Embed Size (px)
Citation preview
Health and Long-Term Care Insurance for Better Place employees and their family
members
CONFIDENTIAL © 2011 Better Place
The Presentation Contains:
2
A. Introduction: Why do I need health insurance?
B. Insurance – Plan 1: Basic Coverage (Paid by the Company)
C. Insurance – Plan 2: Extended Coverage (Optional, Employee-paid)
D. Insurance – Plan 3: Extra Coverage (Optional, Employee-paid)
E. FAQ
F. Contact info and how to file an insurance claim
3
A. Introduction
4
Israeli Health Insurance System
Medicare system in Israel; includes three levels:
Private Insurance
Supplemental Insurance - Other
Health Services
Public Health Insurance
Medical Services in Israel – A Paradox
Israel has the ability to provide some of the most advanced medical care in the world (in terms of knowledge, methods, qualified physicians, etc.). However – when needed, Israel's medical services are not enough!
A great service for healthy people! (A little problematic when you are sick…)
• Surgeries: Long waiting periods; no choice of surgeon.
• Drugs: Only those covered by Public Health Insurance.
• Transplants: Years of waiting for an organ.
• Long Term Care Insurance: Not covered by Public Health Insurance.
5
The Process and the Partners
• The program was built by the company to deal first and foremost with extreme medical situations (medical catastrophes).
• A perfect program has been created for the company (based on its demographics), with the help of insurance specialists (YDB, Attorney Dina Beres)
• Selected one of the leading insurance companies (Clal)
• Selected one of the leading insurance agencies (Madanes), which will be the link between employees and the insurance company.
6
The Result: A policy composed of three plans
Basic Coverage (Paid for by the company for employees and their children up to 25 years old).
Extended Coverage
Extra Coverage
7
• Insurance Start Date: June 1st, 2011.
• Contract Duration: 5 Years, with an option for renewal for additional periods with the consent of both parties.
• If the contract is not renewed: All insured employees (and family members) will continue under a private policy without having to qualify again.
8
B. Plan 1: Basic Coverage
(Paid by for the company for all employees)
Basic Coverage – Principles and Main Points
• The Basic Coverage policy deals with medical catastrophes.
• The layer is paid by the company.
• It covers employees and their children up to 25 years old.
• Spouses can join without having to fill in a health declaration until 31/08/2011.
• The layer is an addition to any other existing insurance. The employee is not required to cancel or change anything about any other existing insurance.
• To join, employees must sign a Registration Form, but they do not have to fill in a health declaration.
• Employees who are not interested in the insurance are required to sing the Waiver of Rights & Privileges form.
Plan 1: Basic Coverage
Organ transplants in Israel and abroad; special treatments abroad.Coverage includes expenses such as hospitalization; flights; accommodation for the insured and a companion; an allowance paid after a transplant for two years, and more.
Drugs that are not covered by Public Health InsuranceDeductible of 200 NIS per prescription and a maximum of 500 NIS per month.No deductible for drugs that cost over 3,000 NIS per month. Up to 1.5 million NIS for 3 years.
10
Surgery-related medical technologies
Implants, CT, and MRI for purposes of diagnosis, determining treatment, or preparing for surgery.
Up to 350,000 NIS for the insurance period.
Full coverage of private surgeries abroad
Freedom to choose any doctor or hospital.
Long Term Care Insurance
A compensation payment of 5,000 NIS per month for life (insured person over the age of 5 years).
11
Plan 1: Basic Coverage
Periodic check-ups
Deductible of 300 NIS for one periodic check-up every two
years, only with an approved provider, and on condition
that the insured must be over 45 years of age.
House Call Doctors; 24 hours a day
Deductible of 25 NIS per house call.
Baby Link - A unique service for pregnant women and during birth
• A Baby Link Home Ultrasound Doppler Monitor (Deductible of 95 NIS a month)
• Easy Tense, a pain reliever device during birth (Deductible of 129 NIS a month).
12
Plan 1: Basic Coverage
How to Join - Plan 1: Basic Coverage
• All employees and their children up to 25 years old are included without having to fill in a health declaration.
• The employee must confirm and approve in writing, and sign the registration form.
• Employees who are not interested in the insurance are required to sign the Waiver of Rights & Privileges form.
• Spouses will be able to join (by paying) and without filling in a health declaration up until the 31st of August, 2011.
• After this date, they will have to fill in a health declaration, which will apply terms of acceptance / rejection to the insurance plan.
13
Premiums - Plan 1: Basic Coverage
Monthly Premium (In NIS) Insured
Paid by Better Place Employees and their children up to 25 years old
27 NIS Spouses
27 NIS Children over 25 years old, son/daughter-in-law
6 NIS Grandchildren
14
• The premium for the basic coverage plan for employees and their children up to 25 years old is paid by Better Place.
• The tax value for the health insurance benefit will be deducted from the employee’s salary after he or she gives approval in writing (this is an average of 9 NIS a month, depending on the level of each employee's tax).
• The premium for the basic coverage plan for a spouse and for children over 25 years old will be paid by credit card or direct debit.
15
C. Plan 2: Extended Coverage
Optional, and at a very attractive price
Extended Coverage - Principles
• Different people have different insurance needs. The purpose of the extended coverage is to allow every employee to purchase high-quality insurance adapted to his needs, at a very attractive price.
• As part of the services and commitment that Madanes provides, consultants and agents for the agency will meet with each employee to learn about his or her needs, and to give advice about acquiring an expanded policy. Also, should an employee already have an existing health insurance policy, he or she can consult Madanes, and decide whether or not to acquire an expanded policy.
16
Private surgeries; surgery-related medical services, including replacement therapies.
• Fully Insured Plan: Full coverage with any approved provider (surgeon and hospital).
• Supplemental Plan: The insured must first exhaust his or her supplementary insurance, and then get the remaining costs from the insurance company - up to the cost of the same surgery with an approved provider.
17
Plan 2: Extended Coverage
Ambulatory Care and Pregnancy Tests (20% Deductible)
• Consultations with specialists (up to 800 NIS per consultation, up to 4 consultations per year).
• Diagnostic medical tests such as MRI and CT (up to 4,500 NIS per test and up to 15,000 NIS a year).
• Physical therapy (up to 12 treatments and 2,500 NIS a year).
• Radiotherapy treatment and/or chemotherapy and/or hyperthermia (up to 30,000 NIS per year for each type of treatment).
• Subscription to a Cardiac/Cardiology Transmitter Services (Up to 200 NIS per month and up to 30 months).
18
Plan 2: Extended Coverage
Pregnancy and Fertility
• Pregnancy Tests: Amniocentesis or Chorionic villus sampling,
Ultrasounds, Gene Carrier Detection Tests or Nuchal scan (up to 5,000
NIS per pregnancy; up to 7,500 NIS for a multiple pregnancy).
• Surrogate pregnancy tests: Same as pregnancy tests.
• In-Vitro fertilization treatments (up to 12,000 NIS a year).
• Obtaining egg donations from abroad (Up to 12,000 NIS per
donation, and up to two donations).
19
• Child Development Treatments (children up to 9 years old): Physical therapy treatments and/or occupational therapy and/or speech therapy and/or developmental psychology - for developmental problems that have been diagnosed in children, on condition that the treatment has been recommended by a specialist (up to 120 NIS per treatment, and up to 30 treatments per year)
• Treatments for Bedwetting Problems (children over the age of 5, with a doctor's recommendation): Up to 500 NIS for one series of treatments.
• Special treatment for children (children up to 15 years old):o Art Therapy Treatments – Up to 100 NIS per treatment, and up to 20
treatments per year.o Therapeutic horseback riding – Up to 100 NIS per treatment, and up to
15 treatments per year.o Hydrotherapy Treatments – Up to 80 NIS per treatment, and up to 15
treatments per year.
20
Children…
• Alternative Medicine – Up to 16 treatments pernyear, 20% deductible.
• "Healthy Living" - a quality-of-life service, and preventive medicine (Diet and nutrition advice, healthy weight loss, learning disabilities, smoking cessation, stress relief, personal trainers, fitness, gyms).Deductible as specified in the policy.
21
Extra Ambulatory Care Services
The coverage for children and the Extra Ambulatory Care Services are provided by “Femi”, and the services are
available only through a third agreement.
Extended Coverage Plan
• Employees, spouses and children can join without having to fill in a health declaration up until the 31st of August, 2011.
• After this date, employees joining the plan will have to fill in a health declaration which will apply terms of acceptance / rejection to the insurance plan.
22
How to Join - Plan 2: Extended Coverage
Extended Coverage(Supplemental Plan)
Extended Coverage (Full Plan)
Insured
43.5 NISa month
55 NISa month
Employee
43.5 NISa month
55 NISa month
Spouse
10 NISa month
13 NISa month
Children up to 25 years old/Grandchildren
43.5 NISa month
55 NISa month
Children over 25 years old, son/daughter-in-law
23
• The premium for the extended coverage plan will be paid by credit card or direct debit.
Premiums - Plan 2: Extended Coverage
24
D. Plan 3: Extra Coverage
Optional, and at a very attractive price
Extra Coverage Plan
• To join this plan, employees must first join both the Basic and the Extended plans.
• To join, employees are required to fill a health declaration which will apply terms of acceptance/ rejection to the insurance plan.
25
Extra Coverage- Principles and how to join
Long-Term Care
• Up to 2 units of a 2,500 NIS compensation payment per month.
• Period of compensation – For life
Severe Diseases
• Up to 2 units of a 25,000 NIS one-time compensation payment following a diagnosis of one of 27 severe diseases listed in the policy.
• The diseases include cancer, strokes, severe heart attacks.
26
Plan 3: Extra Coverage
Severe diseases25,000 NIS
Long-Term Care2,500 NIS for life
Insured
2 NISa month per unit
9 NISa month per unit
Adults(25 years and older)
1 NISa month per unit
2 NISa month per unit
Children up to 25 years old
27
• The premium for the extra coverage plan will be paid by credit card or direct debit.
• You can purchase up to 2 units of Long-Term Care Insurance and 2 units of Severe Diseases.
Premiums - Plan 3: Extra Coverage
28
E. Frequently Asked Questions
FAQ
• How can I join the insurance plan?
• Please contact “Madanes” customer services and fill in a registration form. If you have another private insurance policy or insurance from a previous work place, please mention this when you contact us.
• Can my parents join?
• Parents (up to 70 years old) of employees can join a Health Insurance or Long-Term Care Insurance policy. They can join a private insurance policy only, with a 25% discount for 5 years.
• How can a newborn join?
• A newborn baby of an employee whose spouse is not insured can join the plan without the requirement to fill in a medical declaration if the newborn joins within 90 days of his/her birth. If both parents are insured for at least 12 months before the birth of the baby, the baby will be fully covered even if he or she is born with any kind of birth defect, without undergoing any qualifying period.
29
• If I leave the company for any reason, what happens to the policy? Is it canceled? (In other words, is there an option of continuation?)
• An employee who leaves the company can continue with a very similar private policy from Clal, with continuing insurance on the overlapping coverage with a 35% discount (of the product’s market price) for 5 years. To clarify, this transition will significantly raise the monthly premiums.
• Is there a qualification period with the Better Place policy?
• For the Basic Coverage Plan - for employees and children up to 25 years old – there will not be a qualification period. For the rest of the insured parties (spouses, children over 25 years old and their family members) there will be a qualification period of 30 days, except for:• Pregnancy tests and caesarean section: 6-month qualifying period – for
everyone.• Qualifying period will not apply in the case of an accident.• Severe Diseases: 90 days
FAQ
• Should I cancel my supplemental insurance that I have at my HMO (Health maintenance organization)?
• No - the collective insurance comes as additional plan to the supplemental insurance plan; not as a replacement for it.
• What happens when my children reach the age of 25?
• The company will no longer pay the premium for the basic coverage plan. If you have purchased the extender and the extra plan, the children will pay using the existing credit card / direct debit details with Clal. If you have not purchased the extender and the extra plan, contact Madanes Agency to provide details for the basic coverage plan.
• Can I terminate the insurance at any time?
• Yes. You should contact Madanes Agency and fill in the waiver of rights & privileges form. If you want to join again in the future, you will have to fill in a health declaration which will apply terms of acceptance / rejection to the insurance plan.
31
FAQ
• If I and/or a family member have another health insurance policy (private or collective), should I cancel it?
• No. Do not cancel other policies. You will first have a personal meeting with a consultant from Madanes; bring your full policy terms to this meeting. The Madanes consultants will objectively compare your existing policy with the one from Better Place, and will advise you to either cancel or keep the existing policy.
• What happens when I am on parental leave?
• The company will continue to pay for the basic coverage plan up until the 26th week. Starting from the 27th week and up to 1 year, you can continue the policy by paying for the plan yourself via a credit card / direct debit. After a year, the employee will be treated as an employee who has left the company.
• What happens when I am on unpaid leave?
• For up to 3 months of unpaid leave the policy will continue, and the company will pay for the basic coverage plan. After that, the employee will be treated as an employee who has left the company. 32
FAQ
33
E. Contact Information and Filing Insurance Claims
Insurance Claim Procedure• For information on how to file a claim, please contact Madanes
Customer Service team, phone: 03-6380291
• The Customer Service team will assist the insured with everything related to making a claim: information about the policy coverage; instructions on how to fill in the claim forms and what documents are necessary; and any other information about filing a claim.
• Claim forms usually contain 2 parts: The first part contains the personal information of the insured, and the second part contains the medical information related to the claim (what are you claiming for, what kind of treatment you need, etc.).
• For claims related to the Extra Ambulatory Care Services, Periodical Check-Ups, and House Call Doctors – the insured must refer directly to "Femi Premium", phone: *5590 or 03-6388400 (ext 2).
34
• Phone: 03-6380291
• Address: 2 HaShlosha St, Tel Aviv 67060
• Opening Hours: Sunday – ThursdayBetween 08:00 – 17:00
• Fax: 03-6380011
• E-mail: [email protected]
35
“Madanes” Agency at your service
