Date post: | 15-Jul-2015 |
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Solutions Plus+ Gap
Solutions Plus+ Accident
Solutions Plus+ Critical Illness
A group supplemental medical expense insurance plan that is primarily designed to cover deductibles, co-insurance, and co-payments.
Establishing a multiple year strategy to manage your clients benefit costs.
A more efficient way to protect employees and dependents.
Value Proposition for: Employees
Stabilize and decrease out of pocket exposure Positive perception of their benefit package due
to less out of pocket expenses Control payroll contributions Maintain Carrier and PPO Networks over
multiple years
Value Proposition for: Employers
Immediately reduce healthcare benefit costs Provide richer employee benefits A strategy to minimize Healthcare rate
increases at renewal Improve employee retention
Value Proposition for: Brokers
A unique solution for obtaining new accounts Client recognition for providing creative and
innovative solutions Have a competitive edge over the competition Provide a multiple year strategy to control
healthcare costs Increase and stabilize Agency revenue
1) Hospital Confinement : $500 - $10,000For Hospital stays, this plan pays up to $10,000 per insured for out of pocket expenses up to the plan maximum.
2) Outpatient Services: $200 - $2,500Pays up to $2,500 per condition (max of 4 conditions per family, per year) for outpatient out of pocket expenses up to the plan maximum.
1) Hospital Confinement Benefit (HCB)
Pays a first dollar benefit for inpatient out of pocket expenses incurred up to the plan maximum
Examples of covered expenses:
In-Patient Surgeries and Hospital charges Physician In-Hospital charges X-ray, Lab, Diagnostic Testing, MRI’s
15 hours as a bed-patient qualifies for inpatient benefits
Claims Example using a $5,000 HCB
Current Plan
$500 Deductible 80% Coinsurance $3,000 O-O-P Max $20 Physician co-pay
New Plan
$2,500 Deductible 80% Coinsurance $5,000 O-O-P Max $25 Physician co-pay
Current PlanDeductible $50020% Co insurance $3,100Total Charges $3,600
Plan O-O-P Max $3,000HCB $0
Individuals Cost: $3,000
Proposedw/ HCB$2,500$2,700$5,200
$5,000$5,000
$0
2) Outpatient Benefit (OPB)
Pays a first dollar benefit for outpatient expenses incurred up to the plan maximum
Examples of expenses covered:
Surgery in a facility or a doctor’s office Emergency Room – Accident or Sickness X-ray, Lab, Diagnostic Testing, MRI Outpatient Radiation/Chemotherapy Specialist Visits Physical Therapy, Chiropractic, Rehab
Claims Example using a $2,500 OPB
Current PlanDeductible $50020% Co insurance $400Total Charges $900OPB $0
Individuals Cost: $900
Proposedw/ HCB$2,500
$0$2,500$2,500
$0
Sounds good……
But how much $$$ will my client save?
Current Medical Plan Proposed Medical Plan
$500 Deductible80/20 Coinsurance$3,000 Out of pocket max
#of lives Mo. Cost
EE only 30 $375 EE + SP 7 $750 EE + Ch 5 $650 Family 8 $1,050
Monthly Premium $28,150
$2,500 Deductible80/20 Coinsurance$5,000 Out of pocket max
#of lives Mo. Cost
EE only 30 $250 EE + SP 7 $500 EE + Ch 5 $450 Family 8 $750
Monthly Premium $19,250
$5,000 Hospital Confinement Benefit
$2,500 Outpatient Benefit
Monthly Gap Premium - $4,500
Now let’s review the premium savings…..
Annual Cost of Current Plan: $337,800
Annual Cost of Proposed Plan: $231,000Annual Cost of Solutions Plus+ Gap: $54,000 Total Cost of Proposed + Gap: $285,000
Current Plan $337,000Proposed + Gap - $285,000
Total Annual Savings: $52,000
• Guarantee Issue• No Pre-Ex• No Underwriting• Participation is 5 enrolled lives• Rates are the same if Voluntary of ER paid• Must have a group major medical plan• Insured receives an ID card• Benefits are Assignable to the Provider• Simplified Claim Submission
Routine Doctor office visits Wellness Exams Prescription Copays or Deductibles Alcoholism & Drug Abuse Expenses Mental & Nervous Disorders Expenses Treatment & Services not covered under the
group major medical plan
Advantages of Worksite Products
• Gaining popularity because they are not affected by Healthcare Reform
• Helps round out the benefits package• Provides a cash benefit to employees when they
need it the most• Convenience of payroll deduction• Additional revenue stream for Broker
Disadvantages of Worksite Products
• Disrupts workflow and productivity• Product affordability • Policies are often medically underwritten• Those who need it the most can’t qualify• Sales, Enrollment, and Administration are too
time consuming• Risk associated with the introduction of worksite
agents to their clients
The Solution
Use the Medical premium Savings…Bundle the Accident & CI with the Gap
• Address your clients other insurance needs before someone else does
• Creates New Revenue for the Agency• Immediately increase employee income
without increasing salaries• Simplified paperless enrollment
Plan Highlights• Composite Rates - $6.69/mo• Guarantee Issue for Employee & Family• Pays a scheduled benefit to the insured for
injuries, treatments, & services• Pays in addition to any other insurance
• Dislocations $3,000• Fractures $1,500• Coma $10,000• Burns $10,000• Accidental Death $10,000• Dismemberment $25,000
• ER Visits $100• Hospital Admit $400• Mammogram $100• Ambulance $100• Hospital Stay $150/day• ICU $100/day• Surgery $50 - $1,000
(based on surgery schedule)
Plan Highlights
• Composite Rates - $10.85/mo for $5,000• Lump sum payment to insured• Guarantee Issue for Employee & Family• Children covered at no extra cost• Additional Diagnosis Benefit• Reoccurrence Benefit• $50 annual health screening benefit
• Cancer• Heart Attack• Stroke• Renal Failure• Organ Transplant
• Coma• In Situ Caner• Loss of Sight Speech
& Hearing• Coronary Artery
Bypass
a new solution…
…now let’s get started