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The Essentials and the Ultimate Triple Choice: A Creative Approach for Enhancing Employer Affordability of Group Health Coverage.

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Presentation on theme: "The Essentials and the Ultimate Triple Choice: A Creative Approach for Enhancing Employer Affordability of Group Health Coverage."— Presentation transcript:

1 The Essentials and the Ultimate Triple Choice: A Creative Approach for Enhancing Employer Affordability of Group Health Coverage

2 Sekure Healthcare, Symetra Life Insurance Company and Contractor’s Choice have teamed up to enhance employer affordability with: The Essentials 1 – an affordable health coverage product; and The Ultimate Triple Choice – A coordinated offering of coverage products with a wide spectrum of affordability (benefits for all budgets) Healthcare Innovation Announcement Notes: 1. It is important to understand that the Essentials is not a replacement for major medical/comprehensive health coverage

3 It’s an innovative health coverage that uses a Limited Benefit Medical Insurance (MiniMed Plan) with provider networks, 24/7 patient advocacy & other health resources inside an ERISA Trust managed by Contractor’s Choice. Consumer Driven – Members have freedom of choice with no managed care utilization controls. Guaranteed Issue - No pre-existing conditions limitations or health questionnaires. No Deductibles - First dollar fixed benefits coverage the day Member is effective. Participation - Minimum of 5 enrollees. Applicability - Ideal for employers who:  Offer no health benefits  Have low participation on major medical plans  Have a large Hispanic workforce, part-time and/or seasonal workers What is The Essentials?

4 The Essentials consists of two separate product components coupled with a unique sales distribution/administration platform:  Select Benefits - A Limited Benefit Medical Insurance Plan underwritten by Symetra Life Insurance (“Symetra”); and,  Sekure Healthcare Program - PPO provider networks in US & Mexico, patient advocacy & other health resource services When used together, these two product components work in tandem for a more effective benefit plan What is The Essentials Product Structure? Contractor’s Choice uses an ERISA Trust coupled with unique distribution & administration that increases market reach, accessibility & visibility

5 The Symetra Select Benefits Insurance Policy is a fixed indemnity/limited benefit medical plan. The Plan pays a predetermined cash benefit with a maximum limit to the covered person - this is different from an HMO Copay Plan. The benefit is paid without regard to the selected provider or amount of charges. Benefit categories include doctor office visits, preventive care, hospital care, lab/X-ray and more. Symetra (www.Symetra.com) is “A” rated by A.M. Best, has nearly $19B in assets & over 2 million customers.  Insurance Benefits Select Benefits is not a replacement for a major medical policy or other comprehensive policy. It is designed to cover benefits at preselected fixed dollar amount used on a routine basis. Coverage may be subject to exclusions, limitations, reductions and termination of benefits provisions.

6  Sekure Healthcare Program The Sekure Healthcare Program helps to reduce medical expenses. Sekure integrates access to healthcare services (medical, hospital, dental, pharmacy, vision, chiropractic, acupuncture & more) in the US & in Mexico. National PPO networks offer Members savings with 20% to 35% discount before benefits are paid. Health Advocate Unit available toll-free to assist Members in finding network providers. 24/7 toll-free nurse line provides helpful medical information & assistance. www.MySekure.com

7 The Essentials has 3 Standard Plans & 1 Core Buy-Up Plan  The Standard Plans are 100% paid for by employer, available on super composite or 4 tier levels. Pricing on super composite tier from $99/month to $312/month.  The Core Buy-Up Plan is an innovative plan design - employer pays 100% of core level benefits. Each employee has option to buy up to higher levels of benefit coverage. Employer contribution is as low as $50 for the core level benefits on super composite tier. Insurance Benefit Plan Designs Note: Super composite pricing is one tier for employee and includes all eligible dependents To Skip Viewing The Essentials Plan Designs and Proceed to Next Slide in the Presentation Click Here

8 Essentials 300 Plan Design Benefit CategoryBenefits Paid to Members (or assigned to Provider) Doctor’s Office Visit Benefit$35 per visit, with a max of $300 PP/CY (per person per calendar year) Preventive Care Benefit$50 per visit, up to $100 PP/CY Diagnostic X-ray & Lab$40 per visit, up to $300 PP/CY Accident BenefitDiscount Only Hospital Indemnity Maternity covered as any other condition $300 per day for hospitalization, up to 30 days PP/CY $600 per day for intensive care, up to 30 days PP/CY $300 per day for Substance Abuse, up to 30 days PP/CY $150 per day for Mental Health, up to 30 days PP/CY $150 per day for Skilled Nursing, up to 60 days per consecutive stay PP/CY Surgical BenefitDiscount Only Pharmacy BenefitDiscount Only Survivors BenefitExtended benefits to surviving dependents for two years Employer Rates Monthly 100% employer contribution 4 Tier : EE - $77.61, EE+SP - $129.61, EE+C - $93.75, and EE+Fam - $132.61 Super-composite: $99.72/employee (includes all eligible dependents)

9 Essentials 600 Plan Design Benefit Category Benefits Paid to Members (or assigned to Provider) Doctor’s Office Visit Benefit $50 per visit, with a max of $300 PP/CY (per person per calendar year) Preventive Care Benefit $75 per visit, up to $150 PP/CY Diagnostic X-ray & Lab $55 per visit, up to $300 PP/CY Accident Benefit $500 PP/CY maximum Hospital Indemnity Maternity covered as any other condition $600 per day for hospitalization, up to 30 days PP/CY $1,200 per day for intensive care, up to 30 days PP/CY $300 per day for Substance Abuse, up to 30 days PP/CY $300 per day for Mental Health, up to 30 days PP/CY $300 per day for Skilled Nursing, up to 60 days per consecutive stay PP/CY Surgical Benefit $1,000 PP/CY maximum Pharmacy Benefit $15 Gen/$30 Brand Copay with max of $500 PP/CY & $1,000 per family/CY Survivors Benefit Extended benefits to surviving dependents for two years Employee Life Insurance; AD&D $10,000; $10,000 Dependent Life InsuranceSpouse - $5,000; Child - $2,500; and Infant - $400 Employer Rates Monthly 100% employer contribution 4 Tier : EE - $140.22, EE+SP - $276.78, EE+C - $184.22, and EE+Fam - $284.49 Super-composite: $199.64/employee (includes all eligible dependents)

10 Essentials 800 Plan Design Benefit Category Benefits Paid to Members (or assigned to Provider) Doctor’s Office Visit Benefit $50 per visit, with a max of $300 PP/CY (per person per calendar year) Preventive Care Benefit $75 per visit, up to $150 PP/CY Diagnostic X-ray & Lab $60 per visit, up to $300 PP/CY Accident Benefit $500 PP/CY maximum Hospital Indemnity Maternity covered as any other condition $800 per day for hospitalization, up to 30 days PP/CY $1,600 per day for intensive care, up to 30 days PP/CY $800 per day for Substance Abuse, up to 30 days PP/CY $400 per day for Mental Health, up to 30 days PP/CY $400 per day for Skilled Nursing, up to 60 days per consecutive stay PP/CY Surgical Benefit $3,000 PP/CY maximum Pharmacy Benefit $15 Gen/$30 Brand Copay with max of $500 PP/CY & $1,000 per family/CY Dental BenefitDeductible of $50 PP/CY, $150 per family/CY; $500 PP/CY max benefit Survivors Benefit Extended benefits to surviving dependents for two years Employee Life Insurance; AD&D $10,000; $10,000 Dependent Life InsuranceSpouse - $5,000; Child - $2,500; and Infant - $400 Employer Rates Monthly 100% employer contribution 4 Tier : EE - $211.48, EE+SP - $446.41, EE+C - $286.01, and EE+Fam - $459.78 Super-composite: $312.73/employee (includes all eligible dependents)

11 Essentials Core Buy-Up Plan Employer Pays as low as $50 for Core Plan and Employee has option to Buy Up for higher benefits Description of Benefits Paid to Members (or assigned to provider) Available BenefitsCore Plan Buy Up #1Buy Up #2 Buy Up #3 Doctor's Office Visit Benefit $35/visit; $300 PP/CY max$40/visit; $300 PP/CY max$45/visit; $300 PP/CY max Preventive Care Indemnity Benefit No benefit – discount through Sekure Healthcare $50/visit; $150 PP/CY max Outpatient Diagnostic X-ray and Lab Benefit $35/visit; $300 PP/CY max$45/visit; $300 PP/CY max$55/visit; $300 PP/CY max Additional Accident Benefit No benefit – discount through Sekure Healthcare $300 PP/CY max Hospital Indemnity Benefits Maternity coverage as any other condition $100/day for hospital; up to 30 days PP/CY $200/day for intensive care; up to 30 days PP/CY $100/day for Substance Abuse, up to 30 days PP/CY $50/day for Mental Health, up to 30 days PP/CY $200/day for hospital; up to 30 days PP/CY $400/day for intensive care; up to 30 days PP/CY $200/day for Substance Abuse, up to 30 days PP/CY $100/day for Mental Health, up to 30 days PP/CY $300/day for hospital; up to 30 days PP/CY $600/day for intensive care; up to 30 days PP/CY $300/day for Substance Abuse, up to 30 days PP/CY $150/day for Mental Health, up to 30 days PP/CY $400/day for hospital; up to 30 days PP/CY $800/day for intensive care; up to 30 days PP/CY $400/day for Substance Abuse, up to 30 days PP/CY $200/day for Mental Health, up to 30 days PP/CY Surgical Benefit No benefit – discount through Sekure Healthcare $500 PP/CY maximum Prescription Drug Benefit No benefit – discount through Sekure Healthcare Survivors Benefit – For surviving dependents Extended benefits for 2 years Employee Life Ins/AD&D $5,000 / $5,000 Dependent Life Insurance Spouse - $2,500; Child - $1,250; Infant - $200 Monthly Cost to Employer $50.00 Monthly Cost to Employee (includes eligible dependents) $17.00$39.90$66.17$91.05

12  Sekure Healthcare Program Networks Medical/HospitalBeech Street PPO Network - average savings of 25% - 35% DentalFirst Dental Health - average savings of 30% - 35% PharmacyCaremark - average savings of 20% Vision CareNational Vision Administrators - average savings of 25% Chiropractic, Massage Therapy, Acupuncture American Specialty Health has wide range of complementary care - average savings of 25% - 30% Nurse-lineHealth Contact Partners – No charge Health AdvocacyHealth Contact Partners – No charge Mexico Health AccessSekure Healthcare – average savings of 25% - 35% For healthcare not covered by insurance or for when insurance coverage limits are reached, the Sekure Healthcare Program offers substantial discounts.

13 Several important cultural considerations have been designed into The Essentials. Coverage becomes more relevant to Latinos who make up 57% of California’s 6.6 million uninsured. Sekure Healthcare is expanding its network of community clinics throughout CA.  Some Latinos prefer to have option to access community clinics.  Clinics offer low cost visits and some accept assignment of benefits. 24x7 bi-lingual patient advocacy and nurse-line Cross-border health coverage – healthcare access in Mexico is a feature requested by many Latino workers throughout CA. Integrating Cultural Considerations

14 Members may use insurance benefits and other services in Mexico - Call center in Mexico City performs 24/7 toll-free patient advocacy, appointment facilitation and unlimited “tele-consults” with trained physicians Providers available in 300+ cities throughout Mexico in the Sekure Network Healthcare costs in Mexico are lower than in US - contracted rates for Doctor’s Office Visits: $250 pesos for GP; $350 pesos for Specialist (about $25 US dollars) (about $35 US dollars) Greater geographical reach - as an example, a worker in Fresno can enroll his dependents who live in Guadalajara Innovation - Health Access in Mexico

15 Contractor’s Choice provides an industry first with a PPO/HMO/Mini-Med Plan Offering to an employer - it’s the “Ultimate” Triple Choice. The Ultimate Triple Choice is an innovative coordinated product offering. It addresses issues of high cost and minimum participation by providing employer with a much wider spectrum of affordability. It is available to employers in certain industries - construction, landscaping, contract manufacturing, agriculture – that meet requirements of the Trust. What is the Ultimate Triple Choice?

16 Affordability within the Healthcare Continuum For Group Coverage Limited BenefitsMajor Medical/Comprehensive Insurance LOW COST OF HEALTHCARE COVERAGE HIGH For Family $1,200/mo Limited Benefits Medical Insurance/ MiniMed Plans Traditional Indemnity Coverage Hi Deductibles Low Deductible PPOs Hi Copays Low Co Pays HMOs The Ultimate Triple Choice has a much wider spectrum of health coverage affordability! Example of Super Composite Monthly Rates* Mini-Med Plan Options HMO Plan Options PPO Plan Options Start at $99 $392 to $687 $949 to $1,125 * In Southern California

17 A unique offering for employers needing more affordable choices due to price sensitivity of HMO/PPO Plans. The affordability of the Essentials allows employers to provide something to all classes of employees. Contractor’s Choice provides enrollment support for all products. Contractor’s Choice administers consolidated billing of all 3 products to employer on one monthly bill. Minimum number of enrollees: 1 on PPO Plan, 2 on HMO Plan, and 5 on the Essentials. A new approach in addressing some of the affordability challenges. The Ultimate Triple Choice

18 For more information or a quote, please contact: Thank You For Your Interest Nidia Sandoval Executive Account Manager CONTRACTOR'S CHOICE Telephone: (866) 358-9456 Fax: (714) 542-9309 Email: nsandoval@contractorschoice.net nsandoval@contractorschoice.net


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