1. Fixed Benefit Health Insurance
Filling the growing need for affordable alternatives in the marketplace
Fixed Benefit Health Insurance
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2. Topics for Discussion Pivot Health , SLAICO, Allied National
Why limited benefits
What is limited medical coverage
Approved states
Agent commissions
How to rate and sell – enrollment demo

3. Partners Marketed by Pivot Health
Underwritten by Standard Life and Accident Insurance Company
Administered by Allied National

4. Allied National Marketing Sales Support Premium Collection
Commission Payment
Policy Issuance
ID Card Issuance
Policy Service
Claims Administration

5. Large and Growing Market
Nearly 25 million in the market for individual medical
Roughly 27 million people had a gap in their health coverage of 90-days or more, a recent Kaiser report found
1,200 counties – nearly 40% – will have one or less ACA plan choices in 2018 (roughly 2.4 million Exchange lives)
Over 35,000 may have no coverage in 47 counties
Individuals need alternatives to the ACA marketplace

6. What is a Fixed Indemnity Plan?
It’s a limited medical plan that offers specific amounts of maximum reimbursement on a daily or other basis for medical costs incurred by the persons insured on the policy. These plans are not ACA compliant and contain exclusions and limitations not found in ACA compliant individual major medical policies.

7. PivotCare Advantages:
Answering consumer needs
PivotCare Advantages:
Affordable insurance that offers a choice of 5 plans that meets any budget
Includes specific cash payments for both sickness and accidental injuries regardless of other coverage
No deductible or coinsurance – 1st dollar benefits
Benefits do not vary – a fixed dollar amount covers both in- and out-of-network
One of the nation’s largest medical provider networks
First Health PPO

8. What makes PivotCare unique:
A solution for today’s health insurance crisis
What makes PivotCare unique:
Daily inpatient benefits up to $3,000/$6,000 a day for 365 days a year
ICU benefits up to $6,000/$12,000 a day for up to 30 days
Critical illness coverage for invasive cancer, stroke, heart attack and end- stage kidney failure
Accidental death and common carrier life insurance benefits included
No specialist referrals or precertification needed
Fixed reliable benefit amounts for: Doctor office visits, Hospital stays, Diagnostic lab tests and x-rays, Ambulance services, Childhood immunizations, MRIs
Hospitalization coverage: Daily benefit, ICU benefit, Surgery benefit
No claim forms needed
Specific benefits vary by state.

9. Discount Prescription Drug Card
Additional Benefits
Fracture Benefit
Mental Health Benefit
Burn Benefit
Substance Abuse Benefit
Dislocation Benefit
Ambulance Services
Critical Illness Lump-Sum Benefit
Accidental Death Coverage
Discount Prescription Drug Card
Specific benefit amounts may vary by state.
Pivot Health website provides all of this information from the quote page. Just select "Details" and you'll get the full explanations.

10. What is a Pre-Existing Condition Limitation?
Conditions
What is a Pre-Existing Condition Limitation?
A pre-existing condition limitation occurs when you have already received
medical advice, testing, care, medication, diagnosis or treatment for a
specific condition from a physician prior to enrollment in a PivotCare plan.
Loss caused by or relating to the pre-existing condition is not covered
for the first 12 months after the effective date of each Covered Person. A
pregnancy that was conceived prior to the effective date is also considered
a pre-existing condition.

11. Who are candidates for PivotCare Elite?
Short-term medical plan buyers – looking for long- term solution/add on to short-term policy
Not eligible for ACA exchange plan
Those refusing/can’t afford ACA coverage but want an affordable long-term solution
High deductible plan owners – to supplement their coverage
Families looking for affordable coverage for accidents and sickness

12. Claim Example v. Major Med: ILLNESS Claim*
Expense related to Appendectomy
Average
Costs
Pivot Care (Plan 3) Reimbursement
Use any doctor or hospital!
Standard Major Medical Plan pays:
$5,000 Deductible & 80/20 Coinsurance
Hospital Confinement
(4 $2,296/day)
$9,184.00
$12,000.00
$3,347.20
Surgery (ruptured, infected appendix)
$3,822.78
$1,000.00
$3,058.22
Anesthesia
$1,690.00
$200.00
$1,352.00
TOTAL
$14,696.78
Plan Pays
$13,200.00
$7,757.42
Deductible & Coinsurance paid by insured
N/A
$5,000 Deductible
$1, Coinsurance
Total Balance to be paid by insured
$1,496.78
$6,939.36
*Example is for illustration purposes only. Specific benefits vary by plan and may vary by state.

13. Claim Example v. Major Med: INJURY Claim*
Expense related to car accident: contusions and leg fracture
Average
Costs
Pivot Care (Plan 3) Reimbursement
Use any doctor/hospital!
Standard Major Medical Plan pays:
$5,000 Deductible & 80/20 Coinsurance
Hospital Confinement
(3 $2,296/day)
$6,888.00
$9,000.00
$1,510.40
Surgery (on leg fracture)
$5,978.00
$1,000.00
$4,782.40
Anesthesia
$2,460.00
$200.00
$1,968.00
ER Admission
$2,168.00
$1,734.40
Fracture benefit of plan
$2,500.00
N/A
TOTAL
$17,494.00
Plan Pays
$12,900.00
$9,995.20
Deductible & Coinsurance paid by insured
$5,000 Deductible
$2, Coinsurance
Total to be paid by insured
$4,594
$7,498.80
*Example is for illustration purposes only. Specific benefits vary by plan and may vary by state.

14. (rates vary by state, by plan and are subject to change)
Sample Monthly Rates
(rates vary by state, by plan and are subject to change)
State
Texas. Iowa
Plan 2
Individual
w/spouse
w/children
Family
Age
<39
Hospital
Injury/day
$ ,000
Sickness/day
$ ,000
Mo Premium $ $ $ $
Plan 3
$ ,000
$ ,500 $ $ $ $

15. (rates vary by state, by plan and are subject to change)
Sample Monthly Rates
(rates vary by state, by plan and are subject to change)
State
Texas. Iowa
Plan 2
Individual
w/spouse
w/children
Family
Age
45-49
Hospital
Injury/day
$ ,000
Sickness/day
$ ,000
Mo Premium $ $ $ $
Plan 3
$ ,000
$ ,500 $ $ $ $

16. State Availability Arizona New Mexico Arkansas Nevada Delaware
North Carolina
Georgia
Ohio
Illinois
Oklahoma
Indiana
Pennsylvania
Iowa
South Carolina
Kansas
South Dakota
Kentucky
Tennessee
Louisiana
Texas
Michigan
Virginia
Mississippi
West Virginia
Missouri
Wisconsin
Montana
Wyoming
Nebraska

17. Commissions Retail 25% 1st year 7% 2nd year 3% 3rd year General Agent

18. PivotCare Elite Bonus September 1, 2017 - December 31, 2017
$50 1st PivotCare Policy Issued
$50 2nd PivotCare Policy Issued
$100 3rd PivotCare Policy Issued

19. PivotCare Elite—Medical/Eligibility Knock-Out Questions
Height & weight must be within acceptable range.
“Yes” to any question: coverage cannot be issued
Unemployed or employed in specified hazardous occupation?
Disabled or hospitalized in last 6 months?
Pregnant, an expectant parent or in process of adopting?
Participated in specified hazardous activities (sky diving, hang gliding, etc.)?
In past 2 years, had driver’s license suspended, 3 or more traffic violations, had DUI or been arrested?
In past 2 years, been advised to have medical test or procedure that has not yet been performed?
Within last 5 years, had abnormal test results, been diagnosed or treated for AIDS or tested positive for HIV? Within last 5 years, diagnosis, symptoms, abnormal test result or any treatment for any of the major conditions listed on application? (i.e. cancer, heart, stroke, COPD, liver, kidney, diabetes, Hep C, etc.)
Plus height and weight must be provided and in acceptable range.
(Medical questions may vary in some states.)

20. Preparing to Write a Pivot Individual Limited Medical Plan
Submit appointment paperwork to Allied National
link to SLAICO appointment forms
Paperwork will be held pending issuance of first case
There is a state appointment fee with SLAICO that will be with held from the first commission check ($15-$50 depending on the state)
Receive a discreet URL for your link to the PivotCare Elite rating page from Allied National
URL will be released about Nov. 15, 2017, when all the rating technology
and policy issuing processes have been tested.
This URL will assure that you will be paid on any cases issued using this URL.

21. Quote & Apply Provide your client with the Pivot Health website url:

22. Thank you! Contact Allied Sales Support Phone: 888-767-7133
Fax:
• twitter.com/alliednational
For agent use only. Not to be used for sales or marketing purposes.