Download presentation
Presentation is loading. Please wait.
Published byEstella Willis Modified over 8 years ago
1
Interim Coverage Short-Term Medical Brought to you by: Anthem and The IHC Group © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
2
© IHC Group 2015 For training purposes only. Not for public distribution or solicitation. Why Sell Interim Coverage? Need: Perfect product for individuals and families that missed open enrollment or don’t have a qualifying event outside of open enrollment. Compensation: Great income potential when the open enrollment period closes The Interim Coverage selling season starts Now!
3
The IHC Group Corporate Overview Madison National Life Insurance Company, Inc. (MNL) is the underwriting carrier for Balance Ebix Health Administration Exchange, a member of The IHC Group, administers Balance New York Stock Exchange traded company (NYSE:IHC) © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
4
Interim & Interim 2.0 Coverage Overview While plans are very similar between the series, benefit options may vary by state. These plans are not intended to qualify as Minimal Essential Coverage required by the ACA. Premium may be lower than ACA plans but contains a pre-existing provision and additional limitations. Interim Coverage and Interim Coverage 2.0 are underwritten. Issuance is not guaranteed. All plans are non-network plans and exclude outpatient Rx coverage. If a consumer chooses to utilize the MultiPlan (http://www.multiplan.com/search/search-2.cfm?originator=84453)http://www.multiplan.com/search/search-2.cfm?originator=84453 Or ACS (www.anci-care.com) networks they may have lower costs due to accessing discounts from contracted providers.www.anci-care.com © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
5
Interim Coverage Differences © IHC Group 2015 For training purposes only. Not for public distribution or solicitation. Interim Coverage Association membership in Communicating For America, Inc. (CA) is required. Communicating for America, Inc. is a nonprofit association that has been providing members valued benefits and savings since 1972. The IHC Group short term limited duration medical expense coverage (STM) for which you are applying is a group association plan available to individuals and families. Communicating for America, Inc. (CA) is the master group policyholder. In order to qualify for the short term medical expense insurance, you must be a member of CA. Therefore, your application for IHC Group STM is also application for membership in CA. Your membership will remain in effect as long as you qualify under membership guidelines and pay membership dues, which are charged with the IHC Group STM premiums for your convenience. The association benefits available through CA are offered at the sole discretion of CA and coverage may vary by availability, vendor and state of residence. Cost of the association is included in the monthly retail rate. Interim Coverage 2.0 No association membership required. Policy is issued directly to consumer. Coverage offered is based on the resident state of the consumer.
6
Coverage Benefits Interim Coverage (except CA and OH) © IHC Group 2015 For training purposes only. Not for public distribution or solicitation. Office visit copay The number of copays available is determined by the selected plan duration $50 copay per visit 1 copay for 30–90 days of coverage 2 copays for 91–180 days of coverage 3 copays for 181–364 1 days of coverage 1 Subject to state specific regulation Deductible Family deductible is 3x the individual deductible $1,000 $2,500 $5,000 Coinsurance percentage Out-of-pocket Does not include the plan deductible, precertification penalties or expenses not covered 20% 30% 50% $1,000 $2,000 $3,000 $4,000 $1,500 $3,000 $4,500 $6,000 $2,500 $5,000 $7,500 $10,000 Maximum Benefit per policy period $2 million
7
Coverage Benefits Interim Coverage - California © IHC Group 2015 For training purposes only. Not for public distribution or solicitation. Deductible Family deductible is 3x the individual deductible $1,000 $2,500 $5,000 Coinsurance percentage 20% 50% Out-of-pocket Does not include the plan deductible, precertification penalties or expenses not covered $1,000 $2,000 $2,500 $5,000 Maximum Benefit per policy period $2 million
8
Coverage Benefits Interim Coverage 2.0 - Ohio Office visit copay The number of copays available is determined by the selected plan duration $50 copay per visit 1 copay for 30–90 days of coverage 2 copays for 91–180 days of coverage 3 copays for 181–364 1 days of coverage 1 Subject to state specific regulation Deductible Family deductible is 3x the individual deductible $1,000 $2,500 $5,000 $10,000 Coinsurance percentage Out-of-pocket Does not include the plan deductible, precertification penalties or expenses not covered 20% 30% 50% $1,000 $2,000 $3,000 $4,000 $1,500 $3,000 $4,500 $6,000 $2,500 $5,000 $7,500 $10,000 Maximum Benefit per policy period $2 million © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
9
State Availability Map © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
10
Coverage Eligibility Primary insured up to age 65 A spouse between the ages of 18-65 Dependent children under the age of 26 Child-only plans are available for children ages 2-18 © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
11
Coverage Duration Coverage can be purchased in durations between 30 - 180 days and up to 364 days in some states. Monthly and single pay options are available. If purchasing for a specific number of days (e.g. 57 days) single pay is the only option. Coverage may be rewritten in most states – rules and policies vary by state. If a policy is rewritten, new pre-existing condition limitations and deductibles/out-of-pocket will apply. © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
12
Quoting and Enrollment www.myihcgroup.com www.myihcgroup.com Enroll and assist customers online Email proposals with application links for clients to self enroll Only allows you to quote plans that are available in your state View brochures View product information Access your activity reports Case status View policy information Download policy information © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
13
Enrollment Continued E-signatures are acceptable You can complete the application including the medical questions on behalf of the client or allow them to complete themselves At the end of the enrollment process the client will be asked to review the application for accuracy All policy documents and fulfillment are provided via email © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
14
Expenses not Covered (partial listing) Pre-existing conditions Five-year look back period on pre-existing conditions and includes receiving medical advice, care, diagnosis, treatment, consultation or medication or if there are symptoms that would have caused a reasonable person to seek diagnosis, care or treatment. (look-back period varies by state). Outpatient prescription drugs Inpatient may be considered covered charges Pregnancy or childbirth except for the complications of pregnancy Expenses for the treatment of mental illness or nervous disorders, alcoholism or drug addiction or chemical dependency Expenses paid under workers compensation insurance or automobile insurance Expenses resulting from participation in interscholastic or collegiate sports Claims arising from participation in school or organized competitive sports or any high-risk sport, including riding an all-terrain vehicle, snowmobile or go-cart are not covered © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
15
Underwriting Guidelines Ineligible for Coverage if: Eligible for Medicare or Medicaid Applicant or any immediate family member whether or not applying for coverage that is pregnant, an expectant parent, in the process of adopting a child or undergoing fertility treatment. Over 300 pounds (male) or 250 pounds (female) or undergone weight loss or bariatric surgery Been diagnosed or treated for Acquired Immune Deficiency Syndrome (AIDS) or other Immune Disorders Within the last 5 years (depending on state) if an applicant or any person applying for coverage received any medical or surgical advice, consultation or treatment, including medication for: Stem cell transplant Heart disorder, heart attack, coronary artery disease or circulatory system disorder (includes by-pass or stent surgery or carotid artery disease/surgery Stroke, seizures disorder or other neurological disorder Cancer or tumor OR taking medication to prevent recurrence of cancer or tumorous growth Paraplegia, quadriplegia or multiple sclerosis Emphysema, chronic bronchitis or COPD (chronic obstructive pulmonary disease) Diabetes Kidney disorder other than stones and/or liver disease Degenerative arthritis (degenerative disc disease, herniated disc, rheumatoid or psoriatic arthritis or degenerative joint disease) Alcohol or drug abuse or dependency OR chemical dependency © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
16
Compensation Standard writing agent compensation is 18% in all states except Ohio Ohio standard writing agent compensation is 15% *Enrollment and monthly admin fee not included © IHC Group 2015 For training purposes only. Not for public distribution or solicitation.
17
Getting Started For training purposes only. Not for public distribution or solicitation. © IHC Group 2015 You must be contracted with The IHC Group and Anthem in order to sell Interim Care Contracting is available at the Anthem Coverage Resource Center www.healthedeals.com/ccc-ic www.healthedeals.com/ccc-ic Click “Get set up to sell” You must have an active Health license in each state that you do business and be appointed by the carrier
18
Your Personalized Link Once contracted, you will receive a welcome email which will provide you with a unique link to quote and enroll your clients. Bookmark your link for easy continued access This personalized link will ensure that you receive credit for your sales; do not share with other agents to sell from. Publish and access your link with the “Link Creation Tool” at any time Post your link on your website Place a banner in your email signature Email to a client so they can self-enroll For training purposes only. Not for public distribution or solicitation. © IHC Group 2015
19
Important Information THIS PLAN IS NOT CONSIDERED TO BE MINIMAL ESSENTIAL COVERAGE AS DEFINED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA). ENROLLING IN AND MAINTAINING THIS PLAN WILL NOT EXEMPT YOU FROM THE SHARED RESPONSIBILITY PAYMENT (TAX) THAT MAY APPLY IF YOU DO NOT HAVE PLAN WITH ACA- COMPLIANT COVERAGE. Communicating for America, Inc. (CA) is a national non-profit advocacy organization that supports affordable healthcare for all Americans. Since 1972, more than 100,000 consumers have trusted CA to help them find affordable health insurance and GAP plans to stretch their healthcare dollar while advocating on their behalf with insurance companies, regulators and lawmakers. About Madison National Life Insurance Company, Inc. Madison National Life Insurance Company, Inc. (Madison National Life), domiciled in Wisconsin is licensed to sell insurance products in 49 states, the District of Columbia, Guam, American Samoa and the U.S. Virgin Islands. Its core products and services are health insurance, group life and disability income, employer stop- loss, specialized individual life and annuity products to military and government personnel. It is rated A- (Excellent) for financial strength by A.M. Best Company, a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations (an A++ rating from A.M. Best is its highest rating). Ebix Health Administration Exchange Ebix Health Administration Exchange is a full service administrative services company that operates in 50 jurisdictions in the individual and employer markets, and provides state of the art and highly efficient open health insurance exchanges through its affiliation with Ebix Incorporated, and, through an affiliate, is the provider of pet insurance solutions that provide pet parents, specialty pet hospitals and universities and general veterinary practices with the only open exchange in the country for all interested constituencies. About The IHC Group The IHC Group is an organization of insurance carriers and marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions to groups and individuals for over 30 years. Members of The IHC Group include Independence Holding Company (NYSE:IHC), American Independence Corp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company.. For more information about The IHC Group, visit www.ihcgroup.com. For training purposes only. Not for public distribution or solicitation. © IHC Group 2015
20
Thank you Questions? Please reach out to your Anthem representative, call 855-632-9003 or email start@ihcgroup.comstart@ihcgroup.com For training purposes only. Not for public distribution or solicitation. © IHC Group 2015
Similar presentations
© 2024 SlidePlayer.com. Inc.
All rights reserved.