For Agent use only. Not for distribution to Consumers. Welcome to National General Accident and Health’s Short Term Medical Insurance product video. Temporary health care coverage for the whole family. For Agent use only. Not for distribution to Consumers. National General Accident and Health markets products underwritten by National Health Insurance Company, Time Insurance Company, Integon National Insurance Company, and Integon Indemnity Corporation.
Plan Design Eligibility Enrollment Post Sale In this video we are going to go over National General’s Short Term Medical Plan Design The eligibility for this short term medical plan What is required to enroll into National Generals Short Term Medical insurance And all the post sale information you need to answer the questions your client may have after they purchase a plan. Post Sale
Product Overview Short Term Medical Insurance Two types: Standard and Guaranteed Issue Policy coverage terms available from 30 days to 3 months Broad state availability Easy enrollment process Lifestyle Association Benefits available in most states This is National Short Term Medical plan that CLICK is offered in both as a Standard Issued and Guaranteed Issue build. It is available in a large number of states so it’s easy to add to your current product portfolio The enrollment process is really quite easy This Short Term Medical plan has a benefit offering that’s more than just the standard deductible and coinsurance plan. Our plan designs really help set National General’s Short Term Medical apart from others in the temporary insurance market.
Why Short Term Medical? A plan to bridge the gap Short Term medical is a great option for clients who: Missed Open Enrollment and do not have a Qualifying Life Event Are waiting for Medicare eligibility Are International students needing insurance while here Are waiting for benefits to begin at a new job and worried about the ‘what if’ Short Term Medical Plans Provide Limited Benefits and are not Minimum Essential Coverage as mandated by the Affordable Care Act. Your customers may be subject to a tax penalty if this is their only insurance coverage. So why short term medical? Well there are thousands of different reasons why clients may need this product, especially with the regulations within the Affordable Care Act. Some of the common ones we see, are people who have missed open enrollment and don’t have a Qualifying Life Event. If they miss the open enrollment period they have to wait till the end of the year to get insurance, leaving them unprotected for the whole year. Many clients don’t feel comfortable being uninsured for any amount of time. Those waiting for Medicare, we get a lot of shorter term policies where agents write it for a few months to cover clients while they are waiting to qualify for their Medicare benefits At National General, many of our clients are students who need insurance coverage for a certain class or program, but also quite often, we have international students who need insurance for a semester or two while staying here in the United States. And we can provide coverage for waiting periods some clients have when they start a new job. That one is still out there.
Plan Details Benefit options Deductibles SI: $1,000 to $25,000 GI: $3,500 & $5,000 Coinsurance SI: 50%/50% to 100% GI: 80%/20% & 90%/10% Maximum out-of-pocket SI: $2,500 to $25,000 GI: $10,000 Lets jump into some plan details. As we go through the benefits we are going to look at all 11 of the Standard Issue Builds but also the 2 Guaranteed Issue Builds. CLICK We are going to start with the deductibles. CLICK The Standard Issue Deductibles range from $1,000 to $5,000 and keep in mind here that the deductible is maxed at 3x per family. CLICK The GI deductibles are $3,500 or $5,000. There are only two GI builds so one is a $3,500 the other is a $5,000 The coinsurance options are 50/50 to 100% for the SI and for GI they are either 80/20 or 90/10 The Max Out of Pocket for the Standard Issue plans start at $2,500, and we actually have a few builds that lead to that number, and go to $8,750. The GI plans are both $10,000 MOOP The Coverage period max and yes you heard me right coverage period max. This is one thing that really makes this product stand out from the competition. At National General it is a coverage period, so for the length you have this one policy, that is the max benefits you have available. The SI is is either $250,000 or $1,000,000, depending on your selected plan. $1,000,000 coverage period max is right there with most carriers life time max! The GI’s Coverage period maximum is $100,000 Coverage Period Max SI: $250,000 or $1,000,000 GI: $100,000
Plan design options Standard Issue Deductible Coinsurance Out-of-pocket Maximum After deductible is met Coverage Period Maximum $1,000 50%/50% $2,500 $250,000 80%/20% $1,500 $1,000,000 100% $0 $5,000 $3,750 $2,000 $10,000 $25,000
Plan Design options - Guaranteed Issue Deductible $3,500 Coinsurance 80% / 20% Out -of-pocket Maximum $10,000 Coverage Period Maximum $100,000 Deductible $5,000 Coinsurance 90% / 10% Out-of-pocket Maximum $10,000 Coverage Period Maximum $100,000 If your client qualifies for the GI here are their two options. I know GI STMs are really hard to find and every client I talk to that qualifies for the GI are just happy that something is out there that actually provides them benefits for the big what if. Guaranteed Issue plans are subject to Pre existing condition limitations.
Plan Details: Network Savings Aetna® Open Choice PPO Network 850,000 Medical providers 6,900 Hospitals Open Choice PPO Pre-negotiated discounted rates Average of 50% savings1 The STM uses Aetna Open Choice PPO network. Yes an Aetna network on a STM plan, and not only that, it is one of Aetna’s largest networks, the Open Choice PPO. This network has an on average negotiated discount rate of 30 to 40% savings. The network is so large that it has over 850,000 Medical Providers! And almost 7,000 hospitals The STM plans also come with first dollar office visit benefits. The SI has 1st dollar benefits of $50 for 3 visits to help cover the cost of the visit. Now these are not copays, they are first dollar benefits. So if you take the average cost of a Dr.’s visit, I know one in Portland, near one of our offices. His office visit charge is usually around $100, his rate with the Aetna network was $65, so the client would get $50 benefit it use towards the $65, leaving them with $15 to pay out-of-pocket. The GI as you can see comes with 2 1st dollar office visit benefits, and these are all per persons covered on the plan. 1 Source: National Health Insurance Company paid claims 2015
Plan Details: Benefits Doctor Visit Benefit Subject to deductible and coinsurance 1 Urgent Care Unlimited visits Insured pays $50 access fee per visit, Plan deductible is waived Visit charges are subject to coinsurance Emergency Room Unlimited visits Insured pays $250 access fee, unless admitted Visit charges are subject to deductible and coinsurance The Urgent Care benefit on this plan is a real value added. These plans have unlimited $50 urgent care access fees, then subject to the coinsurance, so the plan’s deductible is waived. To go to urgent care for $50 is a real savings and this helps provide the client the benefits they are looking for right away. For the emergency room your client will have unlimited visits with a $250 access fee unless admitted, now all charges to the Emergency room visit are subject to the client’s deductible and coinsurance For ambulance services your client would also have unlimited trips and the plan pays a $250 benefit per trip. Ambulance Service Unlimited trips Plan pays $250 per trip 1.In Co, FL, OH, MD, NM, OR and UT, this plan pays one $50, first dollar benefit for one doctor visit. Subsequent visits apply to deductible and coinsurance
L.I.F.E. Association HealthCare Family Benefits Entertainment Telemedicine Connect via phone to a physician Unlimited consultations at no extra cost Well Card Pre-negotiated savings on prescriptions, vitamins, and more Hospital Negotiations Direct Labs Family Benefits Fitness Program Identity Theft Auto Discounts Entertainment Travel Services Retail Stores Dining & Entertainment The association membership provides your client with access to special privileges and savings that can positively impact their day-to-day lives, on top of the medical benefits they receive with STM plan. Your client will get access to My-Telemedicine - with access to physicians 24/7 from anywhere - Physicians can review electronic health records, provide medical advice and diagnose common and acute conditions over the phone or via video conference. There are no additional costs or limits on the number of consultations for members. When needed, physicians can call in prescriptions (non-narcotic) Well Cards provides clients with access to pre-negotiated savings on prescriptions, vitamins and diabetic supplies They also get access to a variety of programs and services, including Hospital Negotiations, Direct Labs, Diagnostic Facility Negotiations, Senior Medical Alert, and more The Family benefit category they will get access to a fitness program with •Access to more than 14,000 health and fitness clubs at reduced rates •The Online Fitness Center: A mobile-friendly, lifestyle education tool for weight management providing multiple Online assessments • ID Theft protection that’s Backed by $1,000,000 AIG Insurance Policy & identity risk score for no additional cost Auto Discounts with new and used auto quotes, new car purchase assistance, auto repair and maintenance discounts, and discounts on tires and wheels In the entertainment category, the Association offers discounts on hotel stays, travel flights, resorts, and car-rental packages and unlimited usage to a broad portfolio of resorts And a variety of savings on retail stores and gift cards, and Dining and entertainment And more
STM plan state availability AL AZ AR CA CO FL GA ID IL IN IA* KS* KY LA ME* Massachusetts MI MN MS MO MT* NE NV New Hampshire NM NY NC ND OH OK OR PA SC SD TN TX UT* Vermont VA WA WV WI* WY Connecticut Delaware Maryland New Jersey Rhode Island Alaska, DC, Hawaii STM plan available with L.I.F.E. Association Membership STM available with or without L.I.F.E. Association Membership *Membership options not available in: Iowa, Kansas, Maine, Montana, Utah or Wisconsin.
Eligibility – Age Primary applicant Child only applications Ages 60 days to 64 years Children up to age 26 on parents plan Child only applications 60 days to 17 years of age Youngest as Primary The primary applicant (and spouse, if applying for coverage) must be between the ages of 2 - 64 at the time of application. Children can stay on their parents plans up to age 26. If you are writing a child only plan always put the oldest as the primary
Eligibility, continued Legal Resident of the United States, or reside in the US for the duration of the coverage Not eligible for or enrolled in: Medicare, Medicaid, Medical Disability or any other Federal or state-funded program Not covered under major medical, group health, or other major medical insurance coverage Not a full-time member of the armed forces The Short Term Medical plan has just a few health history questions.
Health Eligibility Questionnaire Are you or any applicant: Now pregnant, an expectant father, in process of adoption, or undergoing infertility treatment? Over 300 pounds if male or over 250 pounds if female? Have you or any applicant been hospitalized for mental illness in the last 5 years or seen a psychiatrist more than 5 times during the last 12 months Within the last 5 years has any applicant been diagnosed or treated by a physician or medical practitioner for Acquired Immune Deficiency Syndrome (AIDS) or tested positive for Human Immunodeficiency Virus (HIV)? The Short Term Medical plan has health history questions. Health history questions: Are you or any applicant: Now pregnant, an expectant father, in process of adoption, or undergoing infertility treatment? Over 300 pounds if male or over 250 pounds if female? Have you or any applicant been hospitalized for mental illness in the last 5 years or seen a psychiatrist more than 5 times during the last 12 months Within the last 5 years has any applicant been diagnosed or treated by a physician or medical practitioner for Acquired Immune Deficiency Syndrome (AIDS) or tested positive for Human Immunodeficiency Virus (HIV)? Some states may require more questions
Health Eligibility Questionnaire Within the last 5 years has any applicant been diagnosed, treated, or taken medication for or experienced signs or symptoms of any of the following: Cancer or Tumor Stroke Liver disorder Heart disease (including heart attack), chest pain or had heart surgery Degenerative disc disease or Herniation/bulge Degenerative joint disease of the knees COPD or emphysema Crohn’s Disease Rheumatoid Arthritis Kidney disorder Diabetes Alcohol abuse or chemical dependency Neurological disorder Health history questions continued: Cancer or tumor Stroke Heart disease (including heart attack), chest pain or had heart surgery Degenerative disc disease or Herniation/bulge Degenerative joint disease of the knees COPD or emphysema Crohn’s Disease Rheumatoid Arthritis Kidney disorder Diabetes Alcohol abuse or chemical dependency Neurological disorder AIDS or HIV
Guaranteed Issue Qualification If the client answers yes to one or more health history questions they may be eligible to enroll in a Guaranteed Issue plan Guaranteed Issue plans are available in: AL HI LA NV PA UT AR ID MI NC SC VA AZ IL MS ND SD WV DC IN MO OH TN WI FL IA MT OK TX WY GA KY NE KS It is important to note, the GI plans do have the pre-existing condition limitations Short Term Medical Guaranteed Issue plans do have the pre-existing condition limitations
Some limitations and exclusions include: Pre-existing conditions Maternity Expenses occurred outside the United States, it’s possessions, or Canada Acts of War Intentionally self-inflicted sickness or injury Mental Illness Joint replacement or spinal/back surgery (unless related to covered injury) this is just a sample and not a complete list of Limitations and exclusions, you can refer to the brochure for a more comprehensive list, but always refer to the policy contract for a complete listing This is NOT a comprehensive list of limitations and exclusions.
Add more financial protection Bundle with our supplemental plans for even more coverage We have many coverage options to choose from Plan Enhancer: AME with optional CHS and SIP riders* TrioMed: AME | Critical Illness |AD & D Cancer and Heart/Stroke Term Life – Critical Illness Foundation Health – Fixed-benefit Indemnity Dental PPO or Dental Indemnity plans also make a great add-on Add more financial protection *Riders not available in all states These Plans Provide Limited Benefits
Enrollment 1st thru 28th Start as early as the next day Coverage terms – 30 days to no more then 3 months Initial Payment Payment options Form of Payment Drawn at time of application Monthly: recurring payments drawn 5 days before the Monthiversary of start date EFT Visa, MasterCard, or Discover Note: When Single Pay Option is selected, insured must pay the total premium amount due for the applicable policy period upon issuance of policy. The one-time payment of the total premium amount is not refundable. Single Payment: available from 30 to 89 days (Single payment option premium is non-refundable)
Enrollment Rewrite policies Connecticut, Idaho & New Mexico Limited to 1 Short Term Plan with Us. No rewrites allowed Colorado A Maximum of 2 plans with any carrier in 12 months before a 6 month gap is required for another STM Plan. Kansas & North Dakota Limited to 1 rewrite Maine Combined total of the new plan and any prior policies cannot exceed 24 months Michigan & Nevada Limited to 185 days of STM coverage with Us in any 365 day period (185 days of coverage does not need to be consecutive Oregon An individual may purchase another Short Term Medical plan. The applicant must wait 60 days from the last day of coverage before reapplying. Tennessee The applicant must wait 30 days from the last day of coverage before reapplying Maryland, Missouri, North Carolina, South Dakota, Utah & Wisconsin There must be at least a 63 day gap in coverage from any health insurance plan in order to obtain a NGAH STM policy
Enrollment – application verification E-Signature www.vipmemberbenefits.com Login to e-sign their application Easiest Method Voice Signature 3 way call with insured on the line Dial 210-835-9969 Need Agent and correct product script When enrolling into National Generals Short Term Medical plan your client must do a final attestation. You have two options to help your client attest to their plan. esignature or a voice verification Esignature is by far the easiest, When you press submit on the application your client will receive an email. This email will ask your client to create an account on Vipmemberbenefits.com portal and from there they will be prompted to read the authorizations and esign their policy. Takes just a few minutes. With voice signature, it takes a bit more of your time. The instructions for voice signature will be present at the end of every application and the steps need to be followed exactly as presented. You, with your client on the line will have to do a 3 way call and read a script verbatim and have your client agree. Esignature is much easier but the voice signature option is there if needed.
Post Sale: Instant Access Electronic policy fulfillment Customers can view all policy documents at www.NGAHDocuments.com ID card(s) will arrive separately in the mail. Customers can manage their policies at www.VIPmemberbenefits.com Change payment types Change of address Your clients will have access to the member portal, vipmemberbenefits.com, where they can change payment types or update their address information for each policy they have with National General Accident & Health.
Post Sale: Member Services Cancellations Plan cancellations 10 days prior to the monthiversary to stop premium withdraw (*not applicable with single pay options) Member Services 888-781-0585 National General Accident & Health PO BOX 1070 Winston Salem, NC 27102-1070 888-344-3232
Short Term Medical recap $50 access fee to urgent care with unlimited visits, subject to coinsurance Aetna Open Choice PPO Network L.I.F.E. Association Membership Benefits As young as 60 days old Options to fit many customer needs and budgets Guaranteed Issue available
Questions? Email: Training@NGISAdmin.com NGAH_STMAGENTTRAINING (3/2017) ®2017 National Health Insurance Company. All rights reserved.