1. Anthem & IHC Sales Training
Brought to you by:
Anthem and The IHC Group
For training purposes only. Not for public distribution or solicitation.

2. Today’s Agenda About IHC Value Proposition Availability Products
Interim Coverage
Fixed Benefit Plan
Balance
Fixed Benefit Plan Combo and Interim Coverage Combo
2x3 Plans
Third Party Administrators

3. We are The IHC Group
In our ever-changing healthcare landscape, there is at least one constant upon which you can rely: The IHC Group. For more than 30 years, we have been an industry fixture known for adapting, growing and responding quickly to the needs of Producers and consumers.   Through product innovation and committed relationships with our policyholders, we have built a strong, successful insurance organization.
Three carriers rated A- (Excellent) by A.M. Best creating solutions together
Standard Security Life Insurance Company of New York
Independence American Insurance Company
Madison National Life Insurance Company, Inc.

4. IHC Working with Washington
HHS
Duration change from 90 to 364
Final rule will be issued with approved effective date (around 6/1/18)
Improving competition in the healthcare marketplace
Standardize policy forms and rates so that they would be standardized across the U.S.
Reducing the MLR to allow for producer compensation
Senate
Promoting the Senate Bill 1661: lowers the MLR on ACA plans to allow for producer compensation
DOL
Association health plans would allow small groups and individual business owners to band together to act as a large group.

5. Sales Value Statements
“A prescription without proper diagnoses is malpractice in any profession.”
Sales is a process, not an event.
Sales is something you do for someone, not to someone.
Prospects don’t buy your products and services, they buy what your products and services will do for them.
Prospects buy your products and services for their reasons, not yours.

6. Value Proposition To Anthem and our members
Offering plans in areas where we couldn’t maintain an ACA plan presence
Generating revenue in a growing market while upholding Anthem’s standards and values
Remaining dynamic and adaptive in a changing market
Our sales teams
Products to offer outside of Open Enrollment with no network or area restrictions
Increase the number of solutions available to meet clients’ needs
Products that make sense to bundle for existing ACA clients
Increased earning potential

7. Product Availability Chart
Balance
(MNL)
Interim Coverage
(SSL)
Interim Coverage 2.0
Fixed Benefit Plan
(IAIC)
Fixed Benefit Plan Combo and Interim Coverage Combo (IAIC)
Connect STM 2x3 CA X CO CT GA IN KY ME MO NH NV NY OH VA WI

8. Anthem and IHC Products
What are your ACA options?
What are your non-ACA options?
Do you have a viable solution for their need/desire?

9. Interim Coverage Short-Term Medical

10. Why Sell Short-Term Medical Coverage?
Perfect product for individuals and families who
Who have a short term gap in traditional ACA or group coverage
Won’t receive a subsidy and cannot afford an ACA plan
Have limited ACA options
Volatile individual major medical market has increased demand for alternatives
Short term medical sales have increased by 134% each year since 2014
Limited medical plan sales have increased by 147% each year since 2015
Deductibles ranging from $1,000 to $5,000
$2,000,000 coverage period maximum benefit

11. Top Reasons Individuals Buy Short-Term Medical Coverage
They can buy it any time they
Want with online quoting and
Enrollment
Client can self-enroll or
producer can complete enrollment on behalf of client
They only need coverage for
a short period of time with option
of per day coverage
They like the ability to see any
medical provider or facility but
they still have access to discounted
medical services through
national preferred provider
organizations (PPOs)
Short term medical costs less
than a traditional ACA plan
They are buying coverage for
the things that are important
to them
Availability of next-day
coverage

12. Outpatient Claim Example
Scenario
Martin had a covered knee surgery, which resulted in $8,000 of medical expenses.
Martin has an Interim Coverage plan with a $2,500 deductible and 30% coinsurance.
Here’s how it works
Martin meets his $2,500 deductible
He pays 30% coinsurance on the remaining $5,500 for a total of $1,650
Martin’s total out-of-pocket cost after his coinsurance is applied is $4,150

13. Underwriting Questions
Eligible for Medicare or Medicaid
Applicant or any immediate family member whether or not applying for coverage that is pregnant, an expectant parent, in the process of adopting a child or undergoing fertility treatment.
Over 300 pounds (male) or 250 pounds (female) or undergone weight loss or bariatric surgery
Been diagnosed or treated for Acquired Immune Deficiency Syndrome (AIDS) or other Immune Disorders
Within the last 5 years (depending on state) if an applicant or any person applying for coverage received any medical or surgical advice, consultation or treatment, including medication for:
Stem cell transplant
Heart disorder, heart attack, coronary artery disease or circulatory system disorder (includes by-pass or stent surgery or carotid artery disease/surgery
Stroke, seizures disorder or other neurological disorder
Cancer or tumor OR taking medication to prevent recurrence of cancer or tumorous growth
Paraplegia, quadriplegia or multiple sclerosis
Emphysema, chronic bronchitis or COPD (chronic obstructive pulmonary disease)
Insulin dependent diabetes
Kidney disorder other than stones and/or liver disease
Degenerative arthritis (degenerative disc disease, herniated disc, rheumatoid or psoriatic arthritis or degenerative joint disease)
Alcohol or drug abuse or dependency OR chemical dependency

14. Fixed Benefit Plan

15. What is Fixed Benefit Plan?
Fixed indemnity coverage with hospital, surgical and critical illness benefits
Three plan options to choose from
Plan pays the fixed dollar amount for the benefits you select, regardless of the amount your providers charge for services
Benefits for covered services include:
Inpatient hospitalization
Physicians visits
Surgery
Ambulance
Outpatient chemotherapy and radiation therapy services
Customizable options include:
Critical illness
Wellness preventive care
Emergency room visit

16. Why sell a Fixed Benefit Plan?
Longer-term approach than STM
First-dollar coverage
Flexibility to choose any doctor or hospital
$0 deductible for injury or illness
No plan calendar year or lifetime dollar amount maximums
No need to reapply; guaranteed renewable
Coverage available outside of U.S. for up to 90 days (On an emergency basis)

17. Underwriting Questions
Build chart
Is any person whether or not they are applying for coverage, pregnant, in the process of adoption, or undergoing infertility treatment or use of a surrogate mother? If yes, coverage cannot be issued to any family member.
If any person applying for coverage answers "Yes" to any condition(s) under question 2 they are not eligible for coverage.
In the past 5 years has any person applying for coverage been diagnosed with, received medical advice or treatment for(including prescribed medications), or had symptoms of, any of the following conditions:
a) Heart disease, stroke, transient ischemic attack, coronary artery disease, peripheral vascular disease, carotid artery disease, coronary bypass, angioplasty or stent, atherosclerosis, or congenital heart disease
b) Cancer (other than basal or squamous cell skin cancer), or malignant melanoma
c) Disease or disorder of the brain or central nervous system including but not limited to brain tumor or cyst, muscular dystrophy, multiple sclerosis, cerebral palsy, mental retardation, chorea (Huntington’s, Sydenham’s or Wilson’s Disease or other) or amyotrophic lateral sclerosis
d) Emphysema, chronic obstructive lung disease (COPD), cystic fibrosis or other chronic lung or respiratory condition (except for asthma or allergies)
e) Hepatitis B or C, cirrhosis, enlarged liver, liver tumor or hemangioma
f) Insulin dependent diabetes mellitus or chronic pancreatitis
g) Alcoholism, alcohol abuse, illegal drug use or prescription drug dependence or addiction
h) Bipolar disorder, schizophrenia, anorexia, bulimia, suicide attempt or other mental or nervous disorder (excluding situational depression, anxiety or attention deficit hyperactivity disorder, ADHD)
i) Kidney or bladder disorder (excluding resolved stones or urinary tract infections)
j) Rheumatoid or psoriatic arthritis, quadriplegia, paraplegia, or are you required to use a wheelchair or other device to assist you in ambulation
k) Stem cell transplant, organ transplant or disease of the blood (other than iron deficiency anemia)
l) Autoimmune disorder including but not limited to systemic lupus erythematosis, dermatomyositis, Sjoren syndrome or myasthenia gravis
m) Acquired immune deficiency syndrome (AIDS), AIDS related complex (ARC) or tested positive for the HIV virus
If any person applying for coverage answers "Yes" to any condition(s) under question 3 they are not eligible for coverage.
In the past 2 years has any person applying for coverage been diagnosed with, received medical advice or treatment for(including been prescribed medications), or had symptoms of, any of the following conditions:
a) Herniated or bulging disk or, degenerative disk disease of the spine
b) Ulcerative colitis, Crohn’s disease, terminal ileitis or diverticulitis
c) Gall bladder disease that has not been cured and/or gall stones that have not been removed
d) Endometriosis, human papilloma virus or chronic menstrual disorder
e) Replacement of the hip(s) or knee(s)

18. Key Differences Between Interim Coverage & Fixed Benefit Plan
Permanent coverage X
Deductible requirement
Co-Insurance requirement
Stop-loss Feature
Reapply requirement
Subject to age and trend NB rate increases
Critical illness included
Network discounts
Guaranteed renewable
Year-round enrollment
Benefits available to be paid direct to the insured
Precertification requirement
ACA-compliant meeting MEC
Coverage outside of the U.S. (on an emergency basis)
To understand who may be a good insured for either product, you first must understand who is not a good prospect for one or both of these products.
The application process questions for both products are designed to exclude consideration for individuals/families where the products would not be a good fit for them based upon their medical history.
Complete transparency on the applicant’s part is a MAJOR consideration in their satisfaction. No shortcuts should ever be taken by anyone in this process.

19. Outpatient Claim Example
Scenario
Martin had covered knee surgery, which resulted in $8,000 of medical expenses.
Martin has Fixed Benefit Plan (Plan 3)
Here’s how it works
Martin’s total outpatient surgical claim is $8,000
Fixed Benefit Plan pays: Facility: $1, Surgeon: $1, Assistant surgeon: $ Anesthesiologist: $ Total benefits paid: $3,750
Martin’s out-of-pocket cost after his Fixed Benefit Plan benefits are applied is $4,250.

20. Inpatient Benefit Example
$12,250
$ 5,875
Difference = $6,375
Theoretically a check back to insured since price wasn’t equal or greater than total benefits paid!
*Medical cost data provided by Health Care Blue Book ( Blue Book prices illustrated is based on the national average discounted fees that providers accept as payment from insurance companies (i.e. PPO Discounted Prices). Healthcare Bluebook example is based on procedures performed in Pinellas County, FL, Zip
© IHC Group 2017

21. Balance

22. Balance Plan Highlights
Accident and critical illness coverage
Lump sum cash benefit to use as member sees fit
Up to $10,000 cash benefit for a covered critical illness
Accident medical expense benefit from $2,500 to $10,000
Accident hospital confinement benefit of $150 per day, up to 30 days
$1,000 monthly accident disability income up to 12 months for primary members
Membership plan benefits included with plan

23. Why Bundle Balance with Interim Coverage?
Balance can be matched with the Interim Coverage deductible to offset the member’s financial responsibility
A richer Balance plan option could offset or eliminate the member’s coinsurance amount on an eligible claim.
Balance options provide richer benefits to the member to help offset out-of- pocket expenses or provide additional household income.

24. Balance + Interim Coverage Claim Example
Scenario
Martin had an accidental knee injury, which resulted in $8,000 of medical expenses.
Martin has an Interim Coverage with a $2,500 deductible and 30% coinsurance.
Covered by Interim Coverage only:
Martin meets his $2,500 deductible
30% coinsurance from his Interim policy pays $1,650 of the remaining $5,500
Martin’s out-of-pocket cost after his coinsurance is applied is $4,150
Adding Balance:
His Balance 2 plan has the Accident Medical Expense benefit, which covers $5,000 in qualifying medical expenses
The $5,000 Accident Medical Expense covers the $4,150 out-of-pocket remaining from his Interim plan

25. Fixed Benefit Plan Combo and Interim Coverage Combo Plan

26. Why Bundle Hospital Indemnity and STM?
Two plans come together as one solution with
Single enrollment
One administrator
Common billing, claims processing, and effective dates
Network discounts
Reapply for STM policy at the end of the 90 day or 180 days if they elect a 2x3
A new rate may apply due to age increase or a trend increase
They could be declined coverage based upon claims experience
If approved, pre/x applies, deductibles/coinsurance resets
The fixed indemnity piece (Fixed Benefit Plan) of the combo plan will stay inforce and uninterrupted as long as the member remains eligible

27. Inpatient Claim Example
Scenario Acute Appendicitis requiring 2 days inpatient hospitalization and surgery resulting in a $12,000 claim.
The STM Portion – Interim Plan 2
STM Deductible
$15,000
Coinsurance
(STM pays/member pays)
70%/30%
Coinsurance Max. OOP
(after Deductible)
$6,000
STM member responsibility
(Deductible + Coinsurance)
$12,000
The Fixed Indemnity Portion (FIP) – Fixed Benefit Plan B
Benefit
Daily Benefit
Total Benefit
Hospital (2 Days)
$2,000 (daily)
$4,000
Surgical Benefit (1)
$6,000
Inpatient Doctor Visits (2)
$50
$100
Total HIP Benefit
$10,100
Member applies FIP benefit to STM Deductible and Coinsurance
Claim Out-of-Pocket after FIP benefits
$1,900

28. Example 2
Insured has selected Fixed Benefit Plan C with Interim Coverage Plan 3
$6,000 inpatient surgery benefit
$3,000 per day hospital confinement benefit
Step 1:
One inpatient surgery = $6,000 benefit
Three hospital confinement days = $9,000 ($3,000 x 3)
Total benefit $15,000

29. Example 3
Insured has selected Fixed Benefit Plan C with Interim Coverage Plan 3
$6,000 inpatient surgery benefit
$3,000 per day hospital confinement benefit (3 days)
Total benefit = $15,000
Step 2:
Total amount billed for surgery and hospital confinement: $22,000
Network discount brings the amount to $18,000

30. Example 4
Insured has selected Fixed Benefit Plan C with Interim Coverage Plan 3
$6,000 inpatient surgery benefit
$3,000 per day hospital confinement benefit (3 days)
Total benefit = $15,000
Total amount billed for surgery and hospital confinement: $22,000
Network discount brings the amount to $18,000
Step 3:
$15,000 total benefit is applied to the $18,000 amount due
$3,000 remains the responsibility of insured
$18,000 of the $20,000 (Plan 3) deductible is deemed fulfilled

31. Fixed Benefit Plan Combo and Interim Coverage Combo Plan Network Discount
Do not sell Fixed Benefit Plan Combo without the Interim Coverage (STM) portion
Since the network discounts are attached to the short-term medical (Interim) portion, selling Fixed Benefit Plan on its own will result in no network with the plan.

32. Fixed Benefit Plan Combo and Interim Coverage Combo
Connect STM 2x3
Fixed Benefit Plan Combo and Interim Coverage Combo

33. Highlights Available for 2/1 effective dates
An STM ‘2x3’ plan is when two consecutive short-term medical plans are sold - each with a duration of 90 days
This applies to Connect STM as well as the STM portion of the Fixed Benefit Plan Combo
Application process will be the same. The link for the ‘2x3’ option will appear on the ‘Submission Complete’ page

34. Third Party Administrators

35. The Loomis Company Loomis administers these products: Connect STM 2x3
About The Loomis Company
The Loomis Company (Loomis), founded in 1955, has been a leading Third Party Administrator (TPA) since Loomis has strategically invested in industry leading ERP platforms, and partnered with well-respected companies to enhance and grow product offerings. Loomis supports a wide spectrum of clients from self-funded municipalities, school districts and employer groups, to large fully insured health plans who operate on and off state and federal marketplaces. Through innovation and a progressive business model, Loomis is able to fully support and interface with its clients and carriers to drive maximum efficiencies required in the ever evolving healthcare environment.
Loomis administers these products:
Connect STM 2x3
Fixed Benefit Plan
Fixed Benefit Plan Combo and Interim Coverage Combo

36. Ebix Health Administration Exchange, Inc.
About Ebix Health Administration Exchange, Inc.
Ebix Health Administration Exchange, Inc. doing business as Ebix Health Administration (“Ebix HAE”) is an administrative services company that operates in 50 jurisdictions in both the individual and employer markets. Through certain administrative agreements with insurance carriers and its affiliation with Ebix Incorporated, Ebix HAE offers state-of-the-art and highly efficient open health insurance exchanges. Ebix HAE also provides pet insurance solutions that furnish pet owners, specialty pet hospitals, universities and general veterinary practices with the only open exchange in the country.
EHAE administers these products:
Balance
Interim Coverage
Interim Coverage 2.0

37. Important Information
These products are not qualifying health coverage (“Minimum Essential Coverage”) that satisfies the health coverage requirement of the Affordable Care Act. If you don't have Minimum Essential Coverage, you may owe an additional payment with your taxes. The termination or loss of this policy does not entitle you to a special enrollment period to purchase a health benefit plan that qualifies as minimum essential coverage outside of an open enrollment period. These products may include a pre-existing condition exclusion provision.

38. Questions?