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HEALTHEMED & HEALTHEFLEX JUSTIN CLEMENT, MBA VP OF BROKER SALES Health Insurance Innovations.

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Presentation on theme: "HEALTHEMED & HEALTHEFLEX JUSTIN CLEMENT, MBA VP OF BROKER SALES Health Insurance Innovations."— Presentation transcript:

1 HEALTHEMED & HEALTHEFLEX JUSTIN CLEMENT, MBA VP OF BROKER SALES Health Insurance Innovations

2 STM Plans Exempt From ACA ACA Definition of Short Term Medical: “Health Insurance coverage provided pursuant to a contract with an issuer that has an expiration date specified in the contract ( taking into account any extensions that may be elected by the policyholder without the issuer’s consent) that is less than 12 months after the original effective date of the contract” Since short –term limited duration insurance is specifically excluded from the definition of individual health insurance coverage in 45CF 144.103, the individual market protections of the PHS Act and the Affordable Care Act do not apply to short-term limited duration insurance.

3 Eligibility 100 Million More than 100 Million Americans will NOT NOT be eligible for a subsidy. Under 100% 20% 100-138% 8% 139-250% 20% 251-399% 19% 400+% 33% Source: http://www.statehealthfacts.org/comparebar.jsp?ind=9&cat=1

4 Impact of Health Care Reform on Major Medical Plans Perfect storm for major medical plans: 80% Medical Loss Ratio (MLR) Expensive mandated benefits; 100% preventative care, guarantee issue, no lifetime maximums, maternity coverage Restrictions on age rating Guarantee acceptance for all starting in 2014Impacts: Monthly premium rates for consumer doubling Commission rate compression Narrowing of networks 12 Month Short Term Plans: Exempt from Health Care Reform (ACA) Perfect storm for major medical plans: 80% Medical Loss Ratio (MLR) Expensive mandated benefits; 100% preventative care, guarantee issue, no lifetime maximums, maternity coverage Restrictions on age rating Guarantee acceptance for all starting in 2014Impacts: Monthly premium rates for consumer doubling Commission rate compression Narrowing of networks 12 Month Short Term Plans: Exempt from Health Care Reform (ACA) 4

5 If You Want To Save Your Clients Thousands STM Target:  Begin targeting these customers as potential buyers for STM ‐ Healthy enough to answer the 5 STM questions correctly ‐ Singles: $40K ‐ Couples: $60K ‐ Families: $70K

6 HII IPO HII is a leading developer and administrator of affordable, web-based individual health insurance plans and ancillary products.  IPO February 8, 2013  Bankers: CS, Citi, BofAML, RJ  Market Cap 4/1/13 @$200M  NASDAQ: HIIQ  Headquarters: Tampa, FL

7 HII STM vs. UHC STM Plan HII State Availability UHC State Availability   HII total STM state: 45 UHC total STM state: 23 AvailableNot Available

8 Unique Affordable Solution 8 Unique advantaged of HII’s Short Term Medical Plans: Accepts High Blood Pressure Children Only accepted (ages 2 and older) Unlimited copays Lowest cost in most markets (best seller on eHealth) Unlimited re-applies in most states 5-7 question app with instant e-approval and e-policy / ID cards Accept non US citizens

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10 A+ by A.M. BestA+ by A.M. Best 46 states, & 11 month duration (23 states)46 states, & 11 month duration (23 states) Coventry Network– Up to 45% average discountsCoventry Network– Up to 45% average discounts Teledoc, Kare360, & Chiro and Podiatry Plus (3/1/14)Teledoc, Kare360, & Chiro and Podiatry Plus (3/1/14) Very Low customer Exposure, and AffordableVery Low customer Exposure, and Affordable Why HII

11 Value Benefits Package Sterling Package  ID Resolution Identity Theft Service  Sprint Cell Phone Service  LensCrafters Vision Club  24 Hour Nurse Helpline Plan  Gateway Medicard  Discount Hearing Service  Travel Assistance Plan  Hewlett-Packard Computer and Digital Equipment  Customized Web Services - NAC Web Services  UPS Express Delivery Services  Offi ce Depot Supplies and Furniture  24-Hour Emergency Roadside Assistance  Hop The Shops  Savers Book® Club  1800Flowers.com  Carperks Buying Network  Car Rental Discounts  GymAmerica.com  Vitamin Discount

12 Both Plans AM Best Rating“A+ “ rated Accept High Blood PressureYES (will still cover Heart Attack & Stroke) Child OnlyYes (ages 2 and up) Out-of-Network PenaltyNo Out-of-Network Penalty (based on R&C) Network Discounts YES - Coventry Network (averages up to 45%) Urgent CareUnlimited $50 co-pay (then coinsurance) Individual Deductibles $250, $500, $1000, $2500, $5000 ($7500 HealtheMed only) Doctor Office visit Covered- Subject to Deductible and Coinsurance *Network Discounts applied if in network Inpatient DrugsCovered Outpatient & Over the Counter DrugsDiscount Card. (consider Agile Rx add-on if needed) Diagnostic testing and laboratoryDeductible & Coinsurance Emergency RoomDed & Coinsurance ($250 copay if illness and not confined) Hospitalized Ded– Average Semi-private room rate including nursing services *Physical Therapy $50 Maximum per visit per day *Skilled Nursing Not to exceed a daily rate of $150 nor a maximum of 60 days *Home Health Care Maximum 1 visit per day. Maximum of 40 visit s during a Coverage Period * Benefits may very by state

13 Covered by the Plans

14 Definition of Urgent Care

15 HealtheMed STM Plan Design Available to individuals age 2 - 64 with a choice of:  Per Term Deductibles: –$250, $500, $1000, $2500, $5000, or $7500  Coinsurance: –80% of the next $5,000 of eligible medical expenses  Coverage maximum: –$2,000,000 Coverage Period Maximum  Length of coverage: –Up to 6 months or 11 months 1 1 Length of term is limited to only 6 months in some states.

16 HealtheFlex STM Plan Design Available to individuals age 2 - 64 with a choice of:  Per Incident Deductibles: –$500, $1000, $2500, or $5000  Coinsurance: –80% of the next $20,000 of eligible medical expenses  Coverage maximum: –$100,000 Coverage Period Maximum  Length of coverage: –Up to 6 months or 11 months 1

17 HII HealtheMed vs. HealtheFlex  Livonia, MI 48150  30 year old male & 30 female with 2 kids PlanRates AM Best Rating Coinsurance out of pocket max Lifetime max DeductibleCopayTeladocKare360 HealtheMed $249.43 A+ 80/20 to $5K $1,000 $2MPer Term $50 copay then coinsurance (Urgent Care) Yes HealtheFlex $148.73 A+ 80/20 to $20K $4,000 $100KPer Event $50 copay then coinsurance (Urgent Care) Yes

18 What Sets HealtheFlex STM Apart?  Lower Rates, providing more cross-sale opportunities  Access to Teladoc & Kare360 Patient Advocacy program  Ability to choose any doctor or hospital with the option to utilize the Coventry Network for discounts  Available to U.S. and non-U.S. citizens who legally reside in the United States during coverage. No requirement for prior length of established U.S. residency

19 HII vs. Competition’s STM  Livonia, MI 48150  30 year old male & 30 female with 2 kids CompanyPlanRates AM Best Rating Coinsurance out of pocket max Lifetime max CopayTeladocKare360 Accepts High Blood Pressure HIIHealtheMed $249 A+ 80/20 to $5,000 $1,000 $2M $50 copay then coinsurance (Urgent Care) Yes UHCSTM Copay$396A 80/20 to $20,000 $4,000 $1M $50 copay (2 per person) No

20 Overall Value : What is the max out of pocket? 30 year old husband & wife with 2 kids; Livonia, MI 48150 PlanMonthly Cost Out of Pocket Per Person HII STM $2,500 deductible 80/20 to $5,000 $249.43 $3,500 UHC STM Copay $2500 deductible 80/20 to $20,000 $396.31 $6,500

21 A+ = Quality

22 Coventry Network

23 Medical Expenses Not Covered Exclusions and Limitations:  Preventive or wellness doctor visits  Dental or optical treatments  Routine physical exams  Normal pregnancy or childbirth  Well child care  Interscholastic and intercollegiate sports injuries  Over-the-counter medications and outpatient prescription drugs  Expenses incurred outside the United States, its possessions or territories, or Canada  Varicose veins  Substance abuse and alcoholism  Chronic fatigue or pain disorders and allergies ( except for emergency treatment of allergic reaction) Expenses during the first 6 months after the effective date are excluded (subject to all other coverage provisions, including the pre-existing condition limitation) For:  Total or partial hysterectomy, unless it is medically necessary due to a diagnosis of carcinoma  Tonsillectomy  Adenoidectomy  Repair of deviated nasal septum or any type of surgery involving the sinus  Myringotomy  Tympanotomy  Herniorraphy or Cholecystectomy Please note that there is a 3 day waiting period from the effective date for sickness. The waiting period does not effect benefit for injuries.

24 TeledocTeledoc Kare360Kare360 Chiro and Podiatry Plus (3/1/14)Chiro and Podiatry Plus (3/1/14) Included Benefits!

25 TelaDoc What is TelaDoc?  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 you 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

26 Kare360 Providing personalized service, Kare360’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, Kare360 will help you take the hassle out of health care saving you valuable time and money. Kare360 is pleased to also provide on-staff chaplains, available by phone to listen and offer counsel in those times when you need it most.  Physician Search - Helping members find quality family doctors, specialists and surgeons.  Appointment Scheduling - Advisors schedule visits with doctors, labs and more.  Medical Bill Mediation - Unparalleled results in negotiating savings on medical charges.  Eldercare Solutions - Finding solutions for seniors in all areas including living arrangements, transportation, RX delivery, supplemental insurance and more.  Alternative Treatments - Locating care for Chiropractic, Acupuncture, Massage Therapy and more.  Insurance Policy Assistance - Clarification on benefits, help resolving issues.  Surgery Cost Saver - A specialized R.N. will provide a cost, quality and availability comparison of health care facilities in your area for your particular needed procedure. This can be used in consultation with your doctor, enabling you to make an informed decision. Clarification on benefits, help resolving issues.

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28 Chiropractic: 28,000 credentialed providers More than 20,000 contracted chiropractors 25% discount off normal fees for services Alternative health care network includes chiropractors, massage therapists, acupuncturists and registered dietitians Direct Labs (DLS) Benefits: Wide variety of important health and wellness blood chemistry tests at discounted prices Saving 10% to 80% off regular retail pricing Over 3,000 certified labs nationwide

29 Easy Underwriting **California, Connecticut, Colorado, North Dakota, Ohio, and Virginia asks the declined condition Declination question not asked (Except: CA, CT, CO, ND, OH & VA)

30 Next Day Effective Dates!

31 Payment Options

32 10 Day Free Look

33 The HII Customer Experience STM Quote Example w/ Available Options Insurance Application w/ Medical History Q&A, Selected Options, Agreement and Agent Information Welcome Letter and ID Card QuoteBuyPrint 33

34 STM Renewal E-Mail Automatically sent 15,10 and 5 days prior to term date Sent to both client and agent When client or agent completes the application it’s considered new business. Typical re-apply rate is 30% to 50% Dear First Last, Please be advised your Med Plus STM insurance coverage, underwritten by Starr Indemnity & Liability Company, ID#: STT1234567, Effective 11-11-1111, is scheduled to terminate on 11-11-1111. This insurance coverage is important and you can reapply for another period of coverage with the convenient link provided below. This link enables you to quote your own plan options and apply online. However, you will have a new effective date and a new preexisting conditions clause will apply. Click Here: https://www.hiiquote.com.link.link.link.linkhttps://www.hiiquote.com.link.link.link.link If you purchased the Extra Care Package (ECP), your payment for the ECP will continue to be processed on the same day of the month. The ECP includes the Careington Dental Network Discounts & Services, and CallMd services for Physician Telephone Consultations 24/7 – that includes 12 free physician telephone consultations per year. These plus the other benefits are listed in your Extra Care Package fulfillment booklet, found at your www.hiiquotecustomers.com login. www.hiiquotecustomers.com Feel free to call our Customer Service Department 1-877-376-5831 with any questions. PS: Some states have rules related to the ability to reapply. See list below: Colorado: We cannot issue coverage to anyone who has had 3 or more STM policies in the last 12 months. Maine: If you combined your policy with all prior short term policies, it cannot exceed 12 months on uninterrupted coverage. Michigan: Your coverage cannot exceed 185 days in any 365 day period. Nevada: We cannot issue 3 or more policies in a 12 month period. AGENTS LINK https://www.hiiquote.com.link.link.link.link.linkhttps://www.hiiquote.com.link.link.link.link.link CC: yourname@youragency.net, adahlke@hiiquote.com, slingle@hiiquote.comyourname@youragency.netadahlke@hiiquote.comslingle@hiiquote.com

35 Thank You!


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