitted in the following additional states: – AK, AL, AR, AZ, FL, GA, MD, MI, MO, MT, NE, PA, SC, TN, TX, WI, WY, IN, MN & OH – States Previously implemented: CO, ID, IA, LA, ND, NV, SD, UT, WV – The spread between prior coverage and no prior coverage rates will be reduced from approximately 26% to 15% Change will be for 6/1 Submission dates

63 63 Rate Reductions (after trend) One Deductible Coremed Michigan8%na Missouri6-26%na Florida26-44%1-25% Georgia1-21%3% Tennessee6-11%

64 64 Rate Reductions (after trend) One Deductible Coremed Oklahoma6-26% Virginia6-26%6% Pennsylvania6-21%6-26% South Carolina11-21%6% Iowana6-26% Rate reductions of 15-30% filed for North Carolina and West Virginia

65 65 Underwriting Changes Easier to do business with: less ratings and CSD’s! – Eliminating approximately 60% of ratings for customers with prior coverage! Will be issued standard Will not apply to the following states: MI, CA, UT, ID, CT, MN, NH – Eliminating CSD’s of $3000 and less for all business! Conditions that historically called for a $3000 or less CSD will now be issued standard. Drug costs will be underwritten as they are today If applicant would otherwise qualify for preferred coverage, they will be issued preferred! In states where CSD's are not allowed, alternative actions (ratings and riders) will be removed for these same conditions

66 Thank You! Assurant Health is the brand name for products underwritten and issued by Time Insurance Company, Milwaukee, WI. J-78881


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