Presentation on theme: "Individual Medical Not for use in AZ. Individual Medical Plans 2 Individual Medical Peace of Mind Individual Medical is the best solution for customers."— Presentation transcript:
Individual Medical Plans 2 Individual Medical Peace of Mind Individual Medical is the best solution for customers whose primary concern is: Asset protection in case of catastrophic costs
Individual Medical Plans 3 Individual Medical Portfolio CoreMed OneDeductible
CoreMed SM Flexible Options and Great Value Option to waive Rx copay and apply prescription costs to the plan deductible/coinsurance Save 7% to 18% in premium! Family deductible – just 2x per family! Option to use Health Savings Account (HSA) to pay medical expenses with tax-free money!
Individual Medical Plans 5 CoreMed – Our most popular plan! For those who want to control premium costs without sacrificing benefits Offers tremendous flexibility with a wide array of options, including the ability to pay medical expenses with tax-free money through a Health Savings Account (HSA) Customize coverage to your familys health care and financial needs Unique features help customers break the copay addiction!
Individual Medical Plans 6 CoreMed helps break the copay addiction Preventive benefits are included without copays Discounts make everyday medical expenses (including Rx) affordable for customers Retail clinics are an affordable alternative to more expensive office visits, and theyre more convenient too! On plans with prescriptions subject to plan deductible/coinsurance and no office visit copay, every dollar out of pocket helps the customer reach the deductible Customers can open an HSA to pay out-of-pocket medical expenses with tax-free funds Copays are an expensive benefit that adds limited value. Help your customers understand how they can save.
Individual Medical Plans 7 Break the Copay Addiction Educate your client: – 85% of policyholders have two or fewer office visits annually – $35 copay pays half the cost of a $70 office visit – Youll pay much more than $35 in additional monthly premium – Copay = cover charge penalty after deductible and coinsurance – Patient Care provides price transparency cost is no longer a mystery – Wellness visits are covered 100%, no deductible or coinsurance
Individual Medical Plans 8 Break the Copay Addiction Educate your client Rx benefits: – Copays are a cost you pay in addition to your deductible and coinsurance – You still receive the discounted cost at the pharmacy – Generic drugs cost $4; do you need insurance for that? – Avoid the additional brand name $500 deductible
Individual Medical Plans 9 Break the Copay Addiction Educate your client Rx benefits Use the premium savings (20% to 25%) for smarter coverage! – Lower plan deductible and coinsurance exposure – Supplemental coverage for critical illness, accident and dental – SuiteSolutions provides accident and critical illness benefits – Fund HSA with premium savings from higher deductible plan
Individual Medical Plans 10 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 Option 2: $35 copay for 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 people.
Individual Medical Plans 11 HSA-Compatible Options (Deductible/Benefit Percentage/Coinsurance/ Coinsurance Out-of- Pocket Maximum) 1. Choose one option: $3,500/50%/50%/$2,000 $5,000/100%/0%/$0 2. Choose office visit copay option 1 3. Choose prescription drugs option 1 4. Choose facility fees option 3 Preventive Services Benefits will be paid in accordance with the Patient Protection and Affordable Care Act; others subject to plan deductible and coinsurance Emergency Room$75 emergency room fee, waived if admitted to hospital Home Health CareUp to 160 hours Air/Ground AmbulanceNo limits on number of trips Intensive Care Unit (ICU)No daily limits Transplant Coverage Kidney, cornea, skin, bone marrow, heart, liver and lung transplants are covered as any other service. All transplants include the following: As much as $10,000 toward travel expenses As much as $10,000 toward donor expenses CoreMed Plan Benefits Availability of certain benefits varies by state.
Individual Medical Plans 12 Health Savings Account (HSA) An HSA plan is a combination of: A qualified high-deductible health plan A tax-favored savings account Clients can use an HSA to pay medical expenses not paid by their high deductible health plan including bills that go toward meeting the deductible and many other expenses Client financial benefits: Pay no income tax on money deposited in HSA No tax on interest or earnings as long as money withdrawn is for qualified medical expenses Unspent money rolls over year to year for future medical expenses or supplementing retirement income NOT use it or lose it At age 65, clients can withdraw money from HSA for non-medical expenses without penalty, paying only standard income tax Funding an HSA is easy! Premium savings from the high deductible health insurance plan can be used to fund HSA contributions
Individual Medical Plans 13 2011 HSA law HSA contributions are allowed to the maximum amount ($3,050 / $6,150) for any HSA qualifying deductible Additional catch-up of $1,000 for those age 55 and older Allows a one-time rollover from an HRA and FSA into an HSA Allows a one-time rollover from an IRA to a HSA
Individual Medical Plans 14 Sample CoreMed Rates Rates below for plans with prescriptions and office visits subject to the plan deductible/coinsurance, $0 facility fee Deductible$5,000$7,500$10,000 Coinsurance80% OOP$3,500 Single male 42$xxx Single Female 42$xxx Family 42 + 2 children$xxx Numbers have been manually entered. Premiums based on preferred rates with prior coverage. Effective date xx/1/2011. Zip code xxxxx.
Individual Medical Plans 15 Valued features included in every plan Patient Care HealthyDiscount* Preventive care Choice of doctors and hospitals *Availability varies by state and plan design.
Individual Medical Plans 16 Patient Care Value Proposition Consumers with high deductible plans or fixed-benefit plans pay for some medical services and procedures out of pocket Patient Care can research cost data for doctors and facilities Common examples = colonoscopies, MRIs, knee surgery Personalized data helps consumers make better decisions about cost effective, quality providers Logical complement to consumer-directed and fixed- benefit plans Patient Care is an independent advocacy company and is not affiliated with Assurant Health.
Individual Medical Plans 17 Patient Care Can Help Provide cost and quality information on doctors and hospitals Identify lower-cost drug options Explain and educate how to manage health care benefits Find the RIGHT provider in the network – Cost – Quality Patient Care does not provide clinical or legal advice.
Individual Medical Plans 18 Claim Example: Colonoscopy Physician information Patient Care estimates (illustrative) Dr. John SmithDr. Bob StevensDr. David Johnson Total price$1,649.00$1,790.00$1,587.00 Actual discount412.25447.50396.75 Balance1,236.751,324.501,190.25 Estimated discount25% Potential savings$ 87.75 --$ 134.25
Individual Medical Plans 19 Claim Example: Colonoscopy Facility 1Facility 2Facility 3 Total price$1,813.91$2,900.00$1,728.75 Actual discount453.48725.00432.19 Balance1,360.432,175.001,296.56 Estimated discount25% Potential savings$ 814.57 --$ 878.44 Facility information Patient Care estimates (illustrative)
Individual Medical Plans 20 Claim Example: Colonoscopy Total cost is less than most deductibles: $2,486.81 $ 134.25 Physician charge savings $ 878.44 Facility charge savings $1,012.69 Total out-of-pocket savings!
Individual Medical Plans 21 Patient Care Benefits to Agents Youll call it Customer Care! Offer another unique, customer-valued feature A team of experts helps you take care of your customers No additional paperwork requiredservice is automatically included You spend more time selling Customers can call 800.305.0377 – Monday through Friday 7 a.m.–9 p.m. CT
Individual Medical Plans 22 HealthyDiscount Reduce renewal premiums by 10%! On up to six renewals Eligibility requirements apply Easy application – Questionnaire automatically sent with renewal statement – Eligible customers are able to answer no to all questions – Sign statement of understanding and authorization – Return to Assurant Health within 60 days Client benefits save 10% at renewal Agent benefits increase persistency and renewal income! For illustration purposes only. HealthyDiscount not available in all states. $250 current monthly premium $300 new monthly premium at renewal - $3010% discount $270monthly renewal premium with HealthyDiscount
Individual Medical Plans 23 Preventive Care Includes routine immunizations, well visits and screenings for a disease-free and symptom-free individual Rules of thumb: – While a number of diagnostic tests and screenings are included, other physician charges related to those services, such as the office visit or physician fees, may not be – When you use a participating network provider, eligible preventive services will be covered and you do not have to pay a copay, coinsurance or deductible first – When services are not preventive, because they are part of a visit to diagnose, treat or monitor an illness or injury, your plan coinsurance, copays and deductibles may apply Defined by the Patient Protection and Affordable Care Act, United States Preventive Services Task Force (USPSTF), Centers for Disease Control (CDC), and Health Resources and Services Administration (HRSA)
Individual Medical Plans 24 Annual Physicals If purpose of the office visit is for a preventive screening, the office visit will be paid for Covered examples – Woman goes for annual exam with a Pap test. Both the Pap test and the office visit will be paid without a deductible/copay/ coinsurance as long as the main purpose of the exam is preventive. – Male goes for annual physical and has his cholesterol tested as a preventive measure. Both the cholesterol test and the office visit will be paid without a deductible/copay/coinsurance if the main purpose of the exam is preventive. Not covered example – Male has high cholesterol. He schedules an office visit each year so his doctor can monitor his condition. The services he receives, including cholesterol tests, will be subject to cost sharing and are not part of the first-dollar coverage requirement. The visit and tests are for his diagnosed condition, not a new screening for the purposes of prevention.
Individual Medical Plans 25 Choice of Doctors and Hospitals You select your doctor and hospital No specialist referrals necessary Provider networks and discounts – Selected primary network – Additional network discounts available Worldwide coverage, 24 hours a day Medco pharmacy network and Rx information Emergencies – Medically necessary emergency care paid at network levels even if at a non-participating provider or facility
Individual Medical Plans 26 Easy to Sell Individual with Supplemental! Enhance your clients benefits with supplemental coverage New integrated quoting and application process for adding supplemental products Increase the commission you earn with each sale! Assurant Supplemental Coverage – Dental – Accident – Critical Illness* Other Supplemental and discount options – SuiteSolutions SecureSolution SelectSolution* – Dental Vision Discount Plan *Based on informal guidance from the IRS, Critical Illness plans may be incompatible with HSA plans. Please consult your tax advisor if you wish to purchase a Critical Illness plan and fund an HSA.
Individual Medical Plans 28 OneDeductible Simple one deductible for all family members Full coverage for preventive services Add an HSA – Realize tax advantages – Multiple options for HSA administration AND Reduce the deductible amount you pay with the One Decreasing Deductible® program* you may never pay your full deductible again! *Availability varies by state
Individual Medical Plans 29 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
Individual Medical Plans 30 Preventive Services Benefits will be paid in accordance with the Patient Protection and Affordable Care Act; others subject to plan deductible and coinsurance Emergency Room$75 emergency room fee, waived if admitted to hospital Home Health CareUp to 160 hours Inpatient Rehabilitation Facility, Subacute Rehabilitation and Skilled Nursing Facilities Up to 90 days Air and Ground AmbulanceNo limits on number of trips Behavioral Health and Substance Abuse Subject to plan deductible, then 50% coinsurance to out- of-pocket maximum; 100% coverage after out-of-pocket maximum Intensive Care Unit (ICU)No daily limits Transplant Coverage Kidney, cornea, skin, bone marrow, heart, liver and lung transplants are covered as any other service. All transplants include the following: As much as $10,000 toward travel expenses As much as $10,000 toward donor expenses OneDeductible Plan Benefits Availability of certain benefits varies by state
Individual Medical Plans 31 Health Savings Account (HSA) Administration Assurant Health HSA administration advantages: – No account fees – Competitive interest rate – Automatic contribution (deposit) options – Checkbook and VISA debit card – HSA Tools free online option to pay bills and manage your account HSA administration options – HSA Tools – HSA Fundamentals – Any outside administrator you choose References are to federal tax laws. State laws may differ. NoSF
Individual Medical Plans 32 Break the Myth of the Low Deductible Plan! HSA deductible $5,700 100% thereafter Maximum out of pocket = $5,700 All expenses, including prescription drugs and doctor visits, are covered at 100% after deductible is satisfied
Individual Medical Plans 33 Cost Comparison – Low Medical Expenses Family coverage (husband and wife are both 32 years old, with two children) 25% federal tax bracket, 7% state tax bracket $1,000 in eligible medical claims
Individual Medical Plans 34 Cost Comparison – Low Medical Expenses Typical planHSA plan Two-per-family deductible: $1,000 Common family deductible: $5,700 Coinsurance: 80%/20%Coinsurance: 100% Premium paid$6,568$4,267 Medical expenses for $1,000 claim+ $1,000 $1,000 for deductible Expenses subtotal= $7,568= $5,267 Tax savings on HSA deposits-$0-$1,968 Net expenses$7,568$3,299 Savings with HSA plan= $4,269 Family coverage (husband and wife are both 32 years old, with two children) 25% federal tax bracket, 7% state tax bracket $1,000 in eligible medical claims
Individual Medical Plans 35 Cost Comparison – Catastrophic Event Typical planHSA plan Two-per-family deductible: $1,000 Common family deductible: $5,700 Coinsurance: 80%/20%Coinsurance: 100% Premium paid$6,568$4,267 Medical expenses for $1,000 claim+ $4,500+$5,700 $1,000 for deductible $3,500 for coinsurance $5,700 for deductible Expenses subtotal= $11,068= $9,967 Tax savings on HSA deposits-$0-$1,968 Net expenses$11,068$7,999 Savings with HSA plan= $3,069 Family coverage (husband and wife are both 32 years old, with two children) 25% federal tax bracket, 7% state tax bracket $50,000 in eligible medical claims (one person) AND…no continued client exposure
Individual Medical Plans 36 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.
Individual Medical Plans 37 Sample OneDeductible Rates Deductible$2,850$3,750$5,000 Family Deductible$5,700$7,500$10,000 Coinsurance100% Single male 42$xxx Single female 42$xxx Family 42 + 2 children$xxx Numbers have been manually entered. Premiums based on preferred rates with prior coverage. Effective date xx/1/2011. Zip code xxxxx.
Individual Medical Plans 38 Individual Medical provides peace of mind For customers who might say… I buy health insurance so that when a catastrophic medical event occurs, I have protected my assets.
Thank You! Assurant Health is the brand name for products underwritten and issued by Time Insurance Company, Milwaukee, WI. J-78881