Supplemental Insurance Protection

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Presentation transcript:

Supplemental Insurance Protection SB ProtectFit Plus Gen DRAFT:06/06/2014 Code: 1402069871 Supplemental Insurance Protection Direct Series ProtectFit Plus Form CH-26110-IP (06/09), or its state variation See Separate Presentation for State Specific Variations ©2014 SureBridge® Product Training Materials | Proprietary and Confidential. For more plan details, refer to the product materials. The benefits described in this presentation are subject to all provisions, terms, definitions, and limitations and exclusions of the applicable policy. Supplemental plans serve a specific purpose in the insurance market. These plans are not intended as substitutes for accident and sickness health insurance and should not be construed as such.

Supplemental Products Availability SureBridge has the largest portfolio of supplemental products including critical illness, cancer, accident, disability, dental and vision policies. We also have the broadest marketing footprint. AK WA ID MT ME OR ND MN NH WI NY VT MI WY SD CA MA RI NV CT UT NE IA PA IL OH IN NJ CO WV DE MO VA KS MD KY HI DC AZ NC NM OK TN TX AR SC GA MS AL All products available Subset of products available No products available LA FL

ProtectFit Plus Superior Client/Broker Experience Quoting Compare packages with different combinations of supplemental products Present total price for solution Commissions First month’s premium is taken at time of application This results in faster commission payments Book of Business report available on the SureBridge Broker Portal Application Single e-app for any combination of supplemental products Flexibility to select different products and/or benefit options for each family member on app Smart app – only the questions for the products selected are asked Simplicity – all questions are yes/no Outlines of coverage provided Claims Claim form provided with complete instructions for submission Claim forms are received, analyzed and adjudicated within a 7 day turn-around time

ProtectFit Plus Superior Client/Broker Experience Changes in the market present opportunities to sell supplemental plans Essential Health Benefits Plans can have out of pocket expenses as high as $6,350 for individuals or $12,700 for families. This leaves large gaps in coverage which can be filled with supplemental plans. Advanced premium tax credits for EHB plans are available for individuals or families making up to 400% of the federal poverty level. Tax credits can be used to purchase extra coverage and fill the gaps left by high deductibles and coinsurance on EHB plans. Number of family members Poverty Guideline for family income (as of 2013) Can still qualify for a subsidy under the ACA with an income up to 1 $11,490 X 400% $45,960 2 $15,510 $62,040 3 $19,530 $78,120 4 $23,550 $94,200 5 $27,570 $110,280 Tax credits can be seen as a way to pay for Supplemental Plans and reduce coverage gaps. Need a subsidy calculator? Try http://kff.org/interactive/subsidy-calculator/

ProtectFit Plus Sales Pitch The ProtectFit Plus plan is a piece of the puzzle to help fill in gaps caused by high out of pocket expenses and lost wages. Coverage Gap Health Coverage Protect Fit Plus On the right health insurance is supplemented by the following: ProtectFit Plus for hospital coverage due to accidental injuries, Critical Illness Direct* for lump-sum illness protection benefit upon a first diagnosis of a qualifying event, Accident Companion* for lump sum accident protection. Critical Illness Direct Accident Companion *See the appropriate training documents for more details on these other products.

ProtectFit Plus Product Comparison Hospital Confinement Benefit Intensive Care/Cardiac Care Unit Confinement Benefit Outpatient Emergency and Diagnostic Benefit Major Diagnostic Exam Benefit Accidental Injury Benefit Follow-up and Restorative Benefit Accidental Death and Dismemberment Benefit Ambulance Benefit The ProtectFit Plus plan is designed to provide customers a daily cash benefit. For inpatient and outpatient hospital care For an accidental injury only There is no annual deductible A comparison of benefits to the Hospital Confinement Direct is shown to the right. Hospital Confinement Direct Hospital Confinement Benefit Intensive Care/Cardiac Care Unit Confinement Benefit

ProtectFit Plus Navigation? The Fixed Indemnity Direct is located under the Packages Tab of the SureBridge Point of Sale Tool.

ProtectFit Plus Benefit Schedule Description High Plan Low Plan Inpatient Hospital Confinement: One-Time Lump Sum Per Insured, per policy year Confinement must begin within 30 days of Accident Injury $1,000 $500 Daily Hospital Confinement Benefit Per Insured, per day $300 $150 One-Time Lump Sum Intensive Care Hospital Confinement Benefit $2,000 Intensive Care Hospital Confinement Benefit Per Insured, per day up to 15 days, for each covered accidental injury $250 Outpatient, Emergency and Diagnostic: Accidental Injury Emergency Treatment Primary/Spouse Covered Dependent Child(ren) One Benefit per Insured, per covered accident; treatment must be received within 72 hours of injury $100 $50 Major Diagnostic Examinations CT Scan, MRI, EEG One exam per person, per policy year $200

ProtectFit Plus Benefit Schedule Description High Plan Low Plan Lump Sum Accidental Injury Dislocation, burn, skin grafts, eye injury, laceration, fracture, brain concussion, emergency dental repairs, coma, paralysis Examples of Covered Injuries and range of benefit amounts shown below. See policy for complete list of covered injuries and benefit amounts. $35 - $12,500 $25 - $6,250 Dislocation (based on type of injury; up to 2 benefits per injury) – treatment must be received with 72 hours of accidental injury $100 - $1,500 $50 - $750 Burns, 2nd Degree (based on percent of body surface burned; 1 benefit per injury – treatment must be received within 72 hours of accidental injury $75 - $1,250 $35 - $625 Burns, 3rd Degree (based on percent of body surface burned; 1 benefit per injury – treatment must be received with in 72 hours of accidental injury $175 - $12,500 $75 - $6,250 Skin Grafts (within 12 months of burn injury) 50% of Burn Benefit

ProtectFit Plus Benefit Schedule Description High Plan Low Plan Lump Sum Accidental Injury Laceration, with no sutures (1 benefit per injury) – treatment must be received within 72 hours of accidental injury $35 $25 Laceration, with sutures (1 benefit per injury) – treatment must be received within 72 hours of accidental injury $65 - $500 $35 - $250 Fracture (1 benefit per fracture type, based on fracture) – treatment must be received within 72 hours of accidental injury $175 - $1,750 $100 - $875 Coma (duration 7 or more days) $12,500 $6,250 Paralysis, Quadriplegia (subject to 30 day elimination period) Paralysis, Paraplegia (subject to 30 day elimination period) $3,125

ProtectFit Plus Benefit Schedule Description High Plan Low Plan Follow-up/Restorative: Accidental Injury Follow-up Treatment Benefit Must follow ER or Urgent Care treatment and must begin within 30 days of the covered injury Per visit, per policy year $35 10 visits $25 5 visits Accidental Injury Follow-up Physical Therapy Benefit Hospital Rehabilitation Unit Benefit Per day of Rehabilitation Maximum for each insured person per hospital confinement Maximum per policy year Paid in lieu of daily hospital confinement $150 30 days 60 days $75 Appliances Blood Plasma and Platelets Prosthesis Per Insured, per covered injury $200 $750 $100 $375

ProtectFit Plus Benefit Schedule Description High Plan Low Plan Accidental Death and Dismemberment: Death Benefit Benefits are payable if death of loss occurs within 90 days of a covered accident. Primary and covered spouse Covered dependent child(ren) $50,000 $15,000 $25,000 $7,500 Common Carrier Death Benefit $150,000 $75,000 $12,500 Dismemberment Benefit $3,000 - $50,000 $1,000 - $15,000 $1,500 - $25,000 $500 - $7,500 Transportation Benefit: Emergency Ground or Water Ambulance Emergency Air Ambulance One trip per Insured person per accident $250 $2,500 $125 $1,250 Supplemental Disability Income Protection Total Disability must occur within 60 days of the accident Subject to a 21-day elimination period Per month, payable up to 12 continuous months Must be employed at the time of purchase for high plan only Primary and covered spouse only $500 N/A

ProtectFit Plus Claims Example Jenny Heart, age 43, was burned from a grease fire in her kitchen. She was taken by ambulance to the nearest Emergency Room where it was determined that she had received 3rd degree burns on 30% of her body surface. She is admitted to the hospital for 3 days for treatment of the burns and to monitor for an infection of the burn sight. After being discharged, she had two follow-up appointments with her primary physician. Luckily, in addition to her bronze level EHB health insurance, Jenny has a High Option ProtectFit Plus plan. The Bronze EHB plan paid $5,450, leaving Jenny OOP $6,350. SureBridge paid $2,425 in daily benefits (shown on the right) and an additional one-time lump-sum hospital confinement benefit of $1,000. The total amount paid to Jenny reduces the gap left by the EHB plan from $6,350 to $2,925. BILL After PPO Discounts Paid By Health Plan Out of Pocket Paid By SureBridge Plan Ambulance $800 $0 $800 $250 Emergency Room $1000 $0 $1000 $150 Hospital Room (3 days) $3,000 $0 $3000 $500 Burn Treatment $2,000 $450 $1550 $625 $6,350 $3,425 Hospital Room (3 Days) $5,000 $5,000 $0 $900

ProtectFit Plus Renewability The policy is guaranteed renewable to age 65, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy. Eligible Dependents Under our business rules, Eligible Dependents covered under the policy may continue coverage until age 26, subject to the termination provisions of the policy.

ProtectFit Plus Fixed Indemnity FAQs New Business and Underwriting This product cannot be sold to dependent children unless the primary and/or spouse/domestic partner have also selected the plan. ProtectFit Plus (Low) and ProtectFit Plus (High) cannot be sold together. No application questions apply to this product. Claim Payment Cash benefit to the member – no assignment of benefits. No coordination of benefits with any health plans. No network of providers. Maternity is not covered. Average claim processing times is 7-10 business days unless an additional review is conducted for provisions of the coverage (i.e. pre-existing, first diagnosis, etc.)

ProtectFit Plus Pricing Examples Rates can change. These rates come from the generic brochure dated March 2014: CH PLUS 314. The chart below is only an illustration of benefit and premium options per covered person for plans. Premiums may vary by state. Monthly Premiums Low Option High Option Individual $11 $23 Couple $22 $46 Individual + Child(ren) $27 $58 Family $41 $90 Sample

ProtectFit Plus This presentation is not inclusive of all policy provisions. See product materials for complete details and any additional state variations regarding Termination of Coverage, Renewability, Premium Changes, Eligible Dependents, and policy Definitions. SureBridge® is a registered trademark used for both insurance and non-insurance products offered by subsidiaries of HealthMarkets, Inc. Supplemental insurance products are underwritten and administered by The Chesapeake Life Insurance Company®. Administrative offices are located in North Richland Hills, TX. The insurance product referenced in this document is underwritten by The Chesapeake Life Insurance Company. SureBridge products are individual supplemental products and are not available as group coverage. There is no list bill and premiums may not be paid by employers for employees. This material cannot be copied or used in any way for advertising or presentation purposes. THIS POLICY PROVIDES LIMITED BENEFITS. This type of plan is not considered “minimum essential coverage” under the Affordable Care Act and therefore a Accidental Injury Only Insurance Policy does not satisfy the individual mandate that you have health insurance coverage. This is not Medicare Supplement Insurance. Benefits may vary by state. See state variations and product materials for more detail.

Thank You For Everything You Do! Protect Fit Plus Accidental Injury Only Insurance Policy