REAL CHOICES INTRODUCTION Assurant Health 1. 2 Overview New group insurance products and tools that will outfit you to sell small group medical insurance.

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Presentation transcript:

REAL CHOICES INTRODUCTION Assurant Health 1

2 Overview New group insurance products and tools that will outfit you to sell small group medical insurance Assurant Health makes health insurance benefits available to working Americans ChoiceChoice –Real Choices I, II and III –Real Choices HRAs and HSAs EfficiencyEfficiency –Online tools for agents and employers –Underwriting ResponsivenessResponsiveness –Administration –Commissions and Agent incentives Agent Outfitters

3 REAL CHOICES SM REAL CHOICES SM Assurant Health’s New Small Group Portfolio WA OR CACO UT WY ND NM KS NE SD IA MN TX WI AR MI OH INIL FL GAALMS TN WV SC NC VT NY NH ME CT RI MD WA OR CA MT ID NV CO UT WY ND NM AZOK KS NE SD IA MN TX LA AR MO MI OH IN IL FL GA ALMS TN KY PA WV VA SC NC VT NY ME CT MD NJ MA NH DC WI DE For internal use only. Assurant Health is the brand name for products underwritten and issued by Time Insurance Company. J (4/2008) Real Choices - as of 5/1/2009 effective date AK

4 Kaiser Family Foundation/HRET Survey of Employer-Sponsored Benefits, 2000 – Kaiser Health Benefits Annual Survey, Published Big Market, Great Opportunities! In 2005, there were 25.3 million Americans working in groups with 2-25 employees In 2005, 61% of all working Americans had health insurance provided by their employer Agent Outfitters

5 Percentage of 3-9 Employee Firms Offering Health Benefits % OFFERING COVERAGE Agent Outfitters

6 87% of insureds have claims < $3,000 84% of insureds have claims < $2,000 80% of insureds have claims < $1,000 Assurant Health’s most popular plans typically include an office visit copay and prescription drug copay so there are less charges being applied to the deductible and coinsurance. Consequently, with a typical Assurant Health plan, fewer insureds reach a higher deductible. A provider discount was also factored in to these statistics. Consumer Choice

7 Markets Tampa Orlando Melbourne Naples Using Great West network

8 Real Choices A virtual warehouse of product enables agents to meet the varied needs of small employer groups! Real Choices

9 Real Choices I Well-established businesses Employers who want top-of-the-line benefits Real Choices II Cost-conscious employers Employers who value flexibility Real Choices III Uninsured groups New businesses with limited budgets Real Choices HRA Plans Real Choices HSA Plans Employers who want tax advantages and more control of their cash flow Employers who want premium savings of HDHP Real Choices Products PROSPECTS Real Choices

10 Real Choices I Premier Plan that Offers the Most Extensive Coverage Preventive care including $750 first-dollar benefit $500 first-dollar diagnostic imaging and lab benefit Prescription drug coverage including $0 generic co-pay option Physician office visit co-pay option that includes co-pays for ER and urgent care Can increase lifetime maximum from $5 million to $10 million Real Choices I

11 Real Choices I Real Choices I – Most Extensive Coverage On copay plans, $100 emergency room copay, then 100% thereafter Unlimited ground and air ambulance after deductible and coinsurance Affiliated provider benefit Extensive transplant network World-wide emergency coverage Real Choices I

12 Not all combinations of deductible, benefit percentage and out-of-pocket maximum are available. Deductible $0, $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, or $10,000 Family Deductible Types Individual/Family or One Deductible Benefit Percentages 100%, 90%, 80%, 70%, 50% (60% in GA) Coinsurance Out-of-Pocket Maximums $0, $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, or $10,000 Real Choices I Real Choices I – Most Extensive Coverage BENEFIT Real Choices I REAL CHOICES I

13 Physician Office Visit Co-pays – Optional (Primary Care Provider / Specialist) $20/$40, $25/$40, $35/$50, $50/$50 Emergency Room Subject to deductible and coinsurance On copay plans, $100 copay, then 100% Urgent Care Subject to deductible and coinsurance On copay plans, $50 copay, then 100% Allergy Shots Subject to deductible and coinsurance On copay plans, 100% coverage Real Choices I Real Choices I – Most Extensive Coverage REAL CHOICES IBENEFIT Real Choices I

14 Outpatient Physical Medicine Deductible and coinsurance Covered to a maximum benefit paid of $5,000 per year Home Health Care Deductible and coinsurance Maximum benefit of 50 visits per year Hospice Care100% - deductible waived Outpatient Behavioral Health & Substance Abuse Deductible and 50% coinsurance Maximum annual benefit of $3,000 Inpatient Behavioral Health & Substance Abuse Covered up to 28 days per year REAL CHOICES I BENEFIT Real Choices I Real Choices I – Most Extensive Coverage Real Choices I

15 Maternity Care Services Complications only (included), or Deductible and coinsurance, or Separate $7,500 maternity deductible, then 100% Preventive Care$750 (included) or $1,250 (optional) Accident Medical Expense - Optional $500 or $1,000 first-dollar benefit REAL CHOICES IBENEFIT Real Choices I Real Choices I – Most Extensive Coverage Features and Optional Benefits Real Choices I

16 Real Choices I Real Choices I – Prescription Drugs Options: $0/$25/$50 (generic/preferred brand name/ nonpreferred brand) $15/$25/ $50 $15/$45/$60 $15/$50/$75 Deductible and coinsurance plus Preferred Pricing Card None - Preferred Pricing Card only Popular Features: Save 10% on copays (copay is 2.7 times the selected copay amount) for any three-month drug supply by mail order Birth control pills covered at retail pharmacy or mail order Real Choices I

17 Real Choices II Popular Plans that Offer the Most Choices Many deductibles and benefit percentage choices A variety of copay choices Preventive care including $300 in first-dollar benefits with the option to increase to $800 $2 million lifetime maximum with option to increase to $5 million Priced 6% lower than Real Choices I Real Choices II

18 Deductibles $0, $500, $1,000, $1,500, $2,500, $3,500, $5,000, or $10,000 Family Deductible TypesIndividual/Family or One Deductible Benefit Percentages100%, 90%, 80%, 70%, 50% (60% in GA) Coinsurance Out-of-Pocket Maximums $0 (on 100% plans only), ($500 - in Michigan only) $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, or $10,000 REAL CHOICES II BENEFIT Real Choices II Real Choices II – Most Choices Real Choices II Not all combinations of deductible, benefit percentage and out-of-pocket maximum are available.

19 Office Visit Copay Options Primary Care Physician / Specialist Copays Unlimited PCP/Specialist visit option, OR Four visit copay per person, per year to network providers, OR Copay applies to unlimited visits to network PCP only – specialist is subject to deductible and coinsurance PCP - $20, $25, $35 or $50 Specialist - $50 Emergency Room Deductible and coinsurance or If office visit copay is selected, option to select $250 copay and then covered at 100% Outpatient Behavioral Health & Substance Abuse Deductible and 50% coinsurance to an annual limit maximum benefit paid of $1,500 Allergy Shots Subject to deductible and coinsurance On copay plans, covered at 100% with no copay BENEFIT Real Choices II Real Choices II – Most Choices Real Choices II REAL CHOICES II

20 Maternity Care Services Complications only (included), or Deductible and coinsurance, or Separate $7,500 maternity deductible, then 100% Preventive Care $300 included with option for $800 (premium increase is 1.5% for upgrade) Outpatient Diagnostic Imaging and Lab Deductible and coinsurance OR $200 first-dollar coverage, then deductible and coinsurance Optional Accident Medical Expense $500 or $1,000 first-dollar benefit REAL CHOICES II BENEFIT Real Choices II Real Choices II – Most Choices Features and Optional Benefits Real Choices II

21 $0/$50/$75 with $500 brand name deductible* $15/$25/$50 $15/$25/$50 with a $250 brand name deductible $15/$45/$60 $20/$50/$75 Subject to medical plan’s deductible and coinsurance Preferred Pricing Card only Popular Features Save 10% on copays for a three-month supply by mail order Birth control pills are covered – retail and mail order * Deductible is for preferred and non-preferred brand name prescriptions Real Choices II Real Choices II Real Choices II – Outpatient Prescription Drugs

22 Real Choices III Streamlined Plans with the Most Affordable Coverage Access point to health insurance market Priced 15-20% below Real Choices II Preventive care including $200 in first-dollar benefits $2 million lifetime maximum Real Choices III

23 Deductible$0, $1,000 or $2,000 Benefit Percentage80% or 50% (60% in GA) Coinsurance Out-of-Pocket Maximums $3,000 or $4,000 Lifetime Maximum$2 million Calendar Year Maximums $100,000 with $5,000 outpatient maximum $250,000 with $10,000 outpatient maximum, with optional buy-up to $25,000 outpatient maximum REAL CHOICES III BENEFIT Real Choices III Real Choices III – Most Affordable Coverage Real Choices III

24 Office Visit/Urgent Care Covered If the Office Visit Maximum Benefit Option is selected, a $40 first-dollar benefit is provided. Emergency Room $100 access fee, then deductible/coinsurance (fee is waived if admitted) Outpatient Physical Medicine Covered up to the plan outpatient annual maximum selected Allergy Shots Deductible and coinsurance On office visit max benefit plans, $40 first-dollar benefit REAL CHOICES III BENEFIT Real Choices III Real Choices III – Most Affordable Coverage Real Choices III

25 Outpatient Prescription Drugs $15/$50/$75 with a $250 deductible for all brand name drugs. Benefit is subject to $5,000, $10,000 or $25,000 calendar year maximum, depending on plan selected Preventive Medical Services $200 first-dollar benefit then subject to deductible and coinsurance. Also an option to buy up to $500 first-dollar benefit. (additional $300) Outpatient Diagnostic Imaging and Lab Deductible and coinsurance up to the plan’s selected outpatient calendar year maximum REAL CHOICES III BENEFIT Real Choices III Real Choices III – Most Affordable Coverage Real Choices III

26 Real Choices HRA and HSA Consumer-driven health care plans which will appeal to many Small Business Owners because they offer premium savings and tax savings

27 Health Reimbursement Arrangements HRAs are a creative means of financing insurance. Assurant Health’s HRA program offers many advantages: More choices in designing a plan Greater control over cash flow More opportunities for tax deductions Ability to retain ownership of funds HRA admin services at no additional cost

28 Real Choices HRA I and II Real Choices HRA I and II – Payment Structures 100%0% $500, $1,000, $1,500, $2,500, $3,500, $5,000, $10,000 90%10% $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, $10,000 80%20% $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, $10,000 70%30% $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, $10,000 50% $0, $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, $10,000 COINSURANCE PERCENTAGECORRESPONDING DEDUCTIBLE CHOICESBENEFIT PERCENTAGE Real Choices HRA I and II

29 Real Choices HRA I and II Real Choices HRA I and II – Payment Structures Coinsurance Out-of-Pocket Maximums $0 (on 100% plans only), $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, $10,000 $0 (on 100% plans only), $1,000, $1,500, $2,000, $2,500, $3,500, $5,000, $10,000 Lifetime Maximum $5 million included or option for $10 million $2 million included or option for $5 million Preventive Medical Services $750 included or option for $1,250$300 included or option for $800 Physician Office Visit Copay Option Copays for PCP/Specialist: $20/$40, $25/$40, $35/$50, $50/$50 Unlimited PCP/Specialist visits, OR Four visit copay per person, per year to network providers, OR Unlimited visits to network PCP only – specialist is subject to deductible and coinsurance PCP copays: $20, $25, $35 or $50 Specialist copay: $50 Accident Medical Expense Option $500 or $1,000 first-dollar benefit REAL CHOICES HRA IREAL CHOICES HRA IIBENEFIT Real Choices HRA I and II

30 Real Choices HRA I and II Real Choices HRA I and II Real Choices HRA I and II – Payment Structures Prescription Drugs Copay of $0/$25/$50 Copay of $15/$25/$50 Copay of $15/$45/$60 Copay of $15/$50/$75 Subject to medical plan deductible and coinsurance Preferred Pricing Card $0/$50/$75 with a $500 brand name deductible $15/$25/$50 $15/$25/$50 with a $250 brand name deductible $15/$45/$60 $20/$50/$75 Deductible and coinsurance Preferred Pricing Card REAL CHOICES HRA IREAL CHOICES HRA II BENEFIT

31 Real Choices HSA I and HSA II Health insurance with tax-favored consumer choice options

32 HSA - Health Savings Accounts Choose an HSA if saving money is your priority. An HSA program combines major medical insurance with a tax-favored savings account. With Assurant Health’s HSA Program, employers can Save on premium with a high deductible health plan Save on income taxes by making tax-free account contributions which can be used to pay for medical expense Save for future needs by rolling over year-end balances Save on separate account fees with HSA Tools

33 HSA Tools HSA Tools is Assurant Health’s comprehensive account services program. It is available at no additional cost and includes: Efficient online claims payment and account tracking services A VISA debit card for easy withdrawals Tax-free interest on HSA funds A line of credit option An investment option Online access to medical and prescription information

34 Deductible $1,500, $2,000, $2,500, $3,000, $3,500, $5,000 Family Deductible TypesIndividual/Family or One Deductible Benefit Percentages100%, 90%, 80%, 70%, 50% Coinsurance Out-of-Pocket Maximums $0, $1,500, $2,000, $2,500, $3,500 BENEFIT Real Choices HSA I and II Real Choices HSA I and II – Payment Structures Real Choices HSA I and II REAL CHOICES HSA I AND HSA II HSA plans have a 24-month rate guarantee available! Not all combinations of deductible, benefit percentage and out-of-pocket maximum are available.

35 Real Choices HSA I and II Real Choices HSA I and II – Payment Structures Real Choices HSA I and II Lifetime Maximum $5 million (included) or $10 million (optional) $2 million (included) or $5 million (optional) First-Dollar Preventive Services $750 (included) or $1,250 (optional) $300 (included) or $800 (optional) Office visits, imaging and lab, emergency room, hospital, equipment Deductible and coinsurance Outpatient Physical Medicine Treatment Deductible and coinsurance to $5,000 limit Deductible and coinsurance to $3,000 limit Prescription Drugs Deductible and coinsurance or No coverage Preferred Pricing Card included on all HSA plans Deductible and coinsurance or No coverage Preferred Pricing Card included on all HSA plans REAL CHOICES HSA IREAL CHOICES HSA II BENEFIT

36 Real Choices HRA and HSA Account/Administration Services at No Additional Cost HSA Contact/Questions: Monday thru Friday From 8:00 a.m. – 5:00 p.m. Central Time HRA Contact/Questions: HRA-7779 or

37 Real Choices Premium Only Plans (POP) Premium Only Plans (POP) allow eligible insurance premiums to run through the employer’s payroll pre-tax Immediate tax savings for both the Employer and employee!

38 Real Choices Premium Only Plans (POP) Free!! Administered through MHM Resources, Inc: Dedicated Employer services toll-free number , weekdays, 8 a.m. – 5 p.m., Central time or, at

Real Choices Out-of-Network Reimbursement Options Usual, Customary, and Reasonable (UCR) Scheduled Network (SCH) Uses established, traditional reimbursement schedule Payment is typically at the 70 th percentile Uses network fee schedule for out-of-network charges Covered, negotiated charge will be lower than UCR fee This option can lower premium 2% to 9%

Real Choices Out-of-Network Claim Example Tonsillectomy with no complications. Out-of-network charge: $2,000. Scheduled Network (SCH)Usual and Customary (UCR) Premium savings when selecting SCH is 2% to 9%. On a 10-person group, premium savings range from $640 to $2,880 per year. Two valuable sales tips: 1. Sell Scheduled Network option to make employer happy! 2. Tell employees to USE THE NETWORK PROVIDERS! Negotiated network rate is $1,200 Insured’s responsibility is $800 UCR charge is $1,400 (70 th percentile) Insured’s responsibility is $600 If insured uses network services, responsibility is $0.

41 3-Year Benefit Packages HSA Example: DedCoin OOP Rate Year 12,000100%0$X Year 22,500100%0$X Year 33,500100%0$X Rate stays the same for 3 years 5 Options available for Real Choices States Additional form to fill out verify selection

42 Online Agent Self-Service Online Employer Self-Service Online Employee Self-Service Efficiency Outfitting agents and employers with electronic, timesaving tools Agent Outfitters Real Choices

43 Online Agent Capabilities Single sign-on through sales site: MyAccount – Agent Outfitters - Efficiency

44 Employer Self-Service Employers can electronically: Update contact information Add or remove employees Add or remove dependents Order ID cards for employees Access group insurance information 24/7 Submit questions to Customer Service Department 24/7 Compare HSAs with other plans using online calculator Online tools at myaccount site on Agent Outfitters - Efficiency

45 Employee Self-Service Online self-service at answersbyassurant.com and myaccount Employees can: Compare drugs and costs through Pharma Advisor ® –Gives brand drug costs vs. generic drug costs Research health conditions with Healthcare Advisor Pharma Advisor® and Healthcare Advisor TM are a registered marks of Subimo, LLC Agent Outfitters - Efficiency

46 Committed to helping agents succeed Underwriting Agent Outfitters - Underwriting

47 Underwriting Attestation form instead of wage and tax information –1-3 life groups require wage and tax Group status available through EASE Choice of waiting periods: 0, 30, 60, 90 and 180 days Agent Outfitters - Underwriting

48 Underwriting Includes the following common medical conditions in base premium –Acne, Acid Reflux, Allergies, AD&D, High Cholesterol, High Blood Pressure and Mild Depression Limited Questionaires Simplified Employer Application Agent Outfitters - Underwriting

49 UW By Plan Design (all except MI and OK) Plan Average Group Rate Today’s Average UW $Future UW $ $ 0 Ded$68,092$12,000$15,240 $ 500 Ded$60,256$12,000$13,560 $1,000 Ded$53,322$12,000$12,720 $1,500 Ded$48,000$12,000 $2,000 Ded$44,598$12,000$11,362 $2,500 Ded$41,424$12,000$10,767 $3,500 Ded$36,280$12,000$9,803 $5,000 Ded$31,350$12,000$8,640

50 Underwriting Employee choice (Plan choice) minimum of 3 employees with minimum of 2 in one plan (except employer HSA) –15% differential only allowed Network Choice 1099 employees Participation requirements - 3 lives and under 100% - 4+ lives 75%

51 New Business Quoting is in the middle of the band +/-15% after underwriting 1-2 Life groups quoted in Home Office only Underwriting Fax Employer, Employee, Quote, last bill, check for submission

52 Agent Compensation Responsive Assurant Health is committed to promptly respond to the varied needs of employers and agents OUR COMMITMENT. Your Success.

53 Producing Agent Commission Schedule Allowed Tiers Schedule Option Option A Option BOption COption DOption E Premium Band First $35, % FY 4 % Ren. 7.5 % FY 5 % Ren. 8.5 % FY 6 % Ren. 9.5 % FY 7 % Ren % FY 8 % Ren. Next $65,000 5 % FY 4 % Ren. 6 % FY 5 % Ren. 7 % FY 6 % Ren. 8 % FY 7 % Ren. 9 % FY 8 % Ren. Next $100,000 5 % FY 4 % Ren. 5 % FY 5 % Ren. 6 % FY 5 % Ren. 7 % FY 6 % Ren. 8 % FY 6 % Ren. Above $200,000 3 % FY 4 % Ren. 5 % FY 5 % Ren. 6 % FY 5 % Ren. 6 % FY 6 % Ren. 6 % FY 6 % Ren. Tier 1-5 Tier 2-5Tier 3-5Tier 4-5

54 Production Milestone Bonus Milestone Bonus Starting Compensation Level Group Production Milestone Bonus Level 1$100,000$1,000 Level 2$500,000$10,000 Level 3$1 million$25,000 Level 4$5 million$25,000 Qualifications for Milestone Bonus: Only Real Choices business qualifies Agent must reach the group production milestone shown in middle column Agent can earn bonus only once for each compensation level

55 Commission Guidelines Agent’s commission level tier setting is calculated every January and is based on previous year’s production Commission schedule tier is effective for the next 12 months Weekly EFT commissions available 1- 2 life groups 1% total commission paid to writing agent (no overrides)

Sales Incentive Earn $1,000 for every 3 cases sold in 2009 Earn $250 for your first Small Group case issues in 2009 Sell another 2 cases Earn an additional $750 for a total of $1,000 for every 3 cases sold Earn $1,000 each time you issue three cases, up to $30,000 max payout PLUS – earn an extra $ for every high deductible plan sold plan sold 1- 2 life groups do not count for campaign OUR COMMITMENT. Your Success.

57 With Assurant Health Real Choices, you’ll be outfitted for success in the small group insurance market! ANY QUESTIONS? LPI Companies Inc Agent Outfitters