1 Defined Benefit Limited Medical Plans Limited Medical plans offer employers of all sizes the most cost-effective solutions to meet the healthcare challenges.

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Presentation transcript:

1 Defined Benefit Limited Medical Plans Limited Medical plans offer employers of all sizes the most cost-effective solutions to meet the healthcare challenges of today. The Association Insurance Cooperative, in conjunction with The American Worker Plans, the industry leading provider of these types of programs, can offer any employer group a multitude of options to meet their specific employee healthcare benefit objectives and needs.

The American Worker Plans, Providing Innovative Solutions Since 1992 The American Worker Plans was founded in 1992 to address the need of millions of uninsured working Americans that were not offered a major medical plan from their employer. In addition to providing health coverage for the uninsured, this concept has also proven to be an effective means for employers to accomplish their primary human resource objective: to recruit and retain the highest quality employees. The American Worker Plans was at the forefront of creating these innovative solutions, and continues to be a leading resource as Limited Medical plans continue adapt to better support employer’s budgetary requirements and changing human capital market conditions. Today, this concept has evolved to not only provide coverage for the uninsured, but also to provide supplemental first-dollar coverage for the most frequently utilized healthcare services as a buffer to ever-increasing major medical plan deductibles. This “GAP in coverage strategy” is rapidly becoming a very popular cost-containment strategy for many employers. Since the underlying first- dollar benefits can be offered either entirely employee-paid or with employer contributions, it allows each employer to meet its particular budgetary and employee compensation objectives. The American Worker Plans is a Managing General Agent for seven of the leading Limited Medical plan insurance carriers, and provides these solutions to many of the nation’s largest employers that incorporate Limited Medical in their employee benefits package. Our plans have proven over the past 19 years to be an innovative solution for all sizes of employers, and are able to meet employer’s objectives in the short or long-term. All of the plans offered by The American Worker Plans are Defined Benefit (Fixed-Indemnity) and are not subject to the new requirements of healthcare reform (PPACA).

3 The American Worker Advantage We represent seven of the nation’s largest insurers that offer Defined Benefit Limited Medical plans. We address each employer’s situation with a collaborative, case- specific approach to create the optimal program design to meet each client’s unique needs. We use only leading administrators that specialize in meeting the specific needs of these types of benefit plans with regards to enrollment, billing, claims administration and customer service. With our 19 years of experience creating successful Limited Medical programs of all sizes, while meeting the particular administrative requirements of each employer, we afford our clients a wealth of consultative services that will optimize each aspect of the program to make it as successful as possible.

4 Key Plan Attributes Plans pay a FLAT BENEFIT for each covered service regardless of charges Are GUARANTEE ISSUE (e.g. no health questions on applications) Have NO Pre-existing Condition limitations Major PPO networks available but NOT required to receive plan benefits Pay benefits regardless of other health insurance Advantages compared to expense-based “Mini-Meds”: First-dollar coverage (No Deductibles or Coinsurance) Guarantee Issue/No Pre-Ex Unlimited Rx benefits available Insured receives cash benefit in excess of the actual cost of service No offsets with other health coverage Relative Rate Stability Not subject to the PPACA guidelines (i.e. no waiver needed)

5 Benefit Utilization The greatest attribute of limited medical plans is providing access to basic health care services. The utilization graph below illustrates the typical distribution of medical claims experienced by our clients. Of significance is that Doctor Office Visits, Diagnostic Tests, X-Rays and Lab Work account for the vast majority of claims, nearly 70%. Furthermore, these plans typically pay for in excess of 80% of the expenses incurred. It is precisely these, and similar outpatient services, for which limited medical plans are designed to cover. Additional Utilization Statistics

6 Sample Plans:

7 Sample Mid-Med Plan (PHCS Network available but not required)

8 Employee Benefit Communications Since a large portion of this type of health insurance is voluntary, or at least partially employee-paid, an effective employee communications strategy is a must for a program’s success. The American Worker develops customized enrollment materials for each of its clients, for both open enrollment as well as packets for newly hired employees. These materials are not limited to, but can include: Enrollment Guides Postcards Posters for the workplace Call Center enrollment (bi-lingual capabilities) Online enrollment at the employee and/or employer level These types of employee communications materials and systems are offered as part of all of our programs. Each client has its own unique needs, and we will collaborate with the client to design the most effective strategy based on their objectives and our vast experience. Please refer to the next page for some sample communications packages that we have developed…

9 We have earned a national reputation for the employee communication materials we have developed over the years, and are industry experts in creating successful enrollments. The enrollment materials we produce can be printed and distributed at a traditional open enrollment meeting, mailed directly to the employee’s home and/or distributed at the workplace. Actual enrollment and ongoing administration can be handled with one or a combination of the following methods: Paper Applications Call Center Online Electronic File Transfer