Solutions Plus+ Gap

Solutions Plus+ Accident

Solutions Plus+ Critical Illness

A group supplemental medical expense insurance plan that is primarily designed to cover deductibles, co-insurance, and co-payments.

Establishing a multiple year strategy to manage your clients benefit costs.

A more efficient way to protect employees and dependents.

Value Proposition for: Employees

Stabilize and decrease out of pocket exposure Positive perception of their benefit package due

to less out of pocket expenses Control payroll contributions Maintain Carrier and PPO Networks over

multiple years

Value Proposition for: Employers

Immediately reduce healthcare benefit costs Provide richer employee benefits A strategy to minimize Healthcare rate

increases at renewal Improve employee retention

Value Proposition for: Brokers

A unique solution for obtaining new accounts Client recognition for providing creative and

innovative solutions Have a competitive edge over the competition Provide a multiple year strategy to control

healthcare costs Increase and stabilize Agency revenue

1) Hospital Confinement : $500 - $10,000For Hospital stays, this plan pays up to $10,000 per insured for out of pocket expenses up to the plan maximum.

2) Outpatient Services: $200 - $2,500Pays up to $2,500 per condition (max of 4 conditions per family, per year) for outpatient out of pocket expenses up to the plan maximum.

1) Hospital Confinement Benefit (HCB)

Pays a first dollar benefit for inpatient out of pocket expenses incurred up to the plan maximum

Examples of covered expenses:

In-Patient Surgeries and Hospital charges Physician In-Hospital charges X-ray, Lab, Diagnostic Testing, MRI’s

15 hours as a bed-patient qualifies for inpatient benefits

Claims Example using a $5,000 HCB

Current Plan

$500 Deductible 80% Coinsurance $3,000 O-O-P Max $20 Physician co-pay

New Plan

$2,500 Deductible 80% Coinsurance $5,000 O-O-P Max $25 Physician co-pay

Current PlanDeductible $50020% Co insurance $3,100Total Charges $3,600

Plan O-O-P Max $3,000HCB $0

Individuals Cost: $3,000

Proposedw/ HCB$2,500$2,700$5,200

$5,000$5,000

$0

2) Outpatient Benefit (OPB)

Pays a first dollar benefit for outpatient expenses incurred up to the plan maximum

Examples of expenses covered:

Surgery in a facility or a doctor’s office Emergency Room – Accident or Sickness X-ray, Lab, Diagnostic Testing, MRI Outpatient Radiation/Chemotherapy Specialist Visits Physical Therapy, Chiropractic, Rehab

Claims Example using a $2,500 OPB

Current PlanDeductible $50020% Co insurance $400Total Charges $900OPB $0

Individuals Cost: $900

Proposedw/ HCB$2,500

$0$2,500$2,500

$0

Sounds good……

But how much $$$ will my client save?

Current Medical Plan Proposed Medical Plan

$500 Deductible80/20 Coinsurance$3,000 Out of pocket max

#of lives Mo. Cost

EE only 30 $375 EE + SP 7 $750 EE + Ch 5 $650 Family 8 $1,050

Monthly Premium $28,150

$2,500 Deductible80/20 Coinsurance$5,000 Out of pocket max

#of lives Mo. Cost

EE only 30 $250 EE + SP 7 $500 EE + Ch 5 $450 Family 8 $750

Monthly Premium $19,250

$5,000 Hospital Confinement Benefit

$2,500 Outpatient Benefit

Monthly Gap Premium - $4,500

Now let’s review the premium savings…..

Annual Cost of Current Plan: $337,800

Annual Cost of Proposed Plan: $231,000Annual Cost of Solutions Plus+ Gap: $54,000 Total Cost of Proposed + Gap: $285,000

Current Plan $337,000Proposed + Gap - $285,000

Total Annual Savings: $52,000

• Guarantee Issue• No Pre-Ex• No Underwriting• Participation is 5 enrolled lives• Rates are the same if Voluntary of ER paid• Must have a group major medical plan• Insured receives an ID card• Benefits are Assignable to the Provider• Simplified Claim Submission

Routine Doctor office visits Wellness Exams Prescription Copays or Deductibles Alcoholism & Drug Abuse Expenses Mental & Nervous Disorders Expenses Treatment & Services not covered under the

group major medical plan

Advantages of Worksite Products

• Gaining popularity because they are not affected by Healthcare Reform

• Helps round out the benefits package• Provides a cash benefit to employees when they

need it the most• Convenience of payroll deduction• Additional revenue stream for Broker

Disadvantages of Worksite Products

• Disrupts workflow and productivity• Product affordability • Policies are often medically underwritten• Those who need it the most can’t qualify• Sales, Enrollment, and Administration are too

time consuming• Risk associated with the introduction of worksite

agents to their clients

The Solution

Use the Medical premium Savings…Bundle the Accident & CI with the Gap

• Address your clients other insurance needs before someone else does

• Creates New Revenue for the Agency• Immediately increase employee income

without increasing salaries• Simplified paperless enrollment

Plan Highlights• Composite Rates - $6.69/mo• Guarantee Issue for Employee & Family• Pays a scheduled benefit to the insured for

injuries, treatments, & services• Pays in addition to any other insurance

• Dislocations $3,000• Fractures $1,500• Coma $10,000• Burns $10,000• Accidental Death $10,000• Dismemberment $25,000

• ER Visits $100• Hospital Admit $400• Mammogram $100• Ambulance $100• Hospital Stay $150/day• ICU $100/day• Surgery $50 - $1,000

(based on surgery schedule)

Plan Highlights

• Composite Rates - $10.85/mo for $5,000• Lump sum payment to insured• Guarantee Issue for Employee & Family• Children covered at no extra cost• Additional Diagnosis Benefit• Reoccurrence Benefit• $50 annual health screening benefit

• Cancer• Heart Attack• Stroke• Renal Failure• Organ Transplant

• Coma• In Situ Caner• Loss of Sight Speech

& Hearing• Coronary Artery

Bypass

a new solution…

…now let’s get started