Word & Brown—Health Plan Reference Guide for … · 2010-02-16 · Aflac ... we recommend that you verify ... emergency room physician must meet the carrier’s definition of a

n e va d a

HeaLTH PLan ReFeRenCe GUIdeFor Brokers

Group Health, dental & vision

Word & Brown simpli�es Large Group sales and service.

• One stop for large group medical, dental, life, vision, LTD and STD

• Turn around from 2-14 business days

• Presentation assistance available

• Underwriting services are dedicated to your timelines

• Broker Services staff available to assist with your service concerns

• Full commissions on all cases

Please contact your Word & Brown

sales representative today!

800.606.4996

10801 West Charleston Blvd., #520, Las Vegas, NV 89135 | Toll Free 800.606.4996 | Fax 800.700.6744 | www.wordandbrown.com

Large Group Services

Helpful Plan Transition Tips for Your Clients ........3Products & Services..........................................5Product Portfolio ..............................................6Health Plan Comparison Chart ..........................8 Medicare Part D Rx &HPV Vaccine Coverages ..................................10Medical Carrier Rating Information &Broker of Record Change Requirements..............11Carrier Online Services & Billing Cycles ..................................................12

WORKSITE VOLUNTARY PRODUCTS ..............13Aflac ............................................................15Allstate Workplace Division ........................21

MEDICAL ........................................................25Aetna ..........................................................27Allied National Companies ..........................33Anthem ......................................................39BEST Life & Health Insurance ......................45Insurers AdministrativeCorporation (IAC) ........................................51Saint Mary’s Health Plans ............................57Starmark......................................................63

CONSUMER DIRECTED PLANS........................69

DENTAL ..........................................................77Dental Plan Comparison Chart ....................78Aetna ..........................................................83Allied National Companies ..........................85Anthem ......................................................87BEST Life & Health Insurance ......................89Delta Dental ................................................91Freedom Dental BEN-E-LECT ......................93GroupLink, Inc. ............................................95Insurers AdministrativeCorporation (IAC) ........................................97 MetLife ........................................................99Principal Financial Group ..........................101Reliance Standard......................................103Saint Mary’s Health Plans ..........................105SecureCare Dental ....................................107SelectDent ................................................109Starmark....................................................111

VISION..........................................................113Anthem......................................................115BEST Life & Health Insurance ....................117Camden Insurance – Affiliate of Vision Plan of America ..........................119Insurers AdministrativeCorporation (IAC) ......................................121Principal Financial Group ..........................123Saint Mary’s Health Plans ..........................125SelectVision ..............................................127

Request forProposal – Small Group (RFP) ....................129

Request forProposal – Large Group (RFP) ....................131

C O N T E N T S

LAS VEGAS OFFICE10801 West Charleston Blvd.

Suite 520Las Vegas, NV 89135

Phone Numbers800-606-4996702-577-9678

Fax Numbers800-700-6744702-577-9684

The Health Plan Reference Guide (HPRG) isa compilation of Carrier Plans and Servicesoffered to you through Word & Brown. TheHPRG provides brokers with information onplan commissions, benefits, enrollment andeligibility requirements and coverage areas.This information is printed on a quarterly basisand the most up to date guidelines are postedon our website.

www.wordandbrown.com

For proposals:[email protected]

TO OUR BROKERS:

The information in this book was collected from carriersmarketed through Word & Brown and is accurate to the bestof our knowledge at the time of printing. However, since thispublication is intended strictly as a guide – and planspecifications may change – we recommend that you verifyany data with your Word & Brown sales representative andthe carrier before basing any decisions on the informationprovided. Word & Brown disclaims any and all liabilityregarding the errors or omissions of the carriers.

Nevada

3

10801 West Charleston Blvd, #520, Las Vegas, NV 89135 | Toll Free 800.606.4996 | www.wordandbrown.com

Helpful transition tips for your clients

Please share these tips with all of your clients changing insurance plans

Until the new insurance plan has been approved, please make sure your clients are aware of the following:

Emergency Care –In case of an emergency situation, your client should call 911 or go to the nearest in-network hospital* for their new plan and pay cashor use a credit card for any incurred fees. Once their group is approved by the carrier, they can request reimbursement (less their plan’semergency room co-payment). Also remind clients to keep a record of their payment for submission to the carrier. Some plans waive theemergency room co-payment if the patient is admitted to the hospital directly from the emergency room. Important: The diagnosis by theemergency room physician must meet the carrier’s definition of a true emergency in order to receive any reimbursement.

* If your client is taken by car or ambulance to a non-network hospital because it’s within closer proximity than an in-network hospital, the new carrier must be notified within24-48 hours. Please have them call their company’s insurance contact person or you, the broker, if they need assistance with this notification process.

Continuity of Care/Completion of Covered Services – If your client or their enrolling spouse is pregnant or your client is undergoing treatment for an acute condition, a serious chronic conditionor terminal illness, it is important that they notify their company’s designated insurance contact person or you as soon as possible soyou can assist them with submitting the continuity of care form to the carrier if their situation meets this law’s criteria and the carrier’sprogram guidelines.

Doctor Office Visit –Some offices will allow the patient to sign a waiver and pay for the visit up front. Remind your client to keep record of their payment forsubmission to the carrier along with their reimbursement form once they have their new ID number. If your client is a current patient, somedoctors will agree to bill the new insurance carrier once the patient gets their new insurance ID number and will have them pay only theoffice visit co-pay for their new plan. It is best to call the office before their appointment and explain their situation so they know what thepayment procedures are in advance. If this visit can be postponed without adverse consequences to their health, they may want to considerrescheduling their appointment for a later date when they have their new ID number.

Prescriptions –Clients should refill maintenance prescriptions prior to the effective date for their new coverage. For example, they should refill a maintenancehigh blood pressure medication no later than 12/31 for new coverage that will be effective 1/1. If they need to fill a prescription on or afterthe effective date for their new coverage, but they do not have their new ID number yet, they can pay for the prescription at the pharmacyand then request reimbursement from the carrier once they receive their new ID number. For reimbursement, they must submit thepharmacy receipt that includes the name of the drug & dosage rather than only the cash register receipt. If they paid for the prescription bycredit or debit card, and return to the pharmacy with their ID number within 7-10 business days, some pharmacies will credit anyoverpayment back to their account. This is the fastest way for them to get their money back. When a medication is expensive, somepharmacies will work with the client by allowing them to buy a smaller amount (Ex: 10-day supply). When the client returns to pick up theremaining balance of their 30-day supply, the appropriate payment adjustment will be made once they show the pharmacy their new IDnumber. Some brand name drugs have generic equivalents that are much more cost effective. You or your client can find out if theirprescription medication is name brand or generic (and the co-pay amount) by using the carrier’s Web site RX search. For your clients’convenience, Web site addresses are included on the other side of this sheet.

Once the plan is approved and your clients’ employees have received their new membership cards:

• They should carry their membership card at all times. It is important for them to show their new ID card to their doctor during theirfirst visit after their new insurance plan becomes effective.

• Your clients should always make sure they use an in-network doctor or an in-network hospital in order to maximize their coverageand prevent significant gaps in coverage and/or higher out of pocket expenses.

• You should encourage your clients to review all of the benefit descriptions they received during enrollment including their Explanationof Benefits booklet (which the carrier mails to their home address) so they are familiar with their co-payments and covered procedures.

• Ensure they are aware of which procedures will require prior authorization in their plan documents. Remember that proceduresauthorized with their previous carrier may require pre-authorization with their new carrier. Each carrier has their own criteria, so anauthorization by one carrier does not guarantee authorization by another carrier in all circumstances.

• For any additional questions, your client should call Member Services (see other side of this sheet or their ID card for the phone number).

4

Contact Member Services forany questions or assistance

CARRIER or PLAN MEMBER SUPPORTBILINGUALSUPPORT

PROVIDER ELIGIBIL-ITY

VERIFICATION

INTERNET SUPPORT

Aetna888-702-3862 (HMO)888-802-3862 (PPO)877-238-6200 (DENTAL)

888-702-3862 (HMO)888-802-3862 (PPO)

888-632-3862 www.aetna.comwww.aetnanavigator.com

Allied National 800-825-7531 800-825-7531 800-825-7531 www.alliednational.com

BEST Life 800-433-0088 800-433-0088 800-433-0088 www.besthealthplans.com

Anthem 877-833-5734 877-833-5734 877-833-5734 www.anthem.com

IAC 800-518-4510 800-518-4510 800-518-4510 www.iacusa.com

Starmark 800-522-1246Option 8

800-522-1246Option 8

800-522-1246Option 8

www.starmarkinc.com

Saint Mary’s 800-863-7515 (POS)800-433-3077 (PPO+HSA)

800-863-7515 (POS)800-433-3077 (PPO+HSA)

800-863-7515 www.saintmaryshealthplans.com

5

10801 West Charleston Blvd., #520, Las Vegas, NV 89135 | Toll Free 800.606.4996 | Fax 800.700.6744 | www.wordandbrown.com

Products and ServicesNevada

Carriers

Individual, Small and Large Group Medical

Dental, Vision, Long Term Disability, Short Term Disability and Group Term Life

Flexible Benefits - Section 125, Section 132 (Parking and Transit)

Section 105 HRAs

COBRA and HIPAA Compliance Services

Prevailing Wage Hour Bank Health Plans, Short Term Medical,Travel Insurance, Discount Rx Card and Individual Dental and Medical

Services

Products

Enrollments

Quoting

Supplies

Technical Support

Underwriting

Commissions

6

10801 West Charleston Blvd, #520, Las Vegas, NV 89135 | Toll Free 800.606.4996 | Fax 800.700.6744 | www.wordandbrown.com

Product PortfolioNevada

Health Plan Premium Level 1st Year Commission

Aetna All 9%

Allied All 10%

Anthem All 10%

BEST Life All 10%

Delta Dental All 10%

Freedom Dental(Ben-e-lect) All 10%

GroupLink All 10%

IAC 2-9 10%10+ 8%

MetLife First $5,000 10%Next $5,000 7.5%Next $20,000 5%Above varies

Principal Financial First $5,000 10%Next $5,000 8%Next $15,000 6%Next $25,000 4%Above varies

Reliance Standard All 10%

Saint Mary’s Dental 1 HFHealth Plans Dental 2 HF

Dental 3 HF 7%Dental 1 HCDental 2 HCDental 3 HC

SecureCare 2-4 Employees - 10%All 5-49 Employees - 10%

50 Employees - 8%

SelectDent All 10%

Starmark 2-10 Employees - 7%Indemnity 11-25 Employees - 6%

26-99 Employees - 5%

Dental PPO


Madison Dental All 10%

Morgan White All 10%

Individual Dental PPO

Health Plan Plan Name 1st Year Commission

Aetna Indemnity PlanLimited Benefit PlansHMO PlansPPO Plans 7%H.S.A. PlansPOS Plans

Allied Cost Saver 10%Cost Saver Plus Major Medical 7%

H.S.A. Plans No Deductible PlansPremium Advantage

Anthem HMO Plans

PPO PlansHSA Plans

BEST Life Build Your Own PlansHealth Solutions II 6.5%H.S.A. Plans

IAC Advantage Plan Premium AdvantageTraditions PlanDaily PlanHDHP 100%HDHP 80%

Saint Mary’s HMOHealth Plans POS

Health Choice 7%Beyond PlansHDHPFlex Fit

Starmark HSA PlanPPO Plan

Large Group Health Plan Plan Name 1st Year Commission

Aetna 51-125 Employees 5%

CIGNA 51-199 Employees 5%

Saint Mary’s 51-199 Employees 5%Health Plans 100+ Employees negotiated

Short Term Medical Health Plan Plan Name 1st Year Commission

Assurant All 20%

Health Plan Overseas Travel Medical Plan 15%Administrators Rx Pay Card 15%(HPA) Secure STM 18%

Group Term Life Health Plan Premium Level 1st Year Commission

Aetna All 15%

Allied All 15%

Anthem All 10%

BEST Life All - FlexLife 10%

IAC All 8%

MetLife

Principal Financial First $5,000 10%Next $5,000 8%Above varies

Reliance Standard All 15%

StarmarkAll

Medical

Individual/Medical Health Plan Premium Level 1st Year Commission

Aetna Standard Base Rate 15%

Assurant All 20%

HumanaOne All 20%

continued

$25,000 or less - 8%$25,001 - $50,000 - 7%$50,001 - $75,000 - 6%$75,001 and over - 5%

2-10 Employees - 7%11-25 Employees - 6%26-99 Employees - 5%

1-8 Employees - 7%9-15 Employees - 6.5%16-25 Employees - 6%26-50 Employees - 5%

2-24 Employees - 6%25-50 Employees - 5%

2-10 Employees - 7%11-25 Employees - 6%26-99 Employees - 5%

First $5,000Next $5,000Above

15%10%

varies(flat 15% available)

(flat 10% available)

7


Product PortfolioNevada


AFLAC Accident Begins (Voluntary Plans) Cancer at

Dental 12%Hospital Confinement IndemnityHospital Confinement Sickness CommissionHospital Intensive Care IncreasesLife with agentSpecified Health Event involvementSTD andVision production

Starmark 32% of annualizedCritical Illness premium paid

Transconnect Group Supplemental 15%Out of Pocket Medical Expense

Creative Solutions


Aetna STD 15%

Anthem LTD 15%STD 10%

MetLife LTDFirst $15,000 15%First $10,000 10%Above varies

STDFirst $5,000 15%First $5,000 10%Above varies

Principal LTD:First $15,000 15%Next $10,000 10%Above varies

Reliance Standard LTD 15%STD 10%

Starmark LTD 2-10 Employees - 7%STD 11-25 Employees - 6%

26-99 Employees - 5%

LTD and STD


Seniors Choice Medical 8%Rx Coverage 4%

Seniors Group ProductsVision Health Plan Premium Level 1st Year Commission

Anthem All 10%

BEST Life All 10%

IAC All 10%

Principal Financial First $5,000 10%Next $5,000 8%Above varies

Saint Mary’s Vision HFHealth Plans Vision HC

SelectVision All 10%

Vision Plan All 10%of America

7%

Vision PPO Health Plan Premium Level 1st Year Commission

Starmark 2-25 Employees 10%26-50 Employees 9%51+ Employees varies

(flat 15% available)

8

w w w. w o r d a n d b r o w n . c o m

HEALTH PLAN COMPARISON CHART

CompositeRates

Aetna

Domestic Partner

Coverage

Full-time Student

Max. Age/Min. Units

MedicarePrimary/

Secondary*

Allied NationalCompanies

BEST Life & Health Insurance

Applicable to groups of

10+ enrolled

Available atemployer’sdiscretion

Maximum age: 24

Minimum units:12

For groups of 15+ enrolled

Available

Dependents eligible

to age 25. Full-time school

not required


15+ enrolled


Maximum age: 21

Full-time students with 12 units: 26

Do your age 65+rates vary based onwhether Medicare is

Primary or Secondary?

If yes, do you requireproof of Medicare PartsA and B before givingthe 65+ employee the

lower Medicare primary rate?

If a 65+ employee ina Medicare primarygroup is not eligiblefor Medicare will yoube the Primary payor

on their claims?

Please see page 10 forinformation regarding

Creditable and Non-Creditable Overview

Yes

No

Yes

Yes

No

No

No

No


10+ enrolled

Maximum age: 24

Full-time minimum

of 12 hours

InsurersAdministrative

Corporation (IAC)

Groups with fewer than 20 employees

Medicare isPrimary.

20 or more employeesMedicare isSecondary

No

No

When a group is composite rated we do not provide a Primary/

Secondary rate

TBD—contact your

Word & Brownrepresentative

Anthem


new business only - down to 5+ enrolled;

Renewals - 15+enrolled


Maximum age: Through age 23

Minimum units:12

No

N/A

N/A

Starmark

Available at 10 lives

Dependents eligible to age 25—

full-time school not required

Groups with fewer than 20 employees

Medicare is Primary.

20 or more employeesMedicare isSecondary

No

TBD—contact your


If there are 20+ taking the plan,Medicare will be

secondary

Saint Mary’s Health Plans

Available at 10 lives

Available as a rider

Maximum age: 25

Minimum units:full-time student

Yes

Yes

No

9


On plans which includeout-of-network

benefits,are these paid

based on aLimited FeeSchedule

(LFS) or Usual,Customary &Reasonable

(UCR)?

LFS:Basic HMO

Standard HMOPPO Basic

PPO StandardPPO $500 80%PPO $750 80%PPO $1000 80%PPO $1500 80%

PPO Basic $1500 80%PPO Limited Benefit

50%/50%POS $250 90%POS $250 80%POS $500 80%POS $500 70%POS $750 80%POS $1000 80%POS $1500 80%POS $1500 100%POS $2500 100%Aetna Indemnity

Aetna Basic IndemnityAetna Standard

Indemnity

POS HSA-compatible $2500 100%

POS HSA-compatible $3000 100%

PPO HSA-compatible $2500 100%

UCR All plans,based on LFS

UCR

Is the Deductible part of the

out-of-pocketMaximum?

Contact yourWord & Brownrepresentative

NoNoNo

New in BusinessMinimum length oftime in business?

Payroll recordsrequired?

If yes, how long?

Copy of businesslicense?

Other documentsrequired?

6 months

At least 2 weeks worth,

if quarterlytax and wage not available

N/A

No minimum time in

business required

First full payroll and first filed

second quarter when available

No

Call home office

In order to be GuaranteeIssue the employer

would need to provethat they employed onbusiness days during

the preceding calendaryear an average of at

least 2 employees, butno more than 50

employees, who have anormal workweek of 30hours or more, and who

employs at least 2employees on the firstday of the plan year

At least 2 weeksworth of payroll or

a letter from anattorney or certifiedpublic accountant(CPA) listing the

names of allemployees and

number of hoursworked each week

Contact your Word & Brown representative


No minimum time in

business required

If quarterly wage and

tax report was not filed,

submit payroll records for

the most recent 2months.

Also, submit a partnership form

Yes



LFS

No(Yes on HSA

products)

2 weeks

No—unless quarterly wage

and tax is unavailable


At least 2 weeks worth,

if quarterlytax and wage not available

UCR

No

3 months

3 months

Yes


HEALTH PLAN COMPARISON CHART

AetnaAllied National

CompaniesBEST Life &

Health Insurance


Corporation (IAC)Anthem Starmark


EME

No

6 weeks

At least 2 weeksworth if quarterlywage and tax not

available

Yes


Anthem (cont.)PPO $40 Copay $2000D ■PPO $40 Copay $4000D ■

CDHP Plans - PPOLumenos HSA $1,500/100% ■Lumenos HSA $2,000/100% ■Lumenos HSA $3,000/100% ■Lumenos HIA Plus $2,000/100%/$750 ■Lumenos HIA Plus $3,000/100%/$1,000 ■Lumenos HSA $3,000/80% ■Lumenos HSA $5,000/100% ■

BEST Life & Health InsurancePPO/EPO Available Available

w/optional without optional drug card drug card

Health Solutions II - HS 70 Plan ■ ■Health Solutions II - HS 80 Plan ■ ■Health Solutions II - HS 90 Plan ■ ■Health Solutions II - HS 100 Plan ■ ■

HSA-Compatible PPOHealth Solutions HDHP $1500/100/80 ■Health Solutions HDHP $1500/80/60 ■Health Solutions HDHP $1500/90/70 ■Health Solutions HDHP $2000/100/80 ■Health Solutions HDHP $2000/80/60 ■Health Solutions HDHP $2000/90/70 ■Health Solutions HDHP $3000/100/80 ■Health Solutions HDHP $3000/80/60 ■Health Solutions HDHP $3000/90/70 ■Health Solutions HDHP $4000/100/80 ■Health Solutions HDHP $4000/100/80 ■Health Solutions HDHP $4000/80/60 ■Health Solutions HDHP $4000/90/70 ■Health Solutions HDHP $5000/1000/80 ■

Insurers Administrative Corporation (IAC)Option 2 $15, $45, $60 and $90 ($250 deductible applies) ■Option 3 $10, $25, $40 and $50 ■

Saint Mary’s Health Plans$5/$20/$40 ■$10/$30/$50 ■$10/$40/$60 ■Generic $10/$40 ■

Starmark†

$0/$30/$50 ■$0/$45/$75 ■$10/$30/$50 ■$15/$45/$75 ■$20/$60/$100 ■

10

Non-Creditable Creditable

wordandbrown.com

Medicare Part D Prescription CoverageCreditable & Non-Creditable Overview by Health Plan

Creditable Coverage Prescription drug benefit with current plan from employer is at least as good as the pharmacy benefits offered through the new Medicare Part D standard planNon-creditable Coverage Prescription drug benefit with current plan from employer is not as good as the pharmacy benefits offered through the new Medicare Part D standard plan

Non-Creditable Creditable

AetnaHMO

Basic HMO ■Standard HMO ■

PPO/EPOPPO Basic ■PPO Standard ■PPO $500 80% ■PPO $750 80% ■PPO $1000 80% ■PPO $1500 80% ■PPO Basic $1500 80% ■PPO Limited Benefit 50%/50% ■

POSPOS $250 90% ■POS $250 80% ■POS $500 80% ■POS $500 70% ■POS $750 80% ■POS $1000 80% ■POS $1500 80% ■POS $1500 100% ■POS $2500 100% ■

INDEMNITYAetna Indemnity ■Aetna Basic Indemnity POS ■Aetna Standard Indemnity ■

HSA-Companion Plans

POS HSA-compatible $2500 100% ■POS HSA-compatible $3000 100% ■PPO HSA-compatible $2500 100% ■

Allied National CompaniesGeneric Only Option ■(Formulary) $150 deductible/$1500 annual max. ■

(Formulary) $150 deductible/no annual max. ■(Formulary) 0 deductible/No annual max ■

AnthemHMO

Premier HMO ■

Saver HMO ■Blue Advantage HMO 25/25 ■

Blue Advantage HMO 20/20 ■Blue Advantage HMO 15/15 ■

PPOPremier PPO $20 Copay ■PPO $35 GenRX ■PPO $45 GenRX ■Premier PPO $25 Copay ■PPO $20 Copay $250D ■PPO $25 Copay $500D ■PPO $30 Copay $1000D ■PPO $35 Copay $1500D ■

GARDASIL is a vaccine against the HPV or Human Papillomavirus. The GARDASIL vaccine protects recipients against 4 types of HPV, including the two types that cause mostcervical cancers and the two types that cause the most genital warts.

GARDASIL is for girls and women ages 9 to 26. GARDASIL works when given before you have any contact with HPV Types 6, 11, 16, and 18. GARDASIL will be given as athree dose series completed over 6 months. The retail price of the vaccine is $120 per dose ($360 for full series).

Federal health programs such as Vaccines for Children (VFC) will cover the HPV vaccine. The VFC program provides free vaccines to children and teens under 19 years of age,who are either uninsured, Medicaid-eligible, American Indian, or Alaska Native. There are over 45,000 sites that provide VFC vaccines, including hospitals, private clinics, andpublic clinics. The VFC Program also allows children and teens to get VFC vaccines through Federally Qualified Health Centers or Rural Health Centers, if their private healthinsurance does not cover the vaccine.

Answers to frequently asked questions about the vaccine:

Quadrivalent HPV Vaccine (Brand Name: Gardasil)X - Approved under Medical Benefit rather than Prescription Drug because it is a vaccine series administered by a physician.Before starting this vaccine series, the parent or member should check the immunization age guidelines for their plan design to be sure the patient meets the age criteria

Carrier StatusAetna X

Allied National Companies X (between ages of 11 and 18)

Anthem X

BEST Life & Health Insurance Not covered

Insurer’s Administrative Corporation (IAC) X

Saint Mary’s Health Plans X (covered between ages of 9 and 26)

Starmark X (up to age 26)

†Ask about Starmark’s new drug card. New drug card goes into effect for 5/1/09

11


Broker of Record Change Requirements

Medical Carrier Rating Information

*Risk Adjustment Factor (RAF) is a rating applied by carrier’s underwriting department based on medical conditions.

CARRIERNAME

MINIMUMRAF*

MAXIMUMRAF*

PPO ACCESS FEE MONTHLY

ADMINISTRATION FEERATING

CONSIDERATIONS

AetnaAll plans

1.00 1.8571 No Fees No FeesMandatory composite

rates at 10 lives

Allied NationalCompaniesCost Saver

Premium Advantage

No Deductible

1.00

0.92

0.92

1.00

1.71

1.71

PPO Access:$6/EE/Month



$8/EE-max. $80 month

$8/EE-max. $80 month

$8/EE-max. $80month

Rates by Spouse’s Actual Age.

†Composite rates available but not quoted. Contact yourWord & Brown representative





Anthem .880 1.55 No Fees No FeesContact your

Word & Brown representative

BEST Life & Health Insurance

All plans1.00 1.86


$25Contact your

Word & Brown representative


Corporation (IAC)All plans

1.00 1.86PPO Access:$11/EE/Month

<20 EEs: $3520+ EEs: $50


Saint Mary’s Health Plans .70 1.30 No Fees No Fees


Starmark .9053 1.6777Fees vary by network

$5/EE-max$30/month


CARRIERNAME

NEED ORIGINAL BOR CHANGE LETTER ON COMPANY

LETTERHEAD ORCOPY OK?

SEND BROKER OF RECORD

CHANGE LETTER TO (DEPT NAME

+ FAX # OR MAILING ADDRESS)

TURN AROUNDTIME FOR

PROCESSING THIS CHANGE

DOES CARRIERNOTIFY EXISTINGBROKER OF THIS

REQUESTEDCHANGE?

EFFECTIVE DATEFOR NEW BROKER IF GROUP DOESNOT RESCIND THIS CHANGE

REQUEST

IS PRIOR AGENTVESTED? IF YES,

HOW LONG?

IS GA VESTED? IF YES,

HOW LONG?

Aetna Copy Sales Support888-258-4530 1 Week No Date of Processing No Life of Plan

Allied NationalCompanies Copy

Underwriting Administration913-945-4390

1 Week Yes Date of Processing 1st Year Life of Plan

Anthem Copy Broker Support888-819-7475 2 Weeks Yes

Honored based upon thewritten effective date

requested by theemployer. If no such

date requested, then firstof the month following

company approval

No Life of Plan

BEST Life & HealthInsurance Copy Customer Service

Fax: 949-724-1603 3 Days Yes1st of the month following date of

notificationNo Life of Plan


Corporation (IAC)Copy Agent Contracting

602-906-4703 1 Week YesNo change for 1st 12 months

of group1st Year Life of Plan

Saint Mary’s Health Plans Copy Sales Support

888-840-9080 1 Week Yes 1st of month following date No Life of Plan

Starmark CompanyLetterhead

License &Commission847-615-3126

24 Hours Yes1st of the month following 30 days

of receipt1st year Life of Plan

Carrier Date of Billing Due Date Termination Date

Aetna 15th of the prior month 1st of the month End of the month

Allied National Companies 15th of the prior month 1st of the month End of the month

Anthem 1st of the prior month 1st of the month End of the month

BEST Life & Health Insurance 1st of the month 1st of the following month End of the following month

Insurers AdministrativeCorporation (IAC) 15th of the prior month 1st of the month End of the month

Saint Mary’s Health Plans 15th of the prior month 1st of the month End of the month

Starmark 9th of the prior month 1st of the month End of the month

View Employee Add-Ons

View Claims Status

View Employee Terminations

Rates For Employees/Dependents

Online Billing

Online Addition of Employee

Online Termination of Employee

View Directory

Download Forms

E-Mail Customer Service

Premium Payment

Order ID Cards

View Benefits

View Current PCP or Doctor

Change Doctor

View Directory

Download Forms

Book Doctor Appointments

Manage Group Account

Commission Information

Group Information (e.g. Add-Ons)

12

Carrier Billing Cycles

1 All features are available to members who enroll on Aetna Navigator. There is no cost for Aetna Navigator.2 Via delegated employer access.

Employer Services:

Employee Services:

Broker Services:

●

●

●1

●1

●1

●1

●1

●1

Aetnaaetna.com

Allied Nationalalliednational.com

BEST Life & Health Insurancebesthealthplans.com


Corp. (IAC)iacusa.com

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

N/A

N/A

● (PPO Level)

●

●

●

●

●

●

●

Carrier Online Services

N/A

N/A

Anthemanthem.com

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●2

Starmarkstarmarkinc.com

●

●

●

●

●

●

●

●

● (EFT only)

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saintmaryshealthplans.com

●

●

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13


WORKSITEVOLUNTARYPRODUCTS

15


NY

VAWVA

MD

DE

NJ

MA

ME

NH

VT

CT RI

Customer Service, Bilingual Support,& Broker Services800-99-AFLAC800-SI-AFLAC (Spanish)Commissions Please contact your Aflac representativeClaimsAmerican Family Life Assurance Company of Columbus (Aflac)Worldwide Headquarters1932 Wynnton RoadColumbus, GA 31999-7251800-99-AFLACFax (Add-ons/Deletes)877-44-AFLAC

Nevada Coverage Area:All of Nevada is covered. Plans areindemnity policies and pay all benefitsto policy holder unless assigned

U.S. Coverage Area:The entire U.S. is covered. Plans areindemnity policies and pay all benefitsto policy holder unless assigned

Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

16


OUT-OF-STATE COVERAGE

PRODUCTS OFFERED

Is Coverage Offered for Out-of-State employees?

What is the minimum % of employees required in NV?

What plans (or plan types, such as PPO, Indemnity,etc) are offered for Out-of-State employees?

What states are allowed (or not allowed) for Out-of-State Coverage?

Are rates for Out-of-State employees based on theNV Employer Zip code or based on Out-of-State ZipCode (and separate rates)?

Any other rules, restrictions or guidelines not mentioned:

Yes

N/A; 3 or more policy holders.

All States are allowedContact your Word & Brown representative

The rates are based on SIC of Company

All plan types

Policy: AccidentFeatures:

• Emergency Treatment Benefit• Specific-Sum Injuries Benefit• Accidental-Death Benefit• Initial Hospitalization Benefit

Policy: Short-Term DisabilityFeatures:

• Selection of:■ Monthly benefit amount■ Elimination Period■ Benefit Period

• Guaranteed-renewable to age 70• Benefits paid directly to policy holder unless chosen otherwise• Benefits paid regardless of any other insurance

Policy: Cancer/Specified-DiseaseFeatures:

• First-Occurrence Benefit• Hospital Confinement Benefit• Radiation and Chemotherapy Benefit• Cancer Screening Wellness Benefit• Ambulance transportation and lodging benefits• Surgical/Anesthesia Benefit

Policy: Hospital Confinement IndemnityFeatures:

• Hospital Confinement Benefit• Rehabilitation Unit Benefit• Surgical Benefit

Policy: Specified Health BenefitFeatures:

• Pays a First-Occurrence Benefit as well as Hospital Confinement and Continuing Care Benefits for:■ Heart attack & coronary artery bypass surgery■ Stroke■ End-stage renal failure■ Major human organ transplant■ Major third-degree burns■ Coma■ Paralysis

Policy: Hospital Intensive CareFeatures:

• Daily ICU Confinement Benefit• Daily Subacute Unit Confinement Benefit

Policy: DentalFeatures:

• Freedom of choice (Pick any dentist)• Portable• Guaranteed-renewable at the same payroll rate• Pays regardless of any other insurance you may have• No deductible• Easy to understand

Policy: LifeFeatures:

• Provides up to $200,000 of term life, whole life, or a combination of both on a very competitive basis

• Waiver of Premium Benefit• Optional Spouse & Child Riders• Optional Accidental-Death Benefit Rider

Policy: Hospital Confinement Sickness IndemnityFeatures:

• Physician Visits Benefit• Initial Hospitalization Benefit• Major Diagnostic Exams Benefit• Surgical Benefit

Policy: VisionFeatures:

• Eye Examination Benefit• Vision Correction Benefit• Specific Eye Disease/Disorder Benefit• No network restrictions

17


ENROLLMENT INFORMATION & REQUIREMENTS

Are Commission-Only employees allowed?Yes—but limited products

Are 1099 employees allowed?Yes—but limited products

Any ineligible industries?Possibly for Disability. Please contact your Word & Brown representative

RATING INFORMATION

MINIMUM EMPLOYER CONTRIBUTION

EXCLUSIONS ALLOWED BY CARRIER:Must earn $21,000 per year for Disability in NV

Minimum group size3+ for Disability

IMPORTANT: Aflac products are individual, NOTgroup; therefore, they are NOT guaranteed issue.They are “simplified” issue, meaning, employeeswill/may have to pass underwriting.

*Claims paid to policy holder, NOT to the provider.

CARVE OUTS*

PLAN ELIGIBILITY REQUIREMENTS

Group Size

Rate Guarantee

Rates vary by Industry?

COVERAGE REQUIREMENTS

Minimum 3 Participating Employees

N/A, Individual Products

Yes

None—100% Employee Paid

Carrier's Effective Date1st or 15th of the month

Premium Amount Required for 15th?N/A

Employee Waiting Periods AvailableVaries by Product

Applications must be dated within:Prior to effective date

Spouse/Domestic Partner Employees - 1 application or 2?1 application – if covered by Group Health Plan

Employee Waiver Cards Required at enrollment?Preferred

Is Over Age Dependent Verification Required?No

Are Telephone Interviews done by Underwriting?Yes—life only (large face values)

Must Brokers Carry Errors & Omissions Insurance?No—only the Aflac field force assisting the broker isrequired to have E&O

Does Carrier Offer Open Enrollment?Yes

DOCUMENTATION & PAYMENT INFORMATIONWage & Tax Statements required?

Payroll Records OK if no Wage & Tax Statements?

Is a Prior Booklet required?

Is Prior Billing required?

Must submit check with initial application?

Check Made payable to:

FEESEnrollment Fee Amount

Type of Enrollment Fee

Monthly Administration Fee

BILLING OPTIONS

•Paper

•Online/Web Based

•Express Reconciliation

N/A

N/A

N/A

N/A

None

None

None

No—billed in arrears

Aflac

18


VALUE ADDED SERVICES

Aflac’s payroll deduction and Section 125 capabilities offer powerful ways to:

• Eliminate or reduce the pressure for future company-paid plans.

• Strengthen benefits packages in a tight labor market.

• Introduce choice and portability at the employee level.

• Let employees access the power of pre-tax dollars.

• Save FICA contributions.

• Communicate the value of total company benefits in real-dollar terms.

Aflac is a premier provider of insurance policies, insuring:

• Over 11,937 state governments (and government agencies) and municipalities (company statistics, December 30, 2006).

• More than 1,108 colleges (company statistics, December 30, 2006).

• Over 1,764 hospitals (December 30, 2006).

• Over 12,083 school districts (December 30, 2006).

• More than 372,000 U.S. payroll accounts (December 30, 2006).

Aflac offers superior enrollment, communications, and claims efficiencies, such as:

• Leading-Edge Technology. Our SmartApp® point-of-sale laptop enrollment system (recognized by the Smithsonian Institution)

provides instant submission of applications via electronic signature capture.

• Employee Benefits Communication System. This people-friendly program is designed to show employees the value of the

benefits their employers provide. It can communicate all benefits, including core benefits and policies sold on a voluntary

basis.

• Info One® Personalized Benefits Statements. Generally free of charge, this service illustrates the “hidden paycheck” by

calculating the total cost of employee benefits by including the employer’s share.

• Flexible Spending Accounts, including Medical Reimbursement (Section 125) and Dependent Day-Care Accounts (Section 129).

• Transit One (Section 132) transportation expense program.

• Internet Billing and Payment Capabilities. Designed for smaller accounts, this system facilitates real-time statement changes

and updates on an easy-to-use basis.

• Single-Point Billing Services. These services are for accounts with 50 or more employees.

• Corporate Alliance Programs. These include COBRA/HIPAA administration and PEO services.

• Comprehensive Call Center. This specially dedicated customer service resource handled over 9.9 million calls in 2006

(December 31, 2006).

• Outstanding Performance in Claims Service. In 2006, Aflac processed more than six million claims in the United States. Aflac

processes most claims within four days (December 31, 2006).

19


FEATURES AND BENEFITS

Benefits to Business Owners:

• Wellness Benefits that help provide an incentive for early detection, helping to mitigate claims costs; having a potentially positive

impact on medical plan experience and employee “return to work” times.

• Eliminate or reduce the pressure for future company-paid plans through “Voluntary, employee funded programs”.

• Revenue generation through FICA and Workers Compensation savings from the pre-taxing of Aflac Benefits.

• Expansion of your benefit program, at “No Cost,” increasing your retention and attraction power of quality employees.

• Ability to reduce “exposure” to Workers Compensation claims through additional programs that pay “Cash Benefits” and provide

“Disability Income” from the 1st day an employee misses work.

Benefits to Employees:

• The power to "choose" the quality of care they desire; while using added benefits to "buffer" the added costs of going outside a

managed care network in order to see a specialist or have a second opinion in time of need.

• Provides insurance products that generate cash to employees to help with out-of-pocket costs associated with illness or injury

that are not covered by traditional medical insurance plans. Allowing them the "choice" of protecting themselves, their families or

their paycheck.

• Access to affordable "Consumer Driven Health Plans" that are "owned" by the consumer, completely portable and guaranteed

renewable

Benefits to Broker:

• A client solution by providing some relief to increasing health insurance premiums by offering products that can help the

employer make decisions to increase deductibles and co-pays, position the company to pass premium expense to the

employee, and reduce an employer’s FICA taxes and potentially, Worker’s Compensation premiums.

• Relief to employees by offering products that reduce out-of-pocket expenses related to higher co-pays, deductibles and other

costs.

• Health Savings Account compatible products.

• The ability to attract and retain employer clients by offering additional products to their employees at no direct premium cost

before a competitive broker does.

• Additional credibility by working with Aflac, a rate-stable, Fortune 500 company with tremendous brand awareness and a 92%

claims satisfaction rate.

• Increased commissions and vesting opportunities with little time commitment.

• Provides the broker with an opportunity to maintain his/her competitive position with his/her employer client.

• Positions the broker to assist the employer with developing a more comprehensive benefit portfolio with no additional premium

cost to the employer.

21


NY

VAWVA

MD

DE

NJ

MA

ME

NH

VT

CT RI

Customer ServicePolicyholder ServicesPhone: 800-521-3535Fax: 972-510-1795

Broker ServicesRegional Support Center 888-655-5725

Commissions Please contact your Allstate representative

ClaimsAllstate Workplace Division Workplace Claim Department P.O. Box 43967 Jacksonville, FL 32203-3067 Phone: 800-348-4489 Fax: 972-510-1773

Add-ons/DeletesFax: 972-510-1786

Nevada Coverage Area:All of Nevada is covered. Plans areindemnity policies and pay all benefitsto the insured unless assigned

U.S. Coverage Area:Coverage is available in shaded states. Plansare indemnity policies and pay all benefits tothe insured unless assigned

Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

TC plan only available

These products are designed to cover some of the things a healthinsurance policy may not and to supplement any coveragereceived through an employer. The products are guaranteed issueat initial enrollment – meaning no medical questions are required.

Group Voluntary Term LifeThis program offers Group Voluntary Term Life for the enrollee,their spouse and dependent children. It is meant to supplementany coverage one may already have through their employer byproviding valuable life insurance coverage at an affordable cost.This coverage is ideal for those who want to protect their families,but may not need a permanent Life Policy. For convenience,premiums are payroll deducted.

Group Voluntary Term Life Insurance is designed to providecoverage for a specified time and provides the ability for anenrollee to choose a plan for themselves or the entire family. Thelump sum benefit can help offset final burial expenses or costsincurred as life events happen.

An insured or their family members may use term life insurance to:

Pay off a mortgage or other outstanding debtsProvide for childcare or educational expensesReplace income to continue the same standard of living

Additional Benefit CoverageThe Waiver of Premium and Accelerated Death Benefit are includedwith the Group Voluntary Term Life coverage. Each benefitenhances the basic coverage and can help with expensesassociated with disability or terminal illness.

Waiver of PremiumIf an insured becomes disabled prior to age 60 and the disabilitylasts for 6 months or longer, they will not be required to paypremiums for as long as the disability lasts or until they reach age65, whichever occurs first, provided the group policy remains inforce.

Accelerated Death BenefitIf an insured or spouse are diagnosed with terminal illness (definedas less than 12 months to live), this benefit pays a portion of thetotal face amount up to 50%. The remaining life insurance benefitis paid upon death of the insured.

Benefit Reduction ScheduleReduction in group insurance amounts will apply at older ages,according to the following schedule:

Insured’s Attained Age Reduction to x% of OriginalCoverage

70 65%75 50%80 35%

If the insured does not enroll during their open enrollment period,they may enroll later during the annual re-enrollment period.However, they must submit evidence of insurability with theirenrollment form.

Continuation of CoverageThe insured has the option, when no longer eligible for coverage,to continue coverage at group rates up to age 70, so long as thegroup policy remains in force.

Group Voluntary Critical IllnessGroup Voluntary Critical Illness insurance pays a lump-sum benefitupon diagnosis of a covered critical illness or condition. Havingsupplemental Critical Illness insurance can help lessen financialimpact to the wallet. It allows the insured to concentrate ongetting better, rather than spending time and energy worryingabout how to pay the bills.

The lump-sum benefit for each category of coverage helps to:

Pay for treatments not covered under medical insuranceSpend precious time with family and friendsPay for mortgage and other expenses

Traditional health insurance is valuable, but often has limits.Because medical treatments and technology are advancing daily,people are living longer with major illnesses or disease. This canbe very costly. Financial hardship can happen, due to indirectmedical expenses that health and disability insurance doesn’tcover. Group Voluntary Critical Illness insurance is a strongsupplement to current health and disability insurance coverage.

The insured may choose either a $5,000 or $10,000 basic benefitamount. Depending on the basic benefit amount selected, up to100% of the basic benefit amount will be payable in each of threebenefit categories; Coronary Artery By-Pass Surgery, Alzheimer’sDisease and Carcinoma in Situ pay 25% of the benefit amount.

Group Voluntary AccidentGroup Voluntary Accident Insurance offers the insured and theirfamily coverage against sudden accidental injuries that can occurwithout warning. It protects the insured and their family 24-hours aday, seven days a week, both on- or off-the-job.

Each pre-packaged plan doesn’t just cover the insured; if theychoose, it also covers their dependents (which can include spouseand dependent children). This valuable coverage can helpsupplement traditional medical insurance. Traditional medicalinsurance is valuable, but may limit coverage during anunexpected accidental injury.

The insured and each covered family member can be sure they willreceive:

· A lump sum benefit, in case the accident leads to death or dismemberment

· 24-7 protection for accidental injuries**· Benefit coverage that goes where you go**

Unexpected accidents can also mean unexpected out-of-pocketexpenses. Hospital stays, medical or surgical treatments,dislocations or fractures, and transportation by air or groundambulance can add up quickly and be very costly. This GroupVoluntary Accident Insurance helps offset some of these expensesso that the insured’s finances remain healthy.

**Treatment must be obtained in the U.S. or its territories.

If a covered person sustains an injury which results in a coveredloss within 90 days from the date of an accident, while coverage isin force, Allstate Workplace Division will pay the benefits as statedin the benefits provisions.

· Accidental Death· Common Carrier Accidental Death· Dismemberment· Dislocation and Fracture· Initial Hospital Confinement· Hospital Confinement· Intensive Care· Ambulance (ground and air)· Medical Expenses· Outpatient Physician’s Treatment

NOTE: This Product Overview is an agent recruitment and trainingdocument and is not intended for consumer use. The insuranceproducts discussed in this document may vary based on state ofissue and may not be available for sale in all states.

22


PRODUCTS OFFERED (High and Low Options)

DOCUMENTATION & PAYMENT INFORMATIONWage & Tax Statements required?

Payroll Records OK if no Wage & Tax Statements?





23



Are Commission-Only employees allowed?Yes

Are 1099 employees allowed?Yes

Any ineligible industries?Please contact your Word & Brown representative

RATING INFORMATION


EXCLUSIONS ALLOWED BY CARRIER:

Minimum group size5-200 eligible

CARVE OUTS*


Group Size

Rate Guarantee



5-200 eligible

Minimum 1 Year

No

A minimum of 5 participants are required to initiate the SBSprogram. If the total number of participants fall below 5, theemployer has 3 billing cycles (months) to bring the levels up tominimum before the plan will be terminated. Groups with over200 eligible employees will not qualify for participation

Carrier's Effective Date1st of the month

Premium Amount Required for 15th?N/A

Employee Waiting Periods AvailableEmployer Determines Eligibility

Applications must be dated within:Prior to effective date

Spouse/Domestic Partner Employees - 1 application or 2?1 application

Employee Waiver Cards Required at enrollment?Yes

Is Over Age Dependent Verification Required?No

Are Telephone Interviews done by Underwriting?Initial contact to Region, then Broker, then Employer ifnecessary.

Must Brokers Carry Errors & Omissions Insurance?Yes

Does Carrier Offer Open Enrollment?Yes




BILLING OPTIONS

Paper only

N/A

N/A

No—billed in arrears

Allstate Workplace Division

N/A

N/A

None

None

None

24


VALUE ADDED SERVICES

• 15% broker commission (1st year and renewal)

• Products are Guarantee Issue

• No participation requirements

• Products are portable as an individual component (not as a package)

• Monthly billing








Yes

N/A; 5 or more insureds

Contact your Word & Brown representativeContact your Word & Brown representative

The rates are based on SIC of company

All plan types

FEATURES AND BENEFITS

Additional Wellness Screening BenefitAllstate has enhanced the coverage by providing a Wellness Screening Benefit. A $100 benefit will be paid for one of thefollowing screening tests performed while not hospital confined:

· Bone Marrow Testing· CA15-3 (blood test for breast cancer)· CA125 (blood test for ovarian cancer)· CEA (blood test for colon cancer)· Chest X-ray· Colonoscopy· Flexible sigmoidoscopy· Hemocult stool analysis· Mammography, including breast ultrasound· Pap Smear, including Thin Prep Pap Test· PSA (blood test for prostate cancer)· Serum Protein Electrophoresis (test for myeloma)· Biopsy for skin Cancer· Stress test on bike or treadmill· Electrocardiogram· Carotid Doppler· Echocardiogram· Lipid panel (total cholesterol count)· Blood test for triglycerides

There is no limit to the number of years screening tests can be received, and the benefit is paid regardless of the result ofthe test(s). Limited to one test each calendar year for each covered person.

25

MEDICAL

27


Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

HMO/POSAetnaP.O. Box 24019Fresno, CA 93779

PPO/IndemnityAetnaP.O. Box 981204El Paso, TX 79998-1204

CLAIMS REIMBURSEMENT

Member Support 888-702-3862 (HMO)888-802-3862 (PPO/Indemnity)

Broker Service 877-249-2472

Bilingual Support See member supportnumbers above

Commissions 877-249-2472Employer Support 877-249-7235Adds/Terms Fax 888-258-4528Provider Services 888-632-3862

Pharmacy 800-238-6270 (Prompt 2 for Member)

Mail Order Drug 866-612-3862

This may or may not match what is on the employee’s ID card.

PPO Counties

PPO & POS Counties

ME

DI

CA

L

HMO/POS

Any unshaded areas are indemnityonly. Plan may not be available in allzip codes within county. Contact your Word & Brown representative to confirm if coverage is available foryour group location.

LIFE

DENTAL

VISION

INFERTILITY

CHIROPRACTIC

ACUPUNCTURE

MASSAGE THERAPY

PRODUCTS OFFERED

OPTIONAL BENEFITS

GROUP SIZE

PROVIDER INFORMATION

HMO/EPO PPO POS

28

CONSUMER-DIRECTED HEALTHCARE


ALTERNATIVE DISCIPLINES

HMOAetna

CPOSAetna Choice Point of Service

PPOAetna Open Choice PPOwww.aetna.com

Is Workers' Comp required oncorporate officers, partnersand sole proprietors?No

Is on-the-job covered for corporate officers, partnersand sole proprietors?Yes

Is there a premium adjustmentfor 24 hour coverage?No

How often can members change their Primary Care Physician (PCP)?

Can family members eachchoose a PCP from a differentIPA/Medical Group?

Does carrier allow an OB/GYNto be Primary Care Physician?

Self-referral available?

Express referral available?

Not Available

2-50

Aetna

HMO PPO

Aetna IndemnityAetna Basic Indemnity

Aetna Standard Indemnity

Indemnity

Basic HMOStandard HMO

POS HSA-compatible $2500 100%POS HSA-compatible $3000 100%

DUAL OPTION (MIX AND MATCH)

Aetna's multi option program is called Pick-A-Plan 3. Employers ofgroups with 5+ enrolling employees can select up to 3 of the 15 availableplans at the time of initial enrollment. One person must enroll in eachplan chosen.

Aetna

Aetna

No—see self-referral information above

HMO: Yes—OB/GYN well woman exams (including PAP smear),gynecological-related problems, follow-up care & obstetrical carePPO: Yes

SELECTION

SPECIALIST REFERRALS

NETWORKS

HMO: Anytime. Change must berequested by the 15th of the month tobe effective the 1st of the following monthPPO & Indemnity: No PCP selection is required

Yes

Yes—if OB/GYN is listed as a PCP

We offer chiro with some of our medical plans andalongside of our discount program, this benefit isunlimited with the discount program.

PPO BasicPPO StandardPPO $500 80%PPO $750 80%PPO $1000 80%PPO $1500 80%

PPO Basic $1500 80%PPO Limited Benefit 50%/50%

24 HOUR COVERAGE

POSPOS $250 90%POS $250 80%POS $500 80%POS $500 70%POS $750 80%POS $1000 80%POS $1500 80%POS $1500 100%POS $2500 100%

HSA-Compatible POS

PPO HSA-compatible $2500 100%

HSA-Compatible PPO

Available

Available

Discount Included

Discount Included

Not Covered—only the treatment of the underlyingcause. Refer to Infertility section on page 31


AFTERINITIAL ISSUE

ENROLLMENT GROUP SIZE

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:



PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE CARVE OUTS*

WRAP* REQUIREMENTS

*Indicates flexibility in being offered with products of another carrier.

GROUP Can be written with another SIZE carrier's PPO or indemnity plan?

SPECIAL CONSIDERATIONS

29

EXCLUSIONS ALLOWED BY CARRIER:Hourly/Salary?

Management/Non-management?

Union/Non-union?

Minimum group size

* Indicates a well-defined class of employees which may be selected from (i.e. carved out of) the entire group for coverage.

2-50

50%

N/A

N/A

1* 1*50 N/A

2-50 Yes—standard participation of 75% must be met in order for a group to qualify for coverage.Employees waiving due to coverage throughspouse will NOT be considered eligible incalculating participation for a group sold alongside another carrier

Yes—subject to Aetna Underwriting approval †

Yes—minimum 8 lives

Yes—subject to Aetna Underwriting approval †

8 enrolled with Aetna who reside within Aetna’s Nevada Network Service Area.

Aetna

Aetna

Aetna

Aetna

GROUP Can be written with another SIZE carrier's HMO or POS?

100%

N/A N/A

2-3 4-50

◆◆100%

N/A N/A

† Employer must provide all employee class definitions in writingon company letterhead prior to approval.

Multiple Locations - Employer groups with more than one locationneed Home Office Approval. Please contact your Word & Brownrepresentative.

Groups will go through the Aetna re-verification annually. Aetna sendsout the documentation 6 months prior to the effective date.

Dependents who reside separately from the employee and are not inan approved Aetna service area will be enrolled on the subscriber'sHMO plan and will need to access care via the selected Primary CarePhysician in the subscriber's/family's HMO service area (except forurgent and emergency care). Any dependent that is currently enrolledin the out-of-area dependent Aetna PPO plan will not be impacted bythis change so long as they remain eligible for coverage.

◆ Those covered by another plan are NOT considered eligible in calculating participation

◆◆ In order to NOT be considered eligible, the other coveragemust be a group plan or Medicare

Min. # of employeesMax. # of employees

2-50 Yes—standard participation of 75% must be met inorder for a group to qualify for coverage. Employees waiving due to coverage throughspouse will NOT be considered eligible incalculating participation for a group sold alongside another carrier

COVERAGE RESTRICTIONS

Are Commission-Only employees allowed?Yes—must be full-time employee, have an employer/employeerelationship and have workers' comp coverage. Need to submitwage and tax reports for proof

Are 1099 employees allowed?Employees reported on the IRS 1099 forms who meet Aetna'sstandard criteria for determining 1099 status, and only if all 1099employees are offered coverage. They must meet the followingrequirements:

● No more than 50% of the groups’ employees can be 1099employees.

● 1099 employees must be employed by the company full timeand year round.

● All present and future 1099 employees are subject to the sameeligibility requirements as taxed employees.

● The employee must contribute the same amount for 1099employees as for all other employees qualifying under NRC689C.

● The employer must have at least two taxed employees, with taxdocuments that verify the company is a valid business.

● The new group must include a list of all 1099 employees and acompleted and signed 1099 contractor form.

Are employees covered if traveling out of USA?Emergency services. Other services are paid at the non-networkbenefit level.

Is coverage available for out-of-state employees?POS and HMO: NoPPO: Yes—except in AL, HI, ID, MN, MT, ND, NM, RI, WI & WYIndemnity: Yes—except in HI & VT

Max. % of employees residing out-of-state allowedPPO only - 49%

75% of eligible excludingvalid waivers

100% of eligible excluding valid waivers

* A group of 2 with one valid waiver due to other group coverage or Medicare.

Pick-A-Plan 35-50

Two Options:1) 50% of the employee rate

for plan employee selects;2) Defined contribution of at

least $120 or the actual costof the plans picked,whichever is less

ME

DI

CA

L


MEDICAL UNDERWRITING REQUIREMENTS

Current Employees

TimelyAdd-ons

RAF Increments (2-50 lives)

Composite Rates

Rate Guarantee

Apply Trend Factor?

Use Employee Zips?


Carrier's Effective Date

Premium Amount Required for 15th?

Employee Waiting Periods Available

Applications must be dated within:

Spouse Employees - 1 application or 2?

Employee Waiver Cards Required at enrollment?

Is Over Age Dependent Verification Required?

Are Telephone Interviews done by Underwriting?

Must Brokers Carry Errors & Omissions Insurance?

Does Carrier Offer Open Enrollment?

DOCUMENTATION & PAYMENT INFORMATIONWage & Tax Reports required?

Payroll Records OK if no Wage & Tax Reports?








DEDUCTIBLE CREDITPrior carrier deductible credit given?

4th quarter deductiblecarry-over credit given?

GROUP SIZE

RATING INFORMATION

30

Instant quotes online: www.wordandbrown.comQuotes in 24 hours: (800) 606-4996

ITEMS REVIEWED IN RAF CALCULATION

Medical Conditions

Years in Business

# of Pregnancies

Virgin Group

Type of Industry

Percent of Owners

Group Size

% of COBRA Insureds

% of Family Related

Participation

Plan(s) Requested

24 HR Coverage Req'd

Employer Contribution

Bankruptcy

Gender Mix

Current Employees

TimelyAdd-ons

Yes

Yes—minimum 2 weeks

No

Yes

Yes

Aetna, Inc.

None

N/A

None

Yes

No

Yes

No

Yes

No

Yes

No

No

No

No

No

No

No

Yes

2-50: Determined ona case-by-casebasis

Applicable to groups of 10+ enrolled

12 Months

No

For product network availability only

17 medical 5 medicalquestions on questions on

employee application employee application

Non NonMedical Medical

1st or 15th of the month

N/A

Min: none Max: 6 months/180 days* - 1st of the month followingdate of hire60 days & prior to requested effective date

Either 1 or 2 applications

Yes

Yes

No

Yes

Yes—30 days before renewal anniversary

Aetna

Aetna

GROUP SIZE

HMO & HRAPPO & Indemnity

No

2-25 26-50

*Aetna's underwriting Dept. willconsider, on an exception basis,different waiting periods formanagement & non-managementclasses. Group must submit aspreadsheet clearly identifying the class for each employee

31


Infertility

Adult Physical Child Physical Annual OB/GYNPLAN TYPE Exam Exam/Immunizations Visit/Pap Smear Mammography

SPECIAL CONCERNS*

Hearing treatment

Are Hearing Aids Covered?

Speech therapy

PREVENTIVE BENEFITS*

PRESCRIPTIONS

* Information shown in this section reflects in-network benefits. For Triple Option plans, the most managed plans are shown.

FORMULARY VS. NON-FORMULARYDoes carrier use Rx formulary?

Are non-formulary drugs available?

MAIL ORDER - 90 DAY SUPPLY

Are oral contraceptives covered?

* Unless otherwise noted, information shown in this section reflects in-network benefits. For Triple Option plans, the most managed plans are shown.

BENEFIT INFORMATION SHOWN ON THIS PAGE IS A BRIEF SUMMARY. LIMITATIONS AND EXCLUSIONS APPLY. PLEASE REFER TO CERTIFICATE BOOK, EVIDENCE OF COVERAGE OR CALL REPRESENTATIVE FOR DETAILS.



MAIL ORDER



No—we will honor ‘dispense as written’

Yes

Yes

Yes—higher non-formulary copay applies

HMO: 2X retail copay - 90 day supply available

POS &PPO plans: 2.5X retail copay - 90 day supply available

Indemnity: Varies. Contact your Word & Brown representative

Yes

* Information shown in this section reflects in-network benefits.

Aetna

Aetna

Aetna

HMO & all PPOs 100% after copay 1 100% after copay 1 100% after copay 2 100% after copay 2

PPO & Indemnity

Limited to $300every 12 months

Indemnity Coinsurance applies 1 Coinsurance applies 1 Coinsurance applies 2 Coinsurance applies 2

GENERIC VS. BRAND NAMEIf generic available, and doctor has not indicated“dispense as written,” will member receive ageneric equivalent rather than a brand name drug?

If doctor writes “dispense as written” on prescription, is brand name available at the brandcopay amount?

1Age & frequency schedules apply2Frequency schedules apply

All plans: Coverage only for the diagnosis andtreatment of the underlying medicalcondition. Member cost sharing isbased on the type of service performedand place where it is rendered. (SeeCertificate Book for details). Nocoverage for artificial insemination, IVF,ZIFT, ICSI & other related services


Contact your Word & Brown representative ME

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DIABETIC BENEFITS

These services may change at any time without notice. Please contact your Word & Brown representative for specific inquiries on listed services

32

Are the following items covered under the Prescription Drug Benefit or the Durable MedicalEquipment Benefit of the member’s selected plan design?


Insulin

Needles & Syringes

Glucose Monitor

Chem-Strips and/or Testing Agents

Insulin Pump

Insulin Pump Supplies

SELF-INJECTABLE DRUG BENEFITS

Are self-injectable drugs(other than insulin)covered under the

Prescription Drug Benefitor Medical Benefit?

Is pre-authorizationrequired?

Must self-injectables(other than insulin)

be purchased via thecarrier-contracted

mail order Rx vendor?

Aetna

Aetna

Aetna

Prescription Drug Benefit


Medical/Durable Medical Equipment Benefit




MedicalBenefit

Generally under the 4th tierPrescription Drug Benefit

Generally under the 4th tierPrescription Drug Benefit

Depends on drug*

Depends on drug*

Depends on drug*

Typically through Specialty Pharmacy

Network


Network


Network

* Check Aetna's Rx formulary at www.aetna.com/formulary

HMO plans:

POS plans:

PPO & Indemnity Plans:

Aetna

33


Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

Member Support, Customer Service,& Commissions:Allied National 800-825-7531

BillingPremium DepartmentAllied NationalP. O. Box 29188Shawnee Mission, KS 66201-9188Ph. 800-825-7531Fax 913-945-4390

ClaimsClaims DepartmentAllied NationalP. O. Box 29186Shawnee Mission, KS 66201-9186Ph. 800-825-7531Fax 913-945-4390

Fax (Add-ons/Deletes)913-945-4390

General Fax #:913-945-4390

PPO Only

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LIFE

DENTAL

VISION

INFERTILITY

CHIROPRACTIC

ACUPUNCTURE

MASSAGE THERAPY

PRODUCTS OFFERED

OPTIONAL BENEFITS

GROUP SIZE


34



PPO

Is Workers' Comp required oncorporate officers, partnersand sole proprietors?No

Is on-the-job covered for corporate officers, partnersand sole proprietors?If optional coverage elected

Is there a premium adjustmentfor 24 hour coverage?Yes






SELECTION


NETWORKS

24 HOUR COVERAGE

PPO

Cost Saver

Premium Advantage

HSA

Cost Saver Plus Major Medical

No Deductible

Referrals not required

PCP not required

Allied Beech Street Network - PPOwww.beechstreet.com

Allied First Health Network - PPOwww.firsthealth.com

Allied Health Alliance Network - PPOwww.mccnevada.com

Nevada Preferred Professionalswww.universalhealthnet.com

Referrals not required

2-50

Available

Available

N/A

N/A

Covered with limits

Covered with limits

Covered with limits

Plans administered by Allied National and underwritten by AmericanAlternative Insurance Corporation (AAIC). AAIC is a subsidiary ofMunich•RE America Corporation and an affiliate of Munich ReinsuranceAmerica, Inc. AAIC is rated “A+” (Superior) by A.M. Best Company

PCP not required

PCP not required

Allied National


Employees

Dependents

Employees

Dependents



Union/Non-union?

Minimum group size2 with home office approval



Employees

For Dependents

% of Total Cost:



PARTICIPATION

Min. # of employees

Max. # of employees

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

AFTERINITIAL ISSUE

CARVE OUTS*

WRAP* REQUIREMENTS


GROUP Can be written with another SIZE carrier's HMO, POS or EPO?


35



Are Commission-Only employees allowed?

Are 1099 employees allowed?

Are employees covered if traveling out of USA?

Is coverage available for out-of-state employees?

Max. % of employees residing out-of-stateallowed

Yes—must work exclusively for employer

Yes—must work exclusively for the employer. There must be two W-2 employees. No maximumnumber of 1099’s

Yes

Yes—but prior approval of Allied required

More than 25% requires Home office approval. Contact your Word & Brown representative

100%

N/A

2-50

2-50 Cost Saver only

2-50 Cost Saver only

25%

N/A

N/A

75% of those not coveredelsewhere; min. 50%

N/A

2-50

2 2

50 N/A

Yes—participation based on included class(es) only

Yes

Yes

Allied:1. Multiple Locations - Employer groups with more than

one need Home Office Approval. Please contact yourWord & Brown representative

Cost Saver 10001. No well baby benefit coverage is included2. No Medical Underwriting is required

Cost Saver 15001. No well baby benefit coverage is included2. No Medical Underwriting is required

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Allied National

Allied National

Aetna

Allied National


Current Employees

TimelyAdd-ons

Group Size

Composite Rates

Rate Guarantee

Apply Trend Factor?

Use Employee Zips?






Spouse/Domestic Partner Employees - 1 application or 2?






DOCUMENTATION & PAYMENT INFORMATION

Wage & Tax Report statements required?






FEES

Enrollment Fee Amount





GROUP SIZE

RATING INFORMATION

36




Medical Conditions

Years in Business

# of Pregnancies

Virgin Group

Type of Industry

Percent of Owners

Group Size

% of COBRA Insureds

% of Family Related

Participation

Plan(s) Requested



Bankruptcy

Gender Mix

Any day of the month

Yes—submit one month’s premium

Min: 0 days; Max: 180 days

On or before requested effective date

2 apps husband & wife groups-not guaranteed issue

Yes

Yes

Yes

No

Yes—at anniversary

N/A

N/A$10 per employee tomax. of $80/month

Yes

No

Yes

No

No

No

No

No

No

No

Yes

Yes

No

No

Yes

Yes

No

Cost Saver: Non-medicalAll other plans: standard medical app

2-50

Yes

No

Yes

Yes

Allied National

All plans except Cost Saver: 2-50Cost Saver: 2+

For groups of 15+

12 months

Yes

No

Yes

Non-medical

Allied National

Allied National

Infertility

SPECIAL CONCERNS*


PRESCRIPTIONS


GENERIC VS. BRAND NAMEIf generic available, and doctor has not indicated“dispense as written,” will member receive ageneric equivalent rather than a brand namedrug?

If doctor writes “dispense as written” on prescription, is brand name available at thebrand copay amount?








37


Hearing treatment

Are Hearing Aids covered?

Speech therapy

Contact home office

Generic offered. If member chooses brand they paythe cost differential between brand and generic

Yes

Yes—at higher copay

2x copay

Yes

Cost Saver N/A Subject to Office Visit Benefit

Physical diagnosis or treatment of infertility: $500 lifetime benefit

20 visits/calendar year

Contact home office

All other plans Subject to OfficeVisit Benefit up to

$250/year

Subject to Office Visit Benefit

Yes

ME

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Allied National

Allied National

DIABETIC BENEFITS


38



Insulin

Needles & Syringes

Glucose Monitor


Insulin Pump













Durable Medical Equipment Benefit


If available through pharmacy, covered under

Rx drug benefit

Yes NoFormulary plansonly:

Allied National

Allied National

39


Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

Member Support877-833-5734

Broker Support888-445-9236Fax [email protected]

Fax (Adds/Terms)303-831-2399

Commissions888-445-9236

BillingAnthem Blue Cross and Blue Shield P.O. Box 541013 Los Angeles, CA 90054-1013800-922-4770Fax 303-831-2399

ClaimsAnthem Blue Cross and Blue Shield P.O. Box 5747 Denver, CO 80217-5747877-833-5734

www.anthem.com

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Plan may not be available in all zip codes within county. Contact your Word & Brown representativeto confirm if coverage isavailable for your grouplocation

HMO & PPO Counties

LIFE

DENTAL

VISION

INFERTILITY

CHIROPRACTIC

ACUPUNCTURE

MASSAGE THERAPY

PRODUCTS OFFERED

OPTIONAL BENEFITS

GROUP SIZE


HMO/EPO

40


HSA-Compatible PPO



Premier HMO*Saver HMO*

Blue Advantage HMO 25/25*Blue Advantage HMO 20/20*Blue Advantage HMO 15/15*

PPO

Premier PPO $20 CopayPPO $35 GenRXPPO $45 GenRX

Premier PPO $25 CopayPPO $20 Copay $250DPPO $25 Copay $500DPPO $30 Copay $1000DPPO $35 Copay $1500DPPO $40 Copay $2000DPPO $40 Copay $4000D

Lumenos HSA $1,500/100%Lumenos HSA $2,000/100%Lumenos HSA $3,000/100%Lumenos HSA $3,000/80%Lumenos HSA $5,000/100%

HIA Plans

Lumenos HIA Plus $2,000/100%/$750Lumenos HIA Plus $3,000/100%/$1,000

PPO

Is Workers' Comp required oncorporate officers, partnersand sole proprietors?

Is on-the-job covered for corporate officers, partnersand sole proprietors?

Is there a premium adjustmentfor 24 hour coverage?





Express referral available?Open Access

Open Access

SELECTION


NETWORKS

Open Access

24 HOUR COVERAGE

Anthem BC BS Blue Card*HMO Nevada

Anthem DentalDDSBlue ViewBlue View Plus

Yes

No

Available

Available

Available

N/A

N/A

2-50

Yes

No

No

Available—Spinal Manipulation for painmanagement—12 visit limit*

For pain management*

*Both spinal and acupuncture have inside limits

Combinedbenefitlimit

* No lifetime maximum for most covered services. See each plan’s Summary of Benefit and Certificate for details.


EmployeeElect Health CoverageEmployers may offer one plan, a mix of plans or all the EmployeeElectplans to their employees. The EmployeeElect portfolio includes ten PPOplans, seven consumer-driven health (CDH) plans and five HMO plans

Anthem

Anthem

Anthem


Employees

Dependents

Employees

Dependents



Union/Non-union?

Minimum group size



Employees

For Dependents

% of Total Cost:



PARTICIPATION

Min. # of employees

Max. # of employees

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

AFTERINITIAL ISSUE

CARVE OUTS*

WRAP* REQUIREMENTS




41








Yes—must be employed by the company full time and yearround

Yes—no more than 50% of the group’s employees can be1099 employees. Must be employed by the company fulltime and year round. Group must have at least 2 taxedemployees

Yes

Yes—PPO plans only

More than 49% residing outside of the State of Nevadarequires Underwriting approval

2-50

2-50 No

2-50 No

50% (see special considerations)

N/A

N/A

75% of eligible, excluding valid waivers

N/A

Yes

Yes

Yes

5 employees

Location carve outs need prior underwriting approval.

There are three options for employers to select from formonthly contributions to their employees’ health premiums:

■ Fixed-dollar contribution — as little as $125 per employee(certain restrictions and minimums apply)

■ Traditional contribution — as little as 50% per employee

■ Percentage of plan contribution — base a defined percentage on a specific plan (certain restrictions and minimums apply)

2 250 no max.

2-50

100% of all eligible employees—no waivers allowed

N/A

ME

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LAnthem

Anthem

Anthem

Anthem


Current Employees

TimelyAdd-ons

Group Size

Composite Rates

Rate Guarantee

Apply Trend Factor?

Use Employee Zips?






Spouse Employees - 1 application or 2?













FEES






GROUP SIZE

RATING INFORMATION

42




1st or the 15th of the month

Yes—submit 100% of the premium

Min: 0; Max: 12 months from after date of hire

60 days and prior to requested effective date

If husband/wife group, must enroll separately

Yes

Yes—yearly

No

Yes

Yes

Full Medical

No

Yes—for takeover groups

Yes

Anthem Blue Cross & Blue Shield

Full Medical

2-50

Yes—optional for 5+ employees

12 months

Yes

No

Yes

2-50

Only if group in businessless than 3 months

None

N/A

None

Yes—with EOB submission within 180 days

No

Evaluation CriteriaAnthem bases underwriting on the following criteria:

A. Business qualification B. Employer contribution C. Health status D. Employee and dependent eligibilityE. Employee participationF. Geographic locationG. Tobacco useH. AgeI. GenderJ. Standard industry classification codeK. Group size

Anthem

Anthem

SPECIAL CONCERNS*

Infertility


PRESCRIPTIONS










BENEFIT INFORMATION SHOWN ON THIS PAGE IS A BRIEF SUMMARY. LIMITATIONS AND EXCLUSIONS APPLY. PLEASE REFER TO CERTIFICATE BOOK, EVIDENCE OF COVERAGE OR CALL REP FOR DETAILS.

43


Hearing treatment


Speech therapy

No

Yes

Yes—at higher costs

Yes—1X copay—30 day cost for 90 day supply

Yes

All Yes—applicablecopays

If in current treatment - possible rate-up. Contact yourWord & Brown representative.

Yes

No

Yes—applicablecopays



No

Limited

Varies by product—please contact your Word & Brown representative

ME

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LAnthem

Anthem

Anthem

DIABETIC BENEFITS

These services may change at any time without notice. Please contact your Word & Brown rep for specific inquiries on listed services

44



Insulin

Needles & Syringes

Glucose Monitor


Insulin Pump









Durable Medical Equipment or Prescription Drug Benefit

Durable Medical Equipment

Durable Medical Equipment*


Durable Medical Equipment *


30% up to $250 Depends on drug NoPPO Plans

30% up to $250 Depends on drug NoHMO

Deductible and/or max. out-of-pocket, paid at

applicable coinsurance

Depends on drug NoHSA/HIA

* If billed by a provider that is non-pharmacy, member would be subject to the DME limits. If billed by a pharmacy, member would not be subject to the DME limit.

Anthem

Anthem

45


Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

Member Support, Customer Service & Commissions:[email protected]

BillingBEST Life and Health Insurance Co. 2505 McCabe WayIrvine, CA 92614-6243

ClaimsBEST Life and Health Insurance Co. P.O. Box 890Meridian, ID 83890800-433-0088Fax 208-893-5040Email: [email protected]


ME

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PPO Only

LIFE

DENTAL

VISION

INFERTILITY

CHIROPRACTIC

ACUPUNCTURE

MASSAGE THERAPY

PRODUCTS OFFERED

OPTIONAL BENEFITS

GROUP SIZE


46




PPO








Express referral available?N/A

Yes

SELECTION


NETWORKS

BEST Life's Medical products are PPO,there is no preselection necessary andmembers may change their PCP asoften as they like.

24 HOUR COVERAGE

BEST Life PHCS/Multi-Plan Network*www.phcs.com

BEST Life Universal Health Networkwww.uhnppo.com*BEST Life offers Healthy Directionsthrough PHCS/Multi-Plan. This is awraparound network that can beaccessed by members who do not havePHCS as their primary. Members whoare outside their primary in-networkservice area can go to a Multi-Plan doc-tor and receive services at discountedprices.

Yes

There is no preselection necessary,members may choose to see any in-network physician.

Available

Available

Available

N/A

N/A

N/A

N/A

2-50

Health Solutions II - Build Your Own Plans

HSA Plans - Build Your Own Plans

No

No

Yes

PPO

HSA-CompatiblePPO


Employees

Dependents

Employees

Dependents



Union/Non-union?

Minimum group size



Employees

For Dependents

% of Total Cost:



PARTICIPATION

Min. # of employees

Max. # of employees

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

AFTERINITIAL ISSUE

CARVE OUTS*

WRAP* REQUIREMENTS




47








Must be 1099 in order to qualify for eligibility

Yes—cannot comprise of more than 50% of entire group membership

Yes—for emergency coverage

Yes—all states

No more than 50% of enrolling employees may be located out of the State in which the primary business is located.

100% ◆

N/A

2-7

2+ Yes

2+ No—do not allow PPO wrap

50% for employees or50% of employees and dependents

100%

N/A

BEST Life does not offer coverage options for carve-out groups or to professional employerorganizations.

Not allowed

Not eligible

Minimum group size for non-carve out groups is 2employees enrolling.

25+ groups will have different benefits for Severe MentalIllness—see Certificate of Coverage.

Multiple Locations: if 50% of the group is not at the Employer’smain location, Home Office approval is required. Contact yoursales representative.

No requirement except for above

8+ ◆

75%

N/A


◆◆ In order to NOT be considered eligible, the other coveragemust be a group plan (i.e. through their employer or their spouse's employer) or Medicare

2 250 unlimited

2-50

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Current Employees

TimelyAdd-ons

Group Size

Composite Rates

Rate Guarantee

Apply Trend Factor?

Use Employee Zips?













Wage & Tax Reports required?






FEES






GROUP SIZE

RATING INFORMATION

48




Medical Conditions

Years in Business

# of Pregnancies

Virgin Group

Type of Industry

Percent of Owners

Group Size

% of COBRA Insureds

% of Family Related

Participation

Plan(s) Requested



Bankruptcy

Gender Mix

1st or the 15th of the month

1 month

Min: 30 days; Max: 90 days

60 days

2 applications

Yes

Yes—must be submitted at time of claim

No

Yes

Yes

N/A

PPO Access $4 peremployee per month

$25

Yes

No

Yes

No

Yes

No

Yes

No

No

No

No

No

No

No

Yes

Full if prior creditablecoverage

Full Medical

No

Yes

Yes

BEST Life & Health Insurance Company

Full Medical

2-50

Yes*

6-12 months, based on medical underwriting

Yes—trend factors areapplied on a monthly basis

No

Yes

Yes—as long as there is a letter explainingwhy there is no wage report

Yes

* Will allow composite rates for groups of 15 or more, and on an exception basis, allow groups of10 or more enrolled.

2-50

SPECIAL CONCERNS*

Infertility


PRESCRIPTIONS











49


Hearing treatment


Speech therapy

Not a covered service on both Health Solutions II andHDHP products

Formulary is covered on both Health Solutions II andHealth Solutions HDHP.

Yes

Yes—2x copay for 3 months supply

Yes

Health Solutions II Covered at copay and then 100%

up to $250, $500 or$1,000 per year

Health Solutions II and HDHP: Infertility treatment is notcovered. Elective sterilization procedures are covered,but not the sterilization reversals

Health Solutions II: If member chooses the brand name,member will be responsible for the difference between thecost of the Name Brand and the Generic drug in addition tothe generic co-pay

Health Solutions HDHP: Members will receive a discount onlycard. They can apply cost to their plan's deductible and thencoinsurance

Not a covered service on both Health Solutions II andHDHP products

Covered at copay and then100% up to $250 per year,

deductible then coinsurance will apply

Covered at copay andthen 100% up to $250,$500 or $1,000 per year

Covered at copay andthen 100% up to $250,$500 or $1,000 per year

Health Solutions II: Yes—member will be charged theFormulary copay

Health Solutions HDHP: Members can apply costs totheir plan's deductible and then coinsurance

Health Solutions II and HDHP: Speech therapy iscovered at the deductible up to $50 per visit and thenapplied to the coinsurance. There is a Calendar YearMaximum of $2,500

ME

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Health Solutions HDHP Covered at copay and then 100%

up to $300, $500 or $1,000 per year

Covered at copay and then100% up to $300, $500 or

$1,000 per year, deductiblethen coinsurance will apply

Covered at copay and then 100%

up to $300, $500 or $1,000 per year

Covered at copay and then 100%

up to $300, $500 or $1,000 per year

DIABETIC BENEFITS


50



Insulin

Needles & Syringes

Glucose Monitor


Insulin Pump









Covered under Prescription Drug Benefit and under regular medical benefits

Covered under regular medical benefits





Outpatient injectableprescription drugs other

than insulin are not acovered benefit

N/A N/AHealth Solutions II& Health Solutions

HDHP

51


Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

Member Support800-518-4510

Broker Service &Commissions800-276-2707

Bilingual Support800-518-4510

Employer Support800-518-4510


Claims800-843-3106 (voice)602-395-0496 (fax)

PPO Only*

* Available in zip codes 889-891 and 893-898

ME

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LIFE

DENTAL

VISION

INFERTILITY

CHIROPRACTIC

ACUPUNCTURE

MASSAGE THERAPY

PRODUCTS OFFERED

OPTIONAL BENEFITS

GROUP SIZE


52












SELECTION


NETWORKS

24 HOUR COVERAGE

No

N/A

N/A

Universal Health NetworkFirst HealthPHCS

N/A

N/A

Available

Available

Available

N/A

Limited

N/A

N/A

Traditions PlanAdvantage Plan

Premium Advantage PlanDaily Plan

HDHP 100%HDHP 80%

If they purchase 24 Hour optional coverage

Yes

Traditions PlanAdvantage Plan

Premium Advantage Plan Daily Plan

HDHP 100%HDHP 80%

2-50

N/A

PPO

HSA-CompatiblePPO

HRA-CompatiblePPO


Employees

Dependents

Employees

Dependents



Union/Non-union?

Minimum group size



Employees

For Dependents

% of Total Cost:



PARTICIPATION

Min. # of employees

Max. # of employees

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

AFTERINITIAL ISSUE

CARVE OUTS*

WRAP* REQUIREMENTS




53








No

Yes—if meets criteria

Yes—limitations apply

Yes

No

75%

75%

2-50

75%

75%

Hourly minimum; 30 hours

Management carve out

Yes—employees to be covered must be clearlyidentified by collective bargaining agreement

11

Plan details are outlined in the IAC Group Health Planbrochure and Producers Guide

2 250 50

2-50

50%

25%

N/A

2-50 No

2-50 No

ME

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Current Employees

TimelyAdd-ons

Group Size

Composite Rates

Rate Guarantee

Apply Trend Factor?

Use Employee Zips?



















FEES






GROUP SIZE

RATING INFORMATION

54




Medical Conditions

Years in Business

# of Pregnancies

Virgin Group

Type of Industry

Percent of Owners

Group Size

% of COBRA Insureds

% of Family Related

Participation

Plan(s) Requested



Bankruptcy

Gender Mix

1st and 15th of the month

1st of the month-full months premium

30, 60 and 90 days; 1st of the month following Date of Hire

60 days

1 application

Yes

Yes

Yes

Yes

Only at initial enrollment of group

Varies on group size

HSA $30.00 set-upHRA $10.00 set-up

$35

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

Yes

Yes

Full medical

No

Yes

Yes

Insurers Adminstration Corporation

Full medical

2-50

Yes—10+ Employees

6 and 12 month

Yes

Yes

Yes

No

Yes

2-50

SPECIAL CONCERNS*

Infertility


PRESCRIPTIONS

Adult Physical Child Physical Annual OB/GYN Visit, Exam Exam/Immunizations Mammography & PAP










55


Hearing treatment


Speech therapy

Non-covered expense

Yes

Yes

Yes—60 day cost for 90 day supply

Yes

All Optional Wellness

Non-covered expense

Limited benefit

Yes

Non-covered expense

Optional Wellness 100%

Yes

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DIABETIC BENEFITS


56



Insulin

Needles & Syringes

Glucose Monitor


Insulin Pump









Specialty drugs—pre-certification required

RX benefits—pre-certification required



Medically-necessary medical benefits—pre-certification required

Medically-necessary medical benefits—pre-certification required

Yes—pre-certificationrequired

Yes YesAll Plans

57


Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

Member SupportHealthFirst & POS 800-863-7515Health Choice PPO & HSA 800-433-3077www.saintmaryshealthplans.comEmail: [email protected]

Unified Life (Contraceptive & Sterilization Plan) 800-342-2641

Catalyst Rx (Prescription Drug Services) 866-358-9534www.CatalystRx.com Fax 866-212-5759

Bio Scripts(Injectable Drugs Mail Order Program) 877-316-8921

Walgreens Customer Service 800-635-3070www.WalgreensMail.com Fax 866-212-5759

Saint Mary’s Nurse Line 800-243-5495

Broker Service & Commissions 888-840-9080

Add-ons/Deletes Fax 775-770-9479

ClaimsSaint Mary’s Health PlansClaims / Member Services1510 Meadow Wood LaneReno, Nevada 89502

HMO/POS


ME

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PPO Only Counties

All Plan Types

LIFE

DENTAL

VISION

INFERTILITY

CHIROPRACTIC

ACUPUNCTURE

MASSAGE THERAPY

PRODUCTS OFFERED

OPTIONAL BENEFITS

GROUP SIZE


HMO

58


HSA-CompatiblePPO











SELECTION


NETWORKS

24 HOUR COVERAGE

Yes

N/A

Yes

Secondary PCP

Yes—on some specialties

Not Available

Rider Available

Rider Available

Available

Available

No

HealthFirst HMO

HDHP

No

No—not offered

As often as they like

PPO

Beyond Plan SeriesHealth Choice

Flex

POS

HealthFirst POS

2-50


HMOHealthFirst

PPOPreferred Healthcare Network

HRA-CompatiblePPO

HDHP


Employees

Dependents

Employees

Dependents



Union/Non-union?

Minimum group size



Employees

For Dependents

% of Total Cost:



PARTICIPATION

Min. # of employees

Max. # of employees

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

AFTERINITIAL ISSUE

CARVE OUTS*

WRAP* REQUIREMENTS




59



Are Commission-Only employees allowed?No

Are 1099 employees allowed?Yes—if the following criteria is met:1) The group must have at least two regular W-2 employees enrolled.2) The 1099 employees must be exclusively contracted on a year-round

basis with the one employer.3) No more than 50% of the enrolled employees can be 1099 employees. 4) All other regular employee eligibility requirements apply (e.g., 30 hours

minimum/week, year-round employment, general eligibility provisionsin group contract, etc.).

5) The employer must contribute the same amount towards 1099 employees' premiums as contributed towards regular W-2 employees'premiums.

6) All 1099 employees that meet the above eligibility criteria will beincluded in determining the group's participation requirements.

7) Upon renewal, all above criteria applies.

Are employees covered if traveling out of USA?Yes—limitations apply. Please contact your Word and Brown Sales Representative

Is coverage available for out-of-state employees?Yes—groups with 10 or more employees may offer aHealthChoice PPO to their out-of-state employees as longas the group is domiciled within the HealthFirst servicearea

Max. % of employees residing out-of-stateallowedNo more than 25% of the group resides outside of theHealthFirst service area

100%

N/A

2-3

100%

N/A

Yes

Yes—management carve outs are allowed as long asthere are at least 5 managers enrolled

Yes—employees to be covered must be clearlyidentified by collective bargaining agreement

5 employees

1) All prospective groups must select an Rx rider as part oftheir group health plan.

2) Association discounts are applicable statewide. Pleaseremember to advise your Word & Brown representativewhen requesting a quote if your client is a member of anassociation. Proof of association membership is requiredbefore discounts can be applied to final underwritingrates. The association discounts do not apply to the highdeductible health plans.

3) Please note that dependents that have not provided proofof full-time student status, marriage or birth certificates,etc., will be added to the plan for 15 days, and thenterminated off the plan pending receipt of the requiredinformation. This applies to both large and small groups.

2 250 50

2-50

50%

N/A

N/A

No

No

100%

N/A

4+

75% of eligible employeesexcluding valid waiver

N/A

ME

DI

CA

L


Current Employees

TimelyAdd-ons

Group Size

Composite Rates

Rate Guarantee

Apply Trend Factor?

Use Employee Zips?



















FEES






GROUP SIZE

RATING INFORMATION

60




Medical Conditions

Years in Business

# of Pregnancies

Virgin Group

Type of Industry

Percent of Owners

Group Size

% of COBRA Insureds

% of Family Related

Participation

Plan(s) Requested



Bankruptcy

Gender Mix

1st of the month

N/A

Employer set

60 days

2 applications

Yes

Yes

No

No

Yes

None

None

None

Yes

No

Yes

No

Yes

No

Yes

No

No

No

Yes

No

No

No

Yes

Yes

2

No

Yes

No


N/A

2-50

Available for 10+ Employees

12 months

Yes

Yes

Yes

Yes

Yes





SPECIAL CONCERNS*

InfertilityInfertility Testing: Diagnosis testing for infertility is coveredwhen coordinated by a plan practitioner/provider and priorauthorized by SMPHIC.

Diagnostic testing is limited to one testing series permember lifetime including but not limited to one of thefollowing: general history and physical examination VDRL,CBC, urinalysis, MA C-12, T3, T4, TSH and T7, endometrialbiopsy, HSG.

For coverage limitations, please consult COC.


PRESCRIPTIONS







61


Hearing treatmentLimited benefits — see COC.

Are Hearing Aids covered?No

Speech therapyShort term rehabilitation services limited to treatment ofconditions that will result in significant clinical improvement.25 visits per calendar year.

ME

DI

CA

L

HMO Yes Yes Yes Yes

PPO Yes Yes Yes Yes

POS Yes Yes Yes Yes

Yes


Yes

Yes—if medically necessary or with rider

Yes

Yes

DIABETIC BENEFITS

These services may change at any time without notice. Please contact your Word & Brown rep for specific inquiries on listed services

62



Insulin

Needles & Syringes

Glucose Monitor


Insulin Pump















Yes Yes Yes All Plans

63


Churchill

Clark

Douglas

Elko

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

MineralNye

Pershing

Storey

Washoe

White Pine

Carson City

Member Support800-522-1246, option 8

Fax (Adds/Terms)847-615-3955

Commissions800-522-1246, [email protected]

Claims800-522-1246, option 7Fax 330-965-7599

ME

DI

CA

L


PPO Counties

LIFE

DENTAL

VISION

INFERTILITY

CHIROPRACTIC

ACUPUNCTURE

MASSAGE THERAPY

PRODUCTS OFFERED

OPTIONAL BENEFITS

GROUP SIZE


64












SELECTION


NETWORKS

N/A

24 HOUR COVERAGE

No


Yes

No

Available

Available

N/A

Limited benefits

$1,000 per year

N/A

N/A

Signature AdvantageSignature Select

2-99

PPO

Consumer Health AdvantageConsumer Health Select

HSA-CompatiblePPO

N/A

N/A

N/A

N/A


Employees

Dependents

Employees

Dependents



Union/Non-union?

Minimum group size



Employees

For Dependents

% of Total Cost:



PARTICIPATION

Min. # of employees

Max. # of employees

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

AFTERINITIAL ISSUE

CARVE OUTS*

WRAP* REQUIREMENTS




65








Yes—for groups with 5 or more enrolling; 1099’s only

Yes—for groups with 5 or more enrolling; cannot comprise more than 50%

Yes—only if emergency

Yes

49%—or 51% in marketed states

100%

N/A

2-99

75%

N/A

Yes

Yes—except if the owners of the company are the only insured

Yes

Contact your Word & Brown representative for moredetails

2 99

2-99

50%

N/A

N/A

1) 25% of the total cost of employees or dependents

2) or 50% of the total cost for employee

ME

DI

CA

L

2 99

★ After creditable waivers are removed

No

No









Current Employees

TimelyAdd-ons

Group Size

Composite Rates

Rate Guarantee

Apply Trend Factor?

Use Employee Zips?






Spouse - 1 application or 2?






FEES






GROUP SIZE

RATING INFORMATION

66




Medical Conditions

Years in Business

# of Pregnancies

Virgin Group

Type of Industry

Percent of Owners

Group Size

% of COBRA Insureds

% of Family Related

Participation

Plan(s) Requested



Bankruptcy

Gender Mix

1st of the month

Pro-rated

Yes

60 days of effective date—cannot be more than

1 application

Yes

Yes

Yes

Yes

1st year is open enrollment

N/A

N/A

$5/EE - Max. $30/month

Yes

No

Yes

No

Yes

No

Yes

Yes

No

Yes

Yes

No

Yes

N/A

Yes

Yes

No

Yes

Optional

Starmark

2-99

Yes—10+ Employees

6 or 12 months

No

No

Yes

No

Yes

Full medical

Full medical

2-99

Infertility

SPECIAL CONCERNS*


PRESCRIPTIONS




† Coverage based on plan benefits selected. Contact your Word & Brown representative for details.* Information shown in this section reflects in-network benefits. For Triple Option plans, the most managed plans are shown.







67


Hearing treatment


Speech therapy

ME

DI

CA

L

Limited benefit

Yes

Yes

Yes

Yes

Signature Advantageand Signature Select†

1 per year

No

60 visit limit per therapy per calendar year

Yes

No

At birth and at 2, 4, 6, 9, 12, 15 & 18

months

1 per year A base line mammogramfor each person age35-39 and an annual

screening mammogramfor each person age 40

and older

No

Consumer HealthAdvantage and

Consumer Health Direct

Immunization, includingflu and pneumonia

shots

DIABETIC BENEFITS


68



Insulin

Needles & Syringes

Glucose Monitor


Insulin Pump















Specialty throughPrecision Rx

Yes YesAll plans

69


CONSUMERDIRECTED

PLANS

71 Continued on back

Nevada Consumer Directed Health Plans

Coinsurance Rx Coverage Hospital

Ded / 100% $2,500 $5,000100%$5,000$2,500100%

Out of Pocket Carrier-approved for sale

✓

Individual Family Individual Family Notes with HRA with HSA

Deductible

Ded / 100% $0 $3,000$6,000

See Below100%

$1,500$2,000$2,500$3,000$3,500$4,000$5,000

$3,000$4,000$5,000$6,000$7,000$8,000$10,000

✓

Ded / 80%

$3,000$4,000$5,000$6,000

$1,500$2,000$2,500$3,000

See Below80%

$1,500$2,000$2,500$3,000$3,500$4,000

$3,000$4,000$5,000$6,000$7,000$8,000

✓

Ded / 100% $3,000 $6,000100%$6,000$3,000100% ✓Ded / 100% $2,500 $5,000100%$5,000$2,500100% ✓

Allied Health SavingsAccount Plans

Ded / 100% $2,500 $5,000Ded / $15, $30, $50100% ✓

Anthem Blue Cross-LumenosHealth Savings Account Plans

HSA 1500

HSA 2000

HSA 3000

HSA 5000

$1,500 $3,000

Ded / 100% $3,000 $6,000Ded / $15, $30, $50100% ✓$2,000 $4,000

Ded / 100%

Ded / 80%

$4,000

$5,000

$8,000

$10,000

Ded / $15, $30, $50

Ded / 80%

100%

80%

✓$3,000

$3,000

$6,000

$6,000

Ded / 100% $3,000 $6,000Ded / $15, $30, $50100%

Anthem Blue Cross-LumenosHealth Incentive Account Plans

HIA Plus 2000

HIA Plus 3000

$2,000 $4,000

Ded / 100% $4,000 $8,000Ded / $15, $30, $50100% $3,000 $6,000

Aetna Compatible Plans

POS HSA

PPO HSA

$2,500 100%

$3,000 100%

$2,500 100%

Ded / 100% $0 $0Discount Only100%

$1,500$2,000$3,000$4,000$5,000

$3,000$4,000$6,000$8,000$10,000

✓

Ded / 90% $500 $1,000Discount Only90%

$1,500$2,000$3,000$4,000

$3,000$4,000$6,000$8,000

✓

Ded / 80% $1,000 $2,000Discount Only80%

$1,500$2,000$3,000$4,000

$3,000$4,000$6,000$8,000

✓

BEST HSA Compatible High Deductible Health Plans

Ded / 100% $5,800 $11,600Ded / $15, $30, $50100% ✓$5,000 $10,000

Options

Option 1

Generic

Option 2 $60$0Medical Deductible

Applies $0

BrandDeductible

PreferredBrand

Non-PreferredBrand

SpecialtyDrugs Available Plans

All HSA Plans

All HSA Plans

The following Rx options are available for the plans listed:

$50$10Medical Deductible

Applies $30 50%

50%

Ded / 100%See Rx Options

below100%

$2,000$4,000$6,000$8,000

$6,000$12,000$18,000$24,000

$1,500$2,000$3,000$4,000$5,000

$4,500$6,000$9,000$12,000$15,000

✓


below

$500$1,000$1,500$2,000$4,000$6,000$8,000

$1,500$3,000$4,500$6,000$12,000$18,000$24,000

$1,500$2,000$3,000$4,000$5,000

$4,500$6,000$9,000$12,000$15,000

✓90%

IAC Traditions PlanDeductible and coinsurance apply in or out-of-network*Out of pocket does not incude deductible




Deductible

72 Continued on next page




Deductible

$250 Copay -Ded / 80%

See Rx Optionsbelow

80%

$1,000$1,500$2,000$5,000

$3,000$4,500$6,000$15,000

$6,000$8,000$10,000

$12,000$16,000$20,000 ✓

IAC Advantage Plan (Out of Pocket varies.Please see Evidence of Coverage)

Ded / 100%See Rx Optionsbelow

100%

$1,150$1,500$2,000$2,500$3,000$4,000 $4,000$5,000$5,000

$2,300$3,000$4,000$5,000$6,000$7,000 $8,000$9,000$10,000 $0 $0

✓

IAC HDHP 100%Deductible and coinsurance apply in or out-of-network* Out of Pocket does not include deductible


80%

$1,150$1,500$2,000$2,500$3,000$4,000 $4,000$5,000$5,000

$2,300$3,000$4,000$5,000$6,000$7,000 $8,000$9,000$10,000 $1,500 $3,000

✓

✓

✓

IAC HDHP 80%Deductible and coinsurance apply in or out-of-network*Out of pocket does not include Deductible


100% $250$500

$500$1,000

$4,000$6,000$8,000

$8,000$12,000$16,000

✓IAC Daily Plan

100% of covered charges after $40 copay (or)100% of covered charges after deductible* Out of Pocket does not include deductible

Options

Option 1

Generic

Option 2 $60 $90$15

If no other Rx option is selected, the plan automatically includes the Rx Discount Only drug feature, providing discounts of up to 25% at ExpresScripts pharmacies. This option is a discounted program only and is not an insurance benefit.

$250 Calendar Year $45

BrandDeductible

PreferredBrand

Non-PreferredBrand


Option 3 $40 $50$10 None $25

Option 4

Traditions Plan, Advantage Plan, Saver Plan, Daily Plan, HDHP 100%, HDHP 80%



Traditions Plan, Advantage Plan, HDHP 100%, HDHP 80%

Coverage prescription drugs are paid the Same As Any Other Illness (SAAOI) under the health plan; subject to anyapplicable plan deductible or coinsurance.


Ded / 100% $0 $0See Below100% ✓Saint Mary's HDHP

Plan 9HD001

Plan 9HD011

Plan 9HD014

Plan 9HD024

Plan 9HD027

Plan 9HD041

$2,300 $4,600

Ded / 70% $2,700 $5,400See Below70% ✓$2,300 $4,600

Ded / 100% $0 $0See Below100% ✓$2,500 $5,000

Ded / 70% $5,000 $10,000See Below70% ✓$2,500 $5,000




Deductible

✓

✓

✓

✓Ded / 100% $0 $0See Below100% ✓$3,000 $6,000

Ded / 100% $0 $0See Below100% ✓$5,000 $10,000

✓✓

Options

Option 1

Generic

Option 2 $50$10 None $30

BrandDeductible

PreferredBrand

Non-PreferredBrand


Option 3 $60$10 None $40

Option 4

9HD001, 9HD011, 9HD014, 9HD024, 9HD027, 9HD041

9HD001, 9HD011, 9HD014, 9HD024, 9HD027, 9HD041

9HD001, 9HD011, 9HD014, 9HD024, 9HD027, 9HD041

9HD001, 9HD011, 9HD014, 9HD024, 9HD027, 9HD041


$40$5 None $20

Generic only$10 None Generic only


below

$500$1,000$1,500$2,000$4,000$6,000$8,000

$1,500$3,000$4,500$6,000$12,000$18,000$24,000

$1,500$2,000$3,000$4,000$5,000

$4,500$6,000$9,000$12,000$15,000 ✓

80%

IAC Traditions PlanDeductible and coinsurance apply in or out-of-network*Out of pocket does not incude deductible

$250 Copay -Ded / 80%

See Rx Optionsbelow100%

$1,000$1,500$2,000$5,000

$3,000$4,500$6,000$15,000

$4,000$6,000$8,000

$8,000$12,000$16,000

IAC Premium Advantage (Deductible and Outof Pocket varies. Please see Evidence of Coverage)

Deductible and coinsurance apply in or out-of-network* Out of Pocket does not include deductible

Deductible and coinsurance apply in or out-of-network* Out of Pocket does not include deductible

73

10801 West Charleston Blvd., #520, Las Vegas, NV 89135 | [email protected] Free 800.606.4996 or 702.577.9678 | Fax 800.700.6744 or 702.577.9684

Call Word & Brown today 800.606.4996




Deductible

70%

60%

Ded / 70%Discount only

$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓


$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓

$5,000$10,000$15,000

$10,000$20,000$30,000

$5,000$10,000$15,000

$10,000$20,000$30,000

Ded / 100%Discount only100%

$1,500$2,000$2,500$3,000$4,000$5,000

$3,000$4,000$5,000$6,000$8,000$10,000

$5,000$10,000$15,000

$10,000$20,000$30,000

✓


$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓


$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓

90%

80%

Starmark Consumer Health Advantage

$5,000$10,000$15,000

$10,000$20,000$30,000

$5,000$10,000$15,000

$10,000$20,000$30,000

✓

✓

✓

✓

✓

70%

100%

90%

80%

60%

Starmark Consumer Health Select


$1,500$2,000$2,500$3,000$4,000$5,000

$3,000$4,000$5,000$6,000$8,000$10,000

✓


$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓


$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓


$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓


$1,200$1,500$2,000$2,500$3,000$4,000$5,000

$2,400$3,000$4,000$5,000$6,000$8,000$10,000

✓

$5,000$10,000$15,000

$10,000$20,000$30,000

$5,000$10,000$15,000

$10,000$20,000$30,000

$5,000$10,000$15,000

$10,000$20,000$30,000

$5,000$10,000$15,000

$10,000$20,000$30,000

$5,000$10,000$15,000

$10,000$20,000$30,000

✓

✓

✓

✓

✓

74



Employer funded medical expensereimbursement plan for qualifying

medical expenses

Employer and/or Employee fundedaccount in the Employee’s name

(eligible individual) for current and future medical expenses – requires aHigh-deductible Health Plan and a

qualified trustee or custodian

DefinitionEmployee and/or employer

funded account for qualifying medical expenses

Any Size Group (Only common-law employees can

participate on a tax free basis.)

Any Size Employer(Only eligible individuals can

establish an HSA).Qualifications

Any Size Group(Only common-law employees

can participate.)

Contributions are Tax Deductible when paid tothe participant to reimburse an expense

Contributions are Tax Deductible in theyear the contribution is madeEmployer Tax Savings

Contributions are Tax Deductible whenpaid to the participant to reimburse anexpense. As a result of salary reductions,

lower adjusted Employee income reduces Employer matching FICA

& Federal Unemployment

An HRA is not subject to a minimum deductible. An HRA may be offered in

conjunction with high deductible healthplan; however, deductible amount

established by employer.

$1,200 min (single)$2,400 min (family)

Deductibles(2010)

A health FSA is not subject to a minimumdeductible. A health FSA may be offered inconjunction with a high deductible healthplan; however, the deductible amount is

established by Employer.

Employer Sets Funding Levels$5,950 min (single)

$11,900 min (family)Maximum Out-of-Pocket

(2010) Employer Sets Funding Levels

Employer Employer, Employee, and for any

other IndividualsSource of Funding Employer & Employee

Employer (unless benefits paid from a trust)

Employee (eligible individual name onthe established trust account)

Who Owns Unused Funds?

If funds attributable to employee pre-tax salary reductions, the plan owns

(if an ERISA plan)

Can be offered alone or in conjunctionwith a major medical plan.

Allows otherwise unreimbursed Code213(d) medical expenses including healthinsurance premiums. May not reimburse

expenses for qualified long term careservices. Employer may restrict scope of

reimbursements by plan design (many plans limit reimbursement to

deductibles, co-payments, coinsurance).

If participant also has an HSA, the HRAmust be limited to the following: qualifieddental expenses, vision expenses, expenses

constituting preventive care, Premiums,“suspended HRA”, and retiree only HRA.

Can only be established by those whohave qualifying high deductible healthplan coverage (deductible must meet

statutory limit) and no disqualifying non-high deductible health plan coverage.

Employees who are entitled to Medicarecannot establish or contribute to an HSA.

Allows otherwise unreimbursed medicalCode Section 213(d) expenses excluding

most premiums. An employer cannotrestrict the scope of HSA distributions

except for expenses paid with anelectronic payment card so long as account

beneficiary has other means to obtainfunds from HSA. Qualified expenses mustbe incurred after the HSA is established.

Allowable Expenses & Plan Restrictions

Can be offered alone or in conjunctionwith a major medical plan.

Allows otherwise unreimbursed Code213(d) medical expense excludingpremiums and qualified long term

care services.

Employer may restrict scope ofreimbursements by plan design.

If participant also has an HSA, the FSA must be limited to the following:qualified dental expenses, vision

expenses, and expenses constitutingpreventive care.

No (however, it may have a post-termination spend-down feature.)

Yes – funds belong to the Employee(eligible individual)Is Fund Portable? No

Yes YesPrescription Co-pay Yes

CONEXIS Insurance Co, Bank, TPAAdministration CONEXIS

Yes, if Employer specifies YesDo Funds Rollover?

No* – however, an employer may establish a graceperiod that follows the end of the plan year duringwhich unused amounts allocated to the FSA maybe used to reimburse eligible expenses incurredduring the grace period. The grace period may

not exceed two months and fifteen days.

Not required to prefund – uniformcoverage rule does not apply

Funds must be present before withdrawal is made. Employer may contribute to

HSA periodically or all at once.Funding Requirement

Uniform coverage rule applies – claims must be paid without regard to

amount contributed

NoTaxable and Subject to 10% Penalty

(no penalty if age 65 or older or disabled as defined by Code Section 72)

Non-medical ExpenseWithdrawals

No

Reimbursements for eligible expenses are excluded

from income

Contributions can be Pre-Tax or are TaxDeductible on the Employee’s personaltax return. Funds earn interest tax-free.Reimbursements for qualified medicalexpenses are excluded from income.Employee may withdraw funds for non-medical expenses subject to

income and excise tax.

Employee Tax SavingsContributions are made Pre-Tax.

Reimbursements for eligible expenses are excluded from income.

The information in this document represents a summary of the information only as of the date referenced below and does not constitute a guarantee of any benefit nor limit CONEXIS’ ability to requireadditional substantiation of a claim. Refer to the published IRS documents for specifics. Health FSAs and HRAs are covered under IRS Section 105 and 106. Health FSAs are subject to additional rules setforth in the regulations under IRS Code Section 125. HRAs are subject to additional rules set forth in Notice 2002-45 and Rev. Rul. 2002-41. HSAs were established under the Medicare Reform Package,covered under IRS Code Section 223.

* As part of the Tax Relief and Health Care Act of 2006, HSAs can now be funded with a one-time tax free rollover from an existing FSA or HRA (a "Qualified HSA Distribution") provided certain conditions are satisfied(this provision is effective upon enactment but expires January 1, 2012).

**Maximum contribution requires either full year eligibility or initial eligibility as of 12/01 and continuation of eligibility throughout the following year.

No – however, an employer may establish annual plan limits.

$3,050 max (single)$6,150 max (family)

$1,000 max (catch up contribution for individuals age 55 or over)

Maximum StatutoryContribution**

(2010)

No – however, an employer may establish annual plan limits.

HRAHealth Reimbursement Arrangement

HSAHealth Savings Account

FSAFlexible Spending Account


75



75

What Expenses Typically Qualify* Under An HRA, HSA, or FSA?

HRAs and Health FSAs are subject to Code Section 105 generally; therefore, only expenses that qualify as medical careunder Code Section 213(d) are eligible for reimbursement, subject to some additional restrictions:

• In accordance with Code Section 106, HRAs cannot reimburse expenses for qualified long term care services• In accordance with Code Section 106 and 125, Health FSAs cannot reimburse expenses for qualified long term

care services and/or insurance premiums

HSAs are subject to Code Section 223; therefore, only expenses that qualify as “medical care” under Code Section 213(d)are eligible for tax free reimbursement except as otherwise limited by Code Section 223:

• No insurance premiums except for long term care premiums, COBRA premiums, health coverage received whilereceiving unemployment compensation, and any deductible health insurance coverage for individuals who areage 65 or older, other than Medicare Supplemental Policies.

Medical Expenses:

Fees paid to the following providers for treatment of a specific disease:

■ Acupuncture■ Ambulance hire■ Artificial limbs and teeth■ Automobile modifications (hand

controls, special equipment, mechanicallifts if for handicapped persons)

■ Braille books & magazines■ Contact lenses & solutions■ Crutches/slings■ Doctor copays■ Examination, physical■ Eye examination

■ Eyeglasses■ Hearing devices■ Hospital bills for medical care■ Iron lungs, operating cost■ Laetrile, when prescribed by doctor■ Laser eye surgery■ Lip reading lessons for the

hearing impaired■ Eligible over-the-counter

(OTC) medications*■ Nursing care■ Obstetrical expenses

■ Operation■ Oxygen equipment■ Prescription drugs for medical care■ Rental of medical or healing equipment

(requires doctor’s note)■ Seeing-eye dogs■ Telephones for the hearing impaired■ Transportation expense relative to illness

(including doctor’s office)■ X-Rays

■ Chiropodist (expense)■ Chiropractor■ Clinic■ Dentist■ Doctor■ Gynecologist■ Hospital■ Laboratory■ Midwife■ Nurse

■ Obstetrician■ Oculist■ Ophthalmologist■ Optician■ Optometrist■ Oral Surgeon■ Osteopath■ Pediatrician■ Physician■ Physiotherapist

■ Podiatrist■ Practical nurse■ Psychiatrist■ Psychoanalyst■ Psychologist■ Psychopathologist■ Sanitarium■ Specialist■ Surgeon

Common expenses that are not eligible for reimbursement include: Cosmetic surgery for non-medical reasons (including liposuction, hair transplantsand electrolysis), weight loss programs (unless physician prescribed for treatment of a specific illness including obesity) and orthodontia services notreceived during the plan year.

FSA expenses must be incurred (i.e. services rendered) during the plan year.

Funds can be withdrawn from an HSA Account for other purposes; however, the withdrawal amount will be subject to taxes and penalties. Pleaseconsult your tax advisor.

*The information in this document represents a summary of information only and does not constitute a guarantee of any benefit nor limit CONEXIS’ability to require additional substantiation of a claim. Please refer to the plan summary that your Health Plan will provide for complete details onthe plan’s benefits, limitations and exclusions for your selected plan. For details concerning your rights and responsibilities with respect to your HSA(including information concerning the terms of eligibility, qualifying High Deductible Health Plan, contributions to the HSA, and distributions from theHSA), please refer to your HSA Custodial Agreement. OTC list available on request.

Qualified expenses must be for out-of-pocket medical care for the diagnosis, cure, mitigation, treatment or prevention ofdisease, or for the purpose of affecting any structure or function of the body.

76


Planning

During this phase, there is fact-finding and analysis betweenCONEXIS and the client toidentify past problems, currentissues, and future concerns andto gain an understanding of theobjectives of the implementationprocess.

IMPLEMENTATION PROJECT OVERVIEW

Phase IFACT FINDING

Executing

Phase IISYSTEM DEVELOPING

Monitoring & Controlling

Phase IIIAUDITING

Closing

Phase ITRANSITIONING

Objectives of Phase I of theImplementation Project are:

· Scheduling a kick-off call to introduce the partiesinvolved, their positions and titles, and theirresponsibilities in theimplementation process.

· Gathering information,which is a critical, on-goingpart of the implementationprocess.

· Understanding anddocumenting the businessrules that define and governthe business needs andrequirements of the client.

· Understanding what isneeded for system setup ofthe client.

· Setting a timeframe forweekly status calls toaddress issues that mayarise during the processand to make and documentdecisions about theprocess.

· Creating a project plan thatis updated throughout theprocess detailing tasks,responsibilities, dates, andmilestones.

During the phase, the BusinessRequirements gathered inPhase I are converted toSystem Requirements. Withanalysis complete, designing,constructing, and testing areperformed.

Objectives of Phase II of theImplementation Project are:

· Designing account structure(i.e., plans and rates forCOBRA; maximums andminimums for FSA) toensure consistency between the client, CONEXIS, and the carriers.

· Building account structurein system.

· Scheduling file specificationmeeting(s) between ITcontacts from CONEXISand client.

· Testing both inbound andoutbound eligibility datatransfer.

· Working with third parties asneeded

During this phase, the ProjectPlan is reviewed to ensure thatproject deliverables andmilestones have been met. Bothquantitative and qualitativemeasures are performed.

Objectives of Phase III of theImplementation Project are:

· Auditing by CONEXIS,which consists of threetollgates to ensure accuracyof information concerningbusiness rules, data, andfiles.

· Auditing by client, whichincludes sign-off of issues.

· Web site training.

Throughout the ImplementationProject, the AccountRepresentative is involved,taking part in meetings andcalls, gaining an understandingof the business rules defined bythe client. This ensures thattransition is as seamless aspossible.

Objectives of Phase IV of theImplementation Project are:

· “Going live” with productionsystem allowing webaccess for client andparticipants.

· Transitioning withinCONEXIS fromImplementation to ClientServices.

· Signing-off of project byinvolved parties.

· Reviewing lessons learned.

Note: This is intended as a high-level overview. As the project progresses and questions arise, the CONEXIS Implementation Team isavailable to answer any questions via telephone at (800) 869-6989, X 2400

77

DENTAL


78

DENTAL PLAN COMPARISON CHART

Are there anyindustries that are

ineligible?

Are there anyindustries that

receive an automaticrate load?

Do you offer Open Enrollment to DMO & DPOgroups at their

anniversary each year?

At Open Enrollment,do members have anyrestrictions (such asreduced benefits or a

waiting period)?

If yes, please providebrief explanation of

restriction:

Is there a waitingperiod for majorservices for newhires (includingEnrollees who

initially waived thewaiting period)?

Aetna Dental Yes Yes No N/A Yes

Allied National No Yes—see specialconsiderations

section on page 86for a complete listing

N/A N/A 12 month wait for major services

Anthem No No No No No

BEST Life & Health

Insurance

Yes Yes DMO:N/A

DPO:Yes

Yes—Groups with 2-4 enrolled will have

12 month wait.

5+ waived with priorcoverage.

10+ waivedautomatically

DMO:N/A

DPO:Yes—see answer

on left

Delta DentalSmall Business

Program(Contact

Word & Brown for quotes outside of this Program)

PPO:Yes—See SpecialConsiderations on

page 92

Yes—based on SIC code

PPO:Yes

DMO:N/A

Employer paid: No

Voluntary PPO:Yes—new

employees aresubject to a 12month waiting

period.

Employer paid:No

Voluntary PPO:Yes

Freedom Dental(BEN-E-LECT)

Yes—excludedindustries includedental offices or

other organizationsassociated with thedental profession

No Yes—all plan changes are

available at group anniversary

No 12 month wait for major benefits for late enrollees

and add-ons with no prior dental

plan. No waitingperiod for individuals

with prior dental

GroupLink, Inc. Yes—Dental services(dentist offices, etc)

are ineligible

Yes—based on SIC Code

Voluntary Dental has year round open

enrollment. Non-Voluntary

is open to new enrollees if the enrollee was on

previous plan. Waiting periods depend on plan being replaced

Restrictions may bewaived depending on ifcoverage with another

group plan is beingreplaced and what that

plan’s benefits are. New with no previouscoverage and turned

down coveragepreviously will have Late

Enrollee Penalty

Depends on plan sold. Word & Brown has

option to waive waitingperiods on most 5+groups. If enrollee

waived coverage, theywill have Late Entrant

Penalty or waitingperiods depending on

plan sold

79



Are there anyindustries that are

ineligible?

Are there anyindustries that

receive an automaticrate load?

Do you offer Open Enrollment to DMO & DPOgroups at their

anniversary each year?

At Open Enrollment,do members have anyrestrictions (such asreduced benefits or a

waiting period)?

If yes, please providebrief explanation of

restriction:

Is there a waitingperiod for majorservices for newhires (includingEnrollees who

initially waived thewaiting period)?


Corporation (IAC)

Yes—dentist offices are ineligible

Yes—see specialconsiderations

section on page 98for a complete listing

No New hires and employeeswithout proof of prior

dental plan receive Basiccoverage at 25% and

Major coverage at 10% forthe first year of coverage.Beginning with the secondyear of coverage, benefits

are as indicated inbrochure.

There is no waitingperiod for any services

except orthodontia.Please see page 98 fordetails and explanationof creditable coverage

conditions

MetLife Yes Yes DMO:N/A

DPO:Yes

No No waiting periodsfor major services for timely added

new hires

Principal LifeInsurance Company

Yes Yes DMO:Not available

DPO:Yes—removing the open

enrollment period isavailable. Contact your


Yes—If a member hasbeen enrolled in the

coverage before,voluntarily disenrolledand then enrolls again(even during the open

enrollment period), he/sheis subject to a late entrant

waiting period

DMO:Not available

DPO:No—waiting periods areoptional, however, and available upon request

through Request aQuote

Reliance Standard

Yes—Dentist Offices & Labs, AssociationGroups/MembershipOrgs/Fraternal Orgs,Trusts, and Unions

Yes—Jewelry-relatedBusinesses, AutomotiveDealers, Direct Selling

Businesses (House to House,Street Vendors, etc.),

Security/Commodity Dealers,Real Estate

Agents/Developers, BeautySalons, Funeral Services,Educational Services and

Carve-Out Groups

DMO:N/A

DPO:No

No Open Enrollment. Ifan insured is deemed a

Late Entrant, benefits arelimited to exams and

cleanings for adults andexams, cleanings, andfluoride treatment for

children for the first 12months

DMO:Not available

DPO:No—waiting periods areoptional, however, and available upon request

through Request aQuote

Saint Mary’sHealth Plans

No No No Yes—12 months onall major restorative

and orthodonticsunless 12 months ofcontinuous coverage

Yes—must have had12 months of

continuous coverage

SecureCare Dental Yes—dental offices and labs, companiesin business less than

12 months and 2person husband/wife

groups

Yes—contact your Word & Brownrepresentative

Yes No No—unless the planitself has a major

benefit wait

SelectDent Yes—dental offices No—however 10% load for groups with

no prior coverage

Yes—must meetparticipation

No No Waiting Period

Starmark No Yes Yes—deductiblewaiting period credit

will not apply

Yes Yes

80

Do any of your plans cover/include

a discount forimplants?

Do any of your plans

cover/include adiscount for teeth

whitening?

Are employees whoreside outside ofNevada eligible?

Any staterestrictions?

Are 1099employees eligible?

Out of NetworkClaim Adjudication

Aetna Dental No No Yes Yes MAC

Allied National No No Yes

No state restrictions

Yes UCR 80th Percentile(option to purchase

90th)

Anthem No No Yes


Yes HIA/UCR

BEST Life & Health

Insurance

DMO:N/A

DPO:Yes—in-networkdiscount applies

DMO:N/A

DPO:Yes—In-network discount applies

Yes


Yes Yes

Delta DentalSmall Business

Program(Contact

Word & Brown for quotes outside of this Program)

PPO:No—however, DeltaDental will pay forsome procedures

in lieu of.

PPO:No

Yes—see out-of-state coverage

on page 91

No Yes—PPO orPremier Plus Premier

(see page 92)

Freedom Dental(BEN-E-LECT)

No No Yes

Contact your Word & Brown

representative to determine any state

restrictions

Yes—if they work full-time for one

employer

2 Options:PPO Network

Allowance or

80th percentile of UCR

GroupLink, Inc. Yes—covered underMajor servicesautomatically

Contact your Word & Brownrepresentative

Contact your Word & Brownrepresentative

Yes UCR, PPO or MAC



81


Do any of your plans cover/include

a discount forimplants?

Do any of your plans

cover/include adiscount for teeth

whitening?

Are employees whoreside outside ofNevada eligible?

Any staterestrictions?

Are 1099employees eligible?

Out of NetworkClaim Adjudication


Corporation (IAC)

Yes—10% first year on Superior and

Economy. See Special

Considerationssection on page 98

for additional information

No Requires secondphysical office

location outside stateof domicile

Yes—see Definitionof Employee section

on page 7 ofProducer Guide

90th percentile

MetLife DMO:N/A

DPO:No

DMO:N/A

DPO:No

Yes—benefit levelsmay vary for

groups of 10+

2-9: No

10+: Contact yourWord & Brownrepresentative

2-9: 80% UCR

10+: Contact yourWord & Brownrepresentative

Principal LifeInsurance Company

DMO:Not available

DPO:No—but implant

coverage is available asa major service orthrough a separate

benefit rider

DMO:Not available

DPO:No—but coverage

for teeth whitening isavailable through a

separate benefit rider

Yes

Benefit and ratingrestrictions may

apply

No Contact your Word & Brown

representative for other percentiles

Reliance Standard

DMO:N/A

DPO:No

DMO:N/A

DPO:No

Yes


Yes The out of network claimallowance level depends onif the Managed Care Optionis quoted. If the Managed

Care Option is chosen, thenthe out of panel allowanceis MAC. If the Managed

Care Option is not chosen,then the out of panel

allowance is U & C 80th

Saint Mary’sHealth Plans

No No Yes Yes 90th percentile

SecureCare Dental No No Yes


Limited—contactyour Word & Brownrepresentative for

underwriting

UCR - 85th percentile

SelectDent Yes—on the Voluntary

Deluxe Plus

N/A YesNo state restrictions;

as long as the company is

based in Nevada itwill cover allemployees

Yes—as long as thecompany can show

that at least twoemployees are on

the payroll

Yes—80th percentile on the Deluxe and

Deluxe Plus

Starmark No No Yes—contactyour Word & Brown

representative

Yes—must notcomprise more

than 50%

80th percentile



NEVADA COVERAGE AREA

Nevada DMO Counties:

PRODUCTS OFFERED

Nevada PPO Counties:







83


Member Support 877-238-6200Prompt 1 for Dental Plan Member

Prompt 2 for Dental Care Provider

Commissions 877-249-2472


Claims ReimbursementAetnaP.O. Box 14094Lexington, KY 40512

All Counties

All Counties

HMO*Option 1 DMO® Access no OrthoOption 1 DMO® Access with Ortho

NOTE: Plans may not be available in all zip codes within a county. Check with your Word & Brown representative to confirm if coverage isavailable for your group location.

Yes

51%

All statesPlease refer to underwriting guidelines in the Aetna PlanGuide, or contact your Word & Brown representative

Out-of-state zip code

PPO

DE

NT

AL


DMO can be either sold as a standalone or packaged with any PPO option as aDual Option.

PPO can be sold standalone or packaged with the DMO as a Dual Option

Voluntary Dental plans cannot be sold or packaged with any other plan as DualOption offering.


HMO Network

PPO Network

Call your Word & Brown representative

Call your Word & Brown representative

PPO*Option 2 PPO 1000 Low no OrthoOption 3 PPO 1000 High no OrthoOption 3 PPO 1000 High with OrthoOption 4 PPO 1500 no OrthoOption 5 PPO 2000 no OrthoOption 6 Preventive CareSM PPO

PPO Out-of-StateOut-of-State PPO 1000 no OrthoOut-of-State PPO 1500 with OrthoOut-of-State PPO 2000 with OrthoOut-of-State Voluntary PPO 1000 with Ortho

* Available standalone to groups with 3 to 50 eligible employees.* All plans are available for employer-sponsored and voluntary.* Ortho only available to groups with 10 or more eligible and to dependent children only.

Nevada Indemnity Counties:N/A

84


Employees



Any ineligible industries?

Virgin groups eligible?

Wage & tax reports required?

Employees

For Dependents

% of Total Cost:

RATING INFORMATION

PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

EXCLUSIONS ALLOWED BY CARRIER:Hourly/Salary?Not allowed

Management/Non-management?Not allowed

Union/Non-union?Not allowed

Minimum group sizeN/A

CARVE OUTS*


ORTHODONTIC COVERAGE

WAITING PERIOD WAIVER/TAKEOVER


OUT OF NETWORK CLAIM ADJUDICATION


Group Size

Rate Guarantee



MINIMUMEMPLOYERCONTRIBUTION

2-50

2-50

12 Months

Yes

100%

No

Yes

Yes—if written standalone

Yes

Yes

Orthodontic coverage is included for groups 10 or more eligible employees and is available fordependent children only

2-3

Maximum Allowable Charge (MAC). Call your Word & Brownrepresentative for details.

4-50

75%

Dependents N/A N/A

50%

N/A

25%

Employees 100% 100%

Dependents N/A N/A

For Major and Ortho services, employees must beenrolled members of the plan for one year (N/A toDMO). Waiting period is waived separately forMajor and Otho for employees who were coveredby the group’s immediately preceding dental plan.Otherwise coverage waiting period for Major andOrtho is 12 months as an enrolled member.




Nevada HMO Counties:


PRODUCTS OFFERED


Nevada Indemnity Counties:





Are rates for Out-of-State employees based on the NVEmployer Zip code or based on Out-of-State Zip Code(and separate rates)?


85


N/A

N/A

All Counties

N/A Standard Base Indemnity** 2-99

N/A

N/A

* Employers may customize base plan benefits shown above by electing these plan options shown above (with rate factors as shown):$1500 annual maximum 1.10$2000 annual maximum 1.17$10 preventive and diagnostic copay .980 month basic services waiting period 1.22$50 deduct. (basic & major services combined) 1.06$100 lifetime deduct. (basic & major services combined) 1.02Endodontics/periodontics to Basic Svcs (10+ EEs only) 1.13Orthodontia $1500 max. benefit ($500/yr) 1.09†

90% U&C 1.04Child Sealants 1.11

No dual option available

NOTE: Plans may not be available in all zip codes within a county. Contact your Word & Brown representative to confirm if coverage isavailable for your group location.

Yes

Insureds can choose any dentist forservices without penalty. However avoluntary discount network using theAIG Dental Network SM is available.Voluntary use of a dentist in thisnetwork may help reduce co-insurance costs.

HMO Network

PPO Network

Indemnity Network

Member Support, Customer Service, & Commissions:Allied National 800-825-7531

BillingPremium DepartmentAllied NationalP. O. Box 29188Shawnee Mission, KS 66201-9188Ph. 800-825-7531 • Fax 913-945-4390

ClaimsUnited States Life Insurance Company P.O. Box 1581 Neptune, NJ 07754-1581 800-221-3480


General Fax #:913-945-4390

Prepaid/HMO Group Size

PPO Group Size

Indemnity Group Size

†Apply to ortho rates only

**Currently not quoting on our system

N/A

All states are allowed for Out-of-State employees as long asemployer is in an approved state. Allied National is notapproved in WA and NC

Indemnity plans only - with a nationwide passive PPO network

For any "multilocation" group, contact your Word & BrownRepresentative for proper rating. We will rate based on thelocations of the multiple employers offices or Out-of-Stateemployees (i.e. salespeople who work out of their home)

N/A

N/A

DE

NT

AL

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE


◆◆ In order to NOT be considered eligible, the other coveragemust be a group plan



Union/Non-union?

Minimum group size

CARVE OUTS*






Group Size

Rate Guarantee



86







If the group has had a comparable Indemnity/PPODental plan in force, employer may elect Takeover. If Takeover criteria is met and the employer elects it,employees and dependents currently covered by theemployer’s plan will get deductible and waitingperiod credit. Rate factor based on group size andplan design applies to groups with takeover.

Option–0 month Basic Services waiting period maybe elected by employer. Apply 1.22 factor to rates.

Indemnity Base Plans





NUCS 4072/NUCS 4073 statements required?

Yes

Yes

Yes

Same minimum group size for non-carve out group(see Products Offered section on previous page)

2-4

2-99

25%

N/A

N/A

2-99

1 Year

Yes

5-99

◆◆ 75%

◆◆ 50%

100%

100%

100%

50%

Pre-authorization required for all services over $300.

100% family-related groups are now eligible for coverage with a 20%rate load.

Plan administered by Allied National and underwritten by The UnitedStates Life Insurance Company of New York, a member company ofAmerican International Group, Inc.

The following Industries receive an automatic rate load:3843 Dental Equipment and Supplies5813 Drinking Places (Alcoholic Beverages)7929 Bands, Orchestras, Actors, and Other Entertainers and

Entertainment Groups8021 Offices and Clinics of Dentists8111 Legal Services8211 Elementary and Secondary Schools8299 Schools and Educational Services, NEC6531 Real Estate Agents and Managers7941 Professional Sports Clubs and Promoters8661 Religious Organizations8023 Orthodontists

No

Yes—as long as they work full-time and exclusivelyfor one employer. Must be approved by Allied priorto case submission.

No

Yes

Groups of 2-9: Yes 10+ groups: No

Two Usual & Customary options available:80th percentile of HIAA (base)90th percentile of HIAA (1.04 rate factor)

◆◆ 100%

◆◆ 100%** One employee may waive that doesn’t fit ◆◆ category.









Dependent children (under age 19) only. One time$50 deductible then 50% to $1000 lifetime max. perperson while insured. 12 month waiting period.

Option–$1500 lifetime max. per person ($500/year).Apply 1.09 factor to ortho rates only.






PRODUCTS OFFERED









87


N/A

All Counties

N/A

PPO Group SizeDental PPODental PPO Plus

2-502-50

Employer may offer one or all PPO plans Dental HMO Network

Dental PPO Network

Indemnity Network

N/A

Anthem Dental DDS - PPOAnthem Dental DDS - PPO Plus

N/A

Yes

51%

All states

All plans

NV employer zip code


Member Support877-833-5734Broker Support888-445-9236Fax (Adds/Terms)303-831-2399Commissions888-445-9236BillingAnthem Blue Cross and Blue Shield P.O. Box 541013 Los Angeles, CA 90054-1013877-833-5734Fax 303-831-2399Dental ClaimsAnthem DentalP.O. Box 9274Oxnard, CA 93031800-627-0004

DE

NT

AL

EmployeesDependents

EmployeesDependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE


◆◆ Creditable coverage includes group, individual, and other qualifying waivers by NRS 689C.053

◆◆◆ Non-contributory must be 100% participation with no waivers

CARVE OUTS*


DMO






Group Size

Rate Guarantee


Indemnity

Dual Option


88







with Medical2-50

2-50

12 Months

No

25% min. 2 enrolled

N/A

N/A

Standalone2-50

50%

N/A

N/A

with Medical2-50

75%N/A

Standalone2-50

50%N/A

100%0

100%0



Union/Associations?

Minimum group size

Yes—need two W-2, no more than 50% can be 1099

Same as above

No

Yes

Yes—if more than 3 months in business


Employer Sponsored: 12-month wait on all class III and class IVservices, waived for groups of 5 to 9 with comparablecoverage. For groups with 10 employee lives enrolling, Majorand Orthodontic Services waiting period is waived (includingtimely applicants). Late entrant provision does not apply during open enrollment.

N/A

Yes

Yes

Yes

5 (could be lower on specialty products. Contact yourWord & Brown representative)

PPOYes—down to 2 employees enrolled

N/A

Yes

None





Boxes containing a number indicate that these coordinate plans offered by this carrier can bewritten together to create a dual option package. The number indicates the minimumenrollment required on each of the coordinate plans. Blank boxes indicate which plans cannotbe written together


PRODUCTS OFFERED









89


PPO Network

N/A

See Diversified Dental Services, Inc. or www.ddsppo.com

All Counties

BEST PPO OptionDental(Offered only through Word & Brown)

2+ PPO HighPPO MidPPO Basic1

PPO Voluntary HighPPO Voluntary MidPPO Voluntary Basic1

2-1492-1492-1492-1492-1492-149

Indemnity HighIndemnity MidIndemnity Basic1

Voluntary Indemnity HighVoluntary Indemnity MidVoluntary Indemnity Basic1

2-1492-1492-1492-1492-1492-149

First Dental Health (CA only)www.firstdentalhealth.com

Diversified Dental Services(Nevada)www.ddsppo.com

Dentemax (National)www.dentemax.com





Basic

NOTE: Plans may not be available in all zip codes within a county.Contact your Word & Brown representative to confirm if coverage isavailable for your group location.

Group Size PPO Group Size Indemnity Group Size

Note: Custom Quotes available for groups of 150+. Contact your Word & Brown representative.1 Currently not quoted on the Word & Brown system. Contact your Word & Brown representative for more information.

BasicSTD/

STD OrthoStar/

Star PlusElite/

Elite Plus

STD/STD Ortho 2

2

Elite/Elite Plus 2

2

2

2

2

2

2

2

2

2

BEST Basic Voluntary1

BEST Basic15-993-99

Minimum of 2 employees must enroll on each plan. Voluntary plan not available for dual option.

BEST PPO OptionDental

Star/Star Plus

PPO High/Mid/Basic

PPO (All) Indemnity (All)

Indem High/Mid/Basic 5

5

Minimum 10 employees must enroll in order for group to be eligible for Dual Option. A minimumof 5 must enroll on either plan.

BEST PPO & Indemnity

5

5

2

2

2

Yes

There is no minimum, BEST Health Plans can blend rates fora multi-state group. Prefers at least 50% of the group in thestate where the business resides

All states allowed

BEST Health Plans can offer a dual option for groups over 10which would work well for a group with many employees outof state. The group could offer a PPO Plan in California andan Indemnity Plan for all Out-of-State employees

If the group had at least 50% of the employees in NV the groupwould most likely be based on the NV Employer Zip Code

N/A

DE

NT

AL

Yes—if group has a carve out in place with prior dental carrier

Yes—if group has carve out in place with prior dental carrier

No

Minimum of 10 employees enrolled as long as prior coverage exists with all 10 on dental carrier billing


Employer-sponsored PPO/Indemnity

RATING INFORMATION



Union/Associations?

Minimum group size

CARVE OUTS*




90






No

Yes

Yes

Yes

Yes—for groups enrolling less than 5 employees

Employer Sponsored: 12-month wait on all class III and class IVservices, waived for groups of 5 to 9 with comparablecoverage. For groups with 10 employee lives enrolling, Majorand Orthodontic Services waiting period is waived (includingtimely applicants). Late entrant provision does not apply during open enrollment.

Voluntary: For groups with five or more enrolled, Major andOrthodontic Services Waiting Period will be waived with 12months of continuous, comparable prior group coverage.

Optional Adult ortho available for groups with 25+employees enrolling on PPO or Indemnity. Adult ortho$1,000 max. Optional child ortho available for enrolleddependent children through age 20 on groups with 2+employees enrolled on PPO or Indemnity. $1,000 and $1,500Lifetime Max. available




Supplemental Dental Accident Benefit included in High andMid PPO and Indemnity plans—up to $1,000 per accident; andBasic—up to $500 per accident. Children’s Good Vision Benefit—Exam included in all PPO andIndemnity plans. 50% of eligible expenses, once every 12months, for children with ortho coverage. Amerisight-LASIKdiscount access plan available. 5% discount on dental bypurchasing vision.

Voluntary PPO and Indemnity:High or Mid Plans - Optional Child ortho available for groupswith 2+ employees enrolling on PPO or Indemnity. $1,000and $1,500 Lifetime Max. available

Basic Plans - Optional Child ortho available for enrolleddependent children through age 20 of groups with 2+employees enrolling on PPO or Indemnity. $1,000 and$1,500 Lifetime Max. available

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE





Group Size



EmployerSponsored 2+

50%

N/A

N/A

*Contributory: 2+ / Voluntary: 5+

N/A

N/A

N/A

◆ 60%

N/A

◆ 60%

N/A

5+

N/A

20%

N/A

Two options available:1 80th percentile of UCR (based on Ingenix data)

Word & Brown quote reflects this option

2 90th percentile of UCR (based on Ingenix data) - Apply a1.02 load to rates shown on Word & Brown quote

5+ 25+

Voluntary Plans5+

Yes

Min. 5 enrolled

100%

N/A

2-4

*$20 per month admin. fee for groups of 2-5

N/A

N/A

Rate Guarantee


1 year; 2 year guarantee available for:Employer contributory: available forgroups with 10+ enrolling and there willbe a 7% loadVoluntary: available for groups with 10-50enrolling and there will be an 8% load





Not available in Nevada


PRODUCTS OFFERED









PPO Network

91


Program AProgram BProgram CProgram D (In and out-of-network)

Program E (High and Low)

Program Vol 1Program Vol 2

PPO Plans

Not available in Nevada

All Counties

All Counties

Yes—PPO only 5-49 lives: no more than 25% out-of-state50-99 lives: no more than 10% out-of-state(25% if business locations are within situs state)100-299 lives: no more than 10% out-of-state

Delta Dental PPO Delta Dental Premier network

Customer Service, & Bilingual Support800-521-2651

Commissions & Broker Services415-989-7443

ClaimsDelta Dental Insurance CompanyP.O. Box 1809Alpharetta, GA 30023-1809


All states are allowed.

Rates are based on the Nevada employer zip code

The PPO plan design, chosen by the employer, covers theiremployees in all states. Employees have access to DeltaDental’s nationwide PPO and Premier Networks, which areamong the largest networks in the U.S.

No

90% or 75% depending on the group size (see above).

Delta Dental’s PPO plans are for groups with 5 to 299 employees. Employers can choose the out-of-network reimbursement, PPOor PPO Plus Premier. Orthodontic benefits are optional for all plans.

100/80/50%100/80/50%100/100/50%100/80/50% - 80/60/40%100/80/50% - 100/50/50%

100/80/50 100/80/50

Coinsurance

YesYesNoYesYes

YesYes

Waived for D&P

OTHER INFORMATION

Delta Dental is able to provide group proposals outside of the Small BusinessProgram. For more information contact your Word & Brown representative.

$50/$150$50/$150$25/$75$50/$150 (In and out-of-network)

$50/$150 (High)$75/$225 (Low)

$50/$150$50/$150

Calendar Year Deductible

$1000 or $1500$1000 or $1500$1000 or $1500$1000 or $1500$1000 or $1500 (H)$750 or $1000 (L)

$1000 or $1500$1000 or $1500

Calendar Year Maximum

DE

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RATING INFORMATION

MINIMUM EMPLOYER CONTRIBUTION& GROUP SIZE

CARVE OUTS*







Group Size

Rate Guarantee



92


Carve Outs are not available in the Small BusinessProgram in Nevada, but may be quoted outside theprogram. Contact your Word & Brownrepresentative for more information.

Are Commission-Only employees allowed?May be eligible if not paid via 1099 – Contact yourWord & Brown representative

Are 1099 employees allowed?No

Any ineligible industries?Non-voluntary: YesVoluntary: Yes

Virgin groups eligible?Yes

Wage & tax reports required?Employers must submit a copy of the group's quarterly wagestatement

Employer contributions of 0% to 49.9%, a minimum of 5 primaryemployees must enroll.Employer contributions of 50% to 74.9%, a minimum of 50% or5 primary employees, whichever is greater, must enroll. Employer contributions of 75% to 99.9%, a minimum of 75% or5 primary employees, whichever is greater, must enroll.100% employer contribution, all employees and their eligibledependents must enroll and the group must maintain a minimumenrollment of 5 primary enrollees.

5-299

1 Year

Non-voluntary PPO: YesVoluntary PPO: Yes

The employer can choose the out-of-network reimbursement:1) PPO - pays the lesser of the submitted charge or the PPO

provider's allowed fee.

2) PPO Plus Premier - pays the lesser of the submitted chargeor:a) PPO provider's allowed feeb) Premier provider's allowed feec) Non-contracted - The fee that satisfies the majority of

dentists of similar training in the same geographical area.

Orthodontic coverage is optional and available tochildren only in all Plans as follows:

Programs A-D: 50% Lifetime max. of $1000/$1500

Program E: High 50% - LTM $1000 or $1500

Vol 1 and Vol 2: 50% LTM $1000 (maximum isincluded in the annual maximum. $350 appliedtowards orthodontic maximums are also applied tothe calendar year maximum.)

No waiting period for plans where the employercontributes 50% or more of the employee premium.There is a 12-month waiting period on major andorthodontic services for plans where the employercontributes less than 50% of the employee premium.The waiting period is waived for initial enrollees andeligible dependents covered under the group's priordental plan. Discount plans and individual plans donot qualify as a prior group dental plan.

Transferring a group from an existing Delta Dental or prepaidHMO to Delta Dental’s small group program is not allowed.The following industries are ineligible for Delta Dental's SmallBusiness Program*: employment agencies/employee leasingfirms, amusement, recreation & entertainment, dentist offices,dental labs, legal, educational services/ /schools/libraries,community service organizations, associations, membershiporganizations and trusts, and jewelry repair.

* Ineligible industries, except dentists offices and dental labs,may be quoted through the home office. Please contactyour Word & Brown representative for more information.

◆◆ Those covered by another plan are NOT considered eligible in calculating participation.

PARTICIPATION & GROUP SIZEAll permanent full-time employees (as determined by theemployer) and their dependents are eligible to enroll within 30days following the employer’s eligibility waiting period.Employees and their dependents not enrolled when eligible mayenroll during the group’s annual open enrollment or within 30days of a qualifying event.





Employer may offer one plan from the ten plan offerings or may offer all tenplan options from which the employees may select.


PRODUCTS OFFERED









93


N/A

All Counties

NOTE: Plans may not be available in all zip codes within a county.Check with your Word & Brown representative to confirm if coverageis available for your group location.

Yes—available for out of state employees for AZ, CA,CO, ID, TX, and UT-based employers

No minimum

All are allowed

All

One rate based on employer location

None

N/A

Dental HMO Network

Dental PPO Network

Indemnity Network

N/A

First Dental HealthInterplan Health GroupDentemaxSafeguard DentalConnection Dental by PPO USA

UCR Plans Available

Calendar Year Max

Lifetime Deductible

Preventative

Basic

Endo/Perio

Major

Ortho

$750

$0

80%

80%

50%

50%

FreedomOne

$1,000

$0

100%

50%

50%

50%

FreedomTwo

$1,250

$0

100%

90%

50%

50%

FreedomThree

$1,500

$100

100%

80%

50% (2-9 lives)80% (10+ lives)

50%

FreedomFour

$2,000

$100

100%

80%

50%

FreedomFive

$2,500

$100

100%

80%

50%

50%

FreedomSix

None

$100

100%

80%

0%

FreedomSeven

$1,000

$0

1st $100

Next $500

Next $1,000

FreedomEight

$1,500

$0

1st $100

Next $1,000

Next $1,200

FreedomNine

$1,500

$0

1st $200

Next $1,000

Next $1,000

FreedomTen

50%$350 Annual$1000 Lifetime

100%

80%

50%

Office Visit Copay $20 $20 $20 $0 $0 $0 $0 $0 $0 $0

50%$350 Annual$1,000 Lifetime

For minordependents to age 19 and fulltime students to age 23





Minimum Group Size: 2 enrolled Six PPO Networks Two Out of Network Options Available

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50% (2-9 lives)80% (10+ lives)

50% (2-9 lives)80% (10+ lives)

Customer Service, Bilingual Support & Broker Services 888-886-7973


Claims Phone 888-886-7973 Fax 559-733-1314 Email [email protected]


Network ChangesPlease email request in writing to:[email protected]

Employees

Dependents

Employees

Dependents

Employees

For Dependents

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE



EXCLUSIONS ALLOWED BY CARRIER:Hourly/Salary?Yes

Management/Non-management?Yes

Union/Non-union?Yes

Minimum group sizeMust meet 75% participation rule

CARVE OUTS*







Group Size

Rate Guarantee



94



Are 1099 employees allowed?Yes—as long as they work full time, for one employer

Any ineligible industries?Yes—excluded industries include dental offices orother organizations associated with the dentalprofession

Virgin groups eligible?Yes—subject to a twelve month wait for major benefits

Wage & tax reports required?Yes

Employer Paid

Group

0-50% of the lowest priced plan

N/A

2-99

12 Months

Yes

Voluntary

Minimum 2

N/A

N/A

N/A

Minimum 2

N/A

2 Options:PPO Network Allowance or80th percentile of UCR

75%—Minimum 2

N/A

Voluntary

0 – 100%

N/A

Available on plans 4, 5 and 10 for dependent childrento age 19 (to age 23 for full time student).

Employer Paid: No waiting period for groups and add-ons with prior dental plans. Late enrollees andvirgin groups have a 12 month wait for major benefits

Voluntary: No waiting period for members withcomparable coverage. 12 month wait for majorbenefits for members with no prior coverage

Groups can elect to have additional waiting periodswaived for an additional fee of 10%

This is a fully insured product. No administration feeapplies.

Employer Sponsored: Employer may make one planavailable or all ten plans available as an option.

Voluntary: Minimum of 2 enrolled, no otherparticipation guidelines.

A $25 monthly billing fee will be added to theemployer’s invoice




The Word & Brown plan of benefits allows each employee to choose his or her planoption with no minimum %


PRODUCTS OFFERED







95


N/A

Availability varies by county

All Counties

PPO/Indemnity

Incentive

N/A

Yes

N/A

N/A

Indemnity and PPO are both offered

We base rates on employer location(s). If there are “at home”employees, we use their zip

Employers have choice of blended rates or providing rates per location (no blended rates on voluntary)

CA: First Dental HealthNV: Diversified Dental ServicesDenteMax & others around USA

Anywhere

Group Size




HMO Network

EPO/PPO Network

Indemnity

Super ValueEconomyPrimarySuperior

1-100+1-100+1-100+1-100+

EPO/PPO Group SizeFlexSelect 1-100+

1-100+

Customer Service, Bilingual Support,& Broker Services800-935-2009, ext. 4

Commissions 800-935-2009, ext. 6

Claims800-935-2009, ext. 2

Claims Fax317-578-7312


DE

NT

AL

Employees

Dependents

Employees

Dependents






Employees

For Dependents

% of Total Cost:

RATING INFORMATION

PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE





Union/Non-union?

Minimum group size

CARVE OUTS*







Group Size

Rate Guarantee


PPO & Indemnity


96


$1,000/$1,500/$2,000 lifetime maximum$500 annual50% coverage12 month waiting period

Yes

Yes

Yes

2 contributory5 voluntary

2-99

75% participation on 2-4 lives

N/A

No employer requirement. 5+ requires 75% participation

2-99 and One Life100+ are rated in home office

1 or 2 Years

Yes

1) 2-4 eligible lives requires 75% participation ofemployees. No requirement on dependents. No waivers accepted.

2) Voluntary 5+ eligible lives requires 5 employee lives.No requirement on dependents. Waivers accepted ifat least 50% of total eligible enroll.

3) Employer-paid 5+ eligible lives require 75%enrolled. No requirement on dependents. Waivers accepted.

Multiple plan options available to employees fromemployers

Done at GroupLink

2-4 lives - 75% participation*

N/A

5 lives

N/A

Varies by plan selected as to coverage waived forprior coverage

*See special considerations section at bottom of page

Yes

Yes

Yes—dental providers

Yes

No


2-99GROUP SIZE

5+






PRODUCTS OFFERED









PPO Network

97


Customer Service, Bilingual Support,& Broker Services800-518-4510


Claims800-935-2009


N/A

N/A

Statewide

Indemnity IAC Dental AdvantageValueEconomySuperior

Diversified Dental Services: NVN/A

Yes—if PPO network is available in the area



Both

Composite rating

See plan certificate

DE

NT

AL

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

EXCLUSIONS ALLOWED BY CARRIER:Hourly/Salary?Hourly minimum of 30 hours

Management/Non-management?Management

Union/Non-union?Yes—the employees to be covered must be clearlyidentified by collective bargaining agreement

Minimum group size2

CARVE OUTS*







Group Size

Rate Guarantee


Indemnity


98







Superior Plan Indemnity

2-4

100%

2-50

12 Months

Yes

No


Yes—dentist offices are ineligible

Yes

Yes

Services received from an out-of-network dentist aresubject to the MAC. However if the out-of-networkdentist charges more than the MAC, the insured isresponsible for the balance.

75%

0%

Benefit Waiting Period and Takeover Credit - There is nowaiting period for any services except orthodontia. Aninsured person who had creditable coverage under theemployer’s group dental plan on the day immediately prior tothat employer’s effective date under the Group Dental Planwill have no waiting period for any services, excludingorthodontia. Employees are eligible for second year levelbenefits for Basic and Major services if they are enrolled onthe employer’s prior dental plan or another group policy onthe day immediately preceding the effective date of thisPolicy. This also applies to new hires and add-on employeesafter the Policy is in effect for groups of 10 or more coveredemployees only.

5+

50%

0-25%

100%

100%

Package 1—Coverage provided for implants and veneers. Value:Discount; Economy: 1st year- 10%/2nd year-40%; Superior andSuperior Indemnity: 1st year - 10%/2nd year - 50%

Package 2—Treat Endodontics and Periodontics as basic ratherthan major services. Economy, Superior and Superior Indemnityplans only.

Package 3—Orthodontia (dependents under 19). See above forbenefit. Economy plan only.

Package 4—Waiver of the $100 deductible forPrev/Diag/Basic/Major services. Economy, Superior and SuperiorIndemnity plans only

Industry LoadThe following have an industry load factor of 1.20:8200 Services-Educational Services8300 Services-Social Services8351 Services-Child Day Care Services8600 Services-Membership organizations8700 Services-Engineering, Accounting, Research, Management8711 Services-Engineering Services8731 Services-Commercial Physical & Biological Research8734 Services-Testing Laboratories8741 Services-Management Services8742 Services-Management Consulting Services8744 Services-Facilities Support Management Services8880 American Depositary Receipts8888 Foreign Governments8900 Services-Services, NEC9721 International Affairs9995 Non-Operating Establishments






PRODUCTS OFFERED









HMO Network

PPO Network

Indemnity Network

99


DE

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Plan 1

Plan 2

Plan 3

N/A

No minimum

PPO Plans

100/80/50%

100/80/50%

1st year - 100/80/252nd year - 100/80/50

Coinsurance

$50/$150

$50/$150

$50/$150$150/$150

Deductible

2-4 $10005-9 $1000 or $1500

2-4 $10005-9 $1000 or $1500

2-4 $10005-9 $1000 or $1500

Calendar Year Max.

Member Services800-275-4638

[email protected]

ClaimsMetLife Dental ClaimsP.O. Box 981282El Paso, TX 79998888-466-8673

Add-ons/DeletesFax 888-505-7446

Yes

All states are allowed

PPO with state variations



All Counties

N/A

N/A

N/A

N/A

MetLife DentalVisit www.metlife.com

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE





Union/Non-union?

Minimum group size

CARVE OUTS*







Group Size

Rate Guarantee



100







Not available

Not allowed

Not allowed

Not allowed

Not allowed

2-9

2-9

Plans 1 & 2: 1 yearPlan 3: 2 years

Yes



Yes



2-9: 80% UCR10+: Contact your Word & Brown representative

Plans 1 & 2 - takeover not available to groups with noprior major services coverage

Plan 3 - New groups - takeover groups discount rateswith 3%

2-9

25%

N/A

25%

Employees

Dependents

75%

100%

101






PRODUCTS OFFERED


PPO Network

Indemnity Network



All counties

N/A

Diversified Dental Services-Las Vegas

Diversified Dental Services-Reno

The Principal Plan Dental

N/A

Customer & Broker Services949-553-1616

Adds/TermsFax 949-553-1898


BOR ChangesFax 515-235-5538

Claims800-247-4695







Yes—contact your Word & Brown representative


All states available through Request-a-Quote. Contact your Word & Brown representative

PPO & Indemnity—contact your Word & Brown representative



DE

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Principal Dental Series II (PDS II)Group SizePPO

3-150


50th percentile60th percentile70th percentile75th percentile80th percentile

85th percentile 90th percentile95th percentile99th percentile


Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


GROUP SIZE



Union/Non-union?

Minimum group size

CARVE OUTS*







102







Yes

Yes

Yes

10 enrolled lives

Yes

No

Yes

Yes

No

Dental - 10 enrolled lives for child ortho, 25 lives foradult or adult/child ortho

Voluntary Dental – Contact your Word & Brown representative

Benefit Waiting Period will not apply to Preventativeservices. You may elect a benefit waiting period forBasic services, Major services and Additional BenefitRiders.

25%

N/A

GROUP SIZE

Employees

For Dependents

% of Total Cost:


Contributory

Voluntary

GROUP SIZEPARTICIPATION

75%

50%

Employees

Dependents

100%

0%

N/A

Non-contributory

50–99%

0%

N/A

Contributory

0-49%

0%

N/A

Voluntary

Employees

Dependents

100%

50%

Non-Contributory

Group Size

Rate Guarantee


3-150 employer paid 10-150 voluntary

Voluntary w/o prior<20 lives: 1 year>20 lives: 1 or 2 year

Dental or Vol w/prior<10 lives: 1 year>10 lives: 1 or 2 year

Yes

3-150 employer paid10-150 voluntary

3-150 employer paid10-150 voluntary

1. For Retiree coverage, please contact your Word & Brown representative.

2. Annual enrollment period options are available.

3. Domestic Partner coverage is available.

4. Additional Benefit Riders are available.

5. For groups over 150 lives, please contact your Word & Brown representative.

6. 3 & 4 life groups must quote 2 or more coverages.

7 Voluntary coverage is not available for groups under 10 lives.






PRODUCTS OFFERED









HMO Network

PPO Network

103


Member Support,Customer Service, Commissions800-659-2223, ext. 0-82149

ClaimsP.O. Box 82510Lincoln, NE 68501800-497-7044


N/A

N/A

All Counties

Indemnity3-19*

N/A

Yes

No minimum

All states allowed

Indemnity with nationwide passive PPO

Rates are based on the firm’s home office (i.e. wherebilled)

No

Ameritas PPO

Group Size

N/A

Plan A: 100/80/50$1000 max., $50 deductible (3 per family)Vision Care option available

Plan B: 100/80-90/100 step-up in Basic/50$1500 max., $50 deductible (3 per family)Ortho benefit (all insureds)Vision Care option available * Large Group available upon request

DE

NT

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Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE





Union/Non-union?

Minimum group size

CARVE OUTS*







Group Size

Rate Guarantee



104







All insureds eligible. 50% to $1000 lifetime benefitwith a 24 month elimination period.

Yes

Yes

Yes

Down to 3 insured employees

3-19

25% of the total

cost

3-19

2 Years

No, some loaded industries considered higher risk

Yes

Yes

Yes

Yes

No

Indemnity:Insureds can choose any dentist with 90% of dentists in-network. Reimbursement outside of network is 80% ofUCR. Maximum Allowable Charge (MAC) option available for plans A and B and pays out-of-network dentist basedon Reliance Standard negotiated fee.

Groups of 3-5 eligible employees: 100%Groups of 6-9 eligible employees: all but one

Groups of 10-19 eligible employees: 75%

100% of eligible employees

12 month Basic Services elimination period waivedand credit given for calendar year deductibles paidfor groups that had a similar coverage in force for atleast 18 months prior to effective date. A rate factorof 10% is applied to takeover groups.

3-19






Customer Service, Bilingual Support,& Broker Services 800-863-7515



ClaimsSaint Mary’s Health PlansClaims/Member Services1510 Meadow Wood LaneReno, NV 89502

PRODUCTS OFFERED








HMO Network

PPO Network

Indemnity Network

105


DE

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Dental Rider Plan 1Dental Rider Plan 2Dental Rider Plan 3

Group SizePPO

2+2+2+

N/A

Diversified Dental Serviceswww.ddsppo.com

N/A

Must be sold with medical HMO

Must be sold with medical PPO

Nevada Indemnity Counties:N/A

Yes

75%

N/A

Yes

Out-of-State Zip code

N/A

N/A

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE





Union/Non-union?

Minimum group size

CARVE OUTS*


DMO






Group Size

Rate Guarantee


DPO

Indemnity

Dual Option


106







None

None

None

None

2

12 months

No

No

Yes

No

Yes

Yes

90th percentile

12 months on all major restorative and orthodonticsunless 12 months of continuous coverage

None

N/A

N/A

N/A

2-50

100%

N/A

100%

N/A

Yes

Yes

Yes

Yes






PRODUCTS OFFERED









HMO Network

PPO Network

Indemnity Network

107


N/A

Las Vegas and Henderson

Las Vegas and Henderson

The Copay Plan- Scheduled PPO (MAC)- No annual maximums- No network waiting periods- No deductibles (employer sponsored)

The PPO Plan- Annual maximums ($1,000, $1,500, $2,000)- UCR out of network reimbursement

The Indemnity Plan- Annual maximums ($1,000, $1,500, $2,000)- See any dentist- UCR out of network reimbursement

Custom plans for large groups available through Word & Brown

N/A

Yes—for all plans including The Copay Plan. Employeesout-of-state enroll on the same Copay Plan as employeesin Nevada and pay the same copays.

51%

All states allowed

The Copay Plan, The PPO Plan, The Indemnity Plan;National PPO Network available in states outside Nevada

Employer zip code

No

Southwest PreferredDental Organization

Yes—groups of 5+

Customer Service, BilingualSupport & Broker Services888-429-0914

Commissions602-241-0914 x2504

Claims602-241-0914 x2505


Southwest PreferredDental Organization

National NetworkDenteMax

DE

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The Copay Plans have no in-network waiting periods.

The PPO and Indemnity employer sponsored plans do nothave waiting periods.

For plans with waiting periods insureds received month-to-month prior coverage credit for satisfaction of waiting periodmet under employer’s prior qualifying group dental plan


Hourly/Salary?Yes


Union/Non-union?Yes

Minimum group size2

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE



CARVE OUTS*


PPO & Indemnity







108



Are 1099 employees allowed?Yes—as long as they work full-time and exclusively for the group

Any ineligible industries?Yes

Virgin groups eligible?Yes—12 months in business

Wage & tax reports required?State

ER Sponsored5+

N/A

2-50*

12 months

No

85th percentile

75%

N/A

5+

50%

N/A

N/A

N/A

All plans include a scheduled (discounted) orthodonticbenefit for adults and children.

Insured orthodontia also available to 10 or more enrolledemployees:

Child only$1,000 lifetime maximum$500 annual50% coverage12 month waiting period

Voluntary2+

N/A

N/A

N/A

* 51 or more - Large group available upon request. Please contactyour Word & Brown Representative for details.

Group Size

Rate Guarantee


* Employer sponsored groups may also contribute 100% of theemployee only cost of The Copay Plan and employees can buyup to The PPO Plan and/or The Indemnity Plan.

Benefit Highlights

- Flexible Triple and Dual choice plans for groups of 5 or more enrolled

- White fillings on molars are standard- Endo & Perio in Basic or Major- 4 cleanings with perio surgery is standard- No age limit on pediatric care- No 6 month limit on cleaning frequency- Missing teeth covered after 36 months

Annual open enrollment for all plans

Monthly administrative fees per group:Groups with 2-24 insured: $15.00 per monthGroups with 25-49 insured: $20.00 per monthGroups with 50+ insured: $30.00 per monthAll PEOs Groups (Employee leasing companies): $50.00 per month

109






Boxes containing a number indicate that these coordinate plans offered by this carrier can bewritten together to create a dual option package. The number indicates the minimum enroll-ment required on each of the coordinate plans. Blank boxes indicate which plans cannot bewritten together


PRODUCTS OFFERED









HMO Network

Indemnity Network

N/A3-993-993-99

3-993-993-99

N/A

DiversifiedSilver

Gold *

SelectDent Group Silver PlanGold PlanPlatinum Plan

SelectDent Voluntary Standard PlanDeluxe PlanDeluxe Plus

N/A

N/A

All Counties

N/A

Yes—available for out of state employees of Nevadabased companies

Platinum *Standard *Deluxe *

HMO Group Size

PPO Group Size*

Indemnity Group Size

* Groups of 100+ — contact your Word & Brown representative for a custom quote

Silver Gold Platinum Standard Deluxe

UCR Plans Available

* All plans require three eligible employees with at least three enrolling in Voluntary and at least 75% enrolling in Group plan

Group Plans Voluntary Group Plans

Customer Service & Bilingual Support866-545-4500

Websitewww.healthedgeinc.comwww.healthedgeonline.com (user ID needed)

Broker Sales & Commissions866-616-4888 [email protected]

Claims and EligibilityHealthEdge Administrators, Inc.PO Box 11210Bakersfield, CA 93389866-545-4500Fax 661-616-4850


Nevada Employer Zip

Deluxe/Deluxe Plus (UCR)

PPO Network

50%

All None

Deluxe Plus

Deluxe Plus *

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

* * * * *

Contact your Word & Brown representative to confirm if coverage is available foryour group location.

DE

NT

AL






110



No Waiting Periods on any plans effective 04/01/07

No

Yes—as long as they work full-time and exclusivelyfor one employer. Must be approved by HealthEdgeprior to case submission

Yes

Yes

No (but we reserve the right to request one)

Employees

Dependents

Employees

Dependents

RATING INFORMATION

PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE

◆ Those covered by another plan are NOT considered eligible in calculating participation. In order to NOT be considered eligible, the other coverage must be a group plan



Union/Non-union?Yes

Minimum group sizeGroup Plan: 3 active employees with at least 75%enrolling

Voluntary Plan: 3 active employees with at leastthree enrolling

CARVE OUTS*

HMO






Group Size

Rate Guarantee

Renewals


PPO

Voluntary


3-99

12 Months

12 Months

No

SelectDent Voluntary Deluxe and Deluxe Plus:Out of Network claims paid at 80th percentile ofIngenix MDR

SelectDent Silver, Gold, Platinum & Standard:Out of Network claims based on the PPO FeeSchedule

N/A

Group

0%-50% of the lowest premium

N/A

N/A

Voluntary

0%-100%

N/A

N/A

Dependent children to age 19 (to age 23 for full timestudent). Services paid at 50% to a lifetime maximum of$1000 on Gold Plan ($350 cym) or $1500 on Platinum Plan($500 cym).

Group Voluntary

Min. 3

◆100%

N/A

◆3 Life

N/A

Min. 3

◆75%

N/A

◆3 Life

N/A

Deluxe ($400 cym) & Deluxe Plus ($700 cym).

Employees

For Dependents

% of Total Cost:


IndemnityDental PPO Plan Group (Gold & Platinum) UCR availableVoluntary (Deluxe & Deluxe +)


1) Three life groups with related employees require home office approval

2) Husband/Wife groups require a minimum of four to enroll

3) 5% discount when enrolling in dental and vision together






Customer Service, Bilingual Support,& Broker Services800-522-1246, option 7

Commissions 800-522-1246, [email protected] 847-615-3955

ClaimsP.O. Box 2980Clinton, IA 52733-2980


PRODUCTS OFFERED









HMO Network

PPO Network

Indemnity Network

111


N/A

Aetna Dental Administrators

Indemnity A - 5 or more insured employees, standaloneIndemnity B - 2 or more insured employees

PPO A - 5 or more insured employees, standalonePPO B - 2 or more insured employees

N/A

All counties

All counties

Yes

Passive Dental PPO with AetnaDental Administrators

Employer zip code

Indemnity

51%

All states are allowedNo

N/A

DE

NT

AL

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE





Union/Non-union?

Minimum group size

CARVE OUTS*


HMO






Group Size

Rate Guarantee


PPO


112







Yes

Yes

Yes

2

2-99

1 year

Yes

Yes

Yes

No

Yes

Yes

80th percentile

Upon receipt of proof, credit will be given for anywaiting period satisfied under the group’s priordental plan that was in effect immediately prior to the effective date of the Starmark plan.

2-99

50%

N/A

N/A

2-99

75%

0

N/A

N/A

N/A

A - Optional

INDEMNITY

A - Optional

113

VISION



PRODUCTS OFFERED







115



Nevada Prepaid HMO Counties:



N/A

N/A

All

2-50Blue ViewBlue View Plus

Yes

51%

All

All plans - PPO

NV Employer Zip Code


Member Support877-833-5734Broker Support888-445-9236Fax (Adds/Terms)303-831-2399Commissions888-445-9236BillingAnthem Blue Cross and Blue Shield P.O. Box 541013 Los Angeles, CA 90054-1013877-833-5734Fax 303-831-2399Vision Claims (out-of-network only)Blue View VisionAttn: OON ClaimsP.O. Box 8504Mason, OH 45040-7111866-723-0515


VI

SI

ON

Employees

Dependents

Employees

Dependents





Wage & tax reportstatements required?

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE


◆◆ Creditable coverage includes group, individual, and other qualifying waivers by NRS 689C.053



Union/Non-union?

Minimum group size

CARVE OUTS*






Group Size

Rate Guarantee



116


2-50

2-50

12 Months

No

50%

N/A

N/A

2-50

75%

Yes

Yes

Yes

5 (could be lower on specialty products. Contactyour Word & Brown representative)






Yes—need two W-2’s, no more than 50% and 1099

Same as above

No

Yes

Yes—if more than 3 months in business





PRODUCTS OFFERED

Nevada Vision Indemnity Counties:







Indemnity Network

117


Outlook Vision Services (National)www.outlookvision.com

The BEST Life Stand Alone Vision plans are available either as stand alonefor groups with 5 or more employees enrolling, or bundled with anotherBEST Life product for groups with 2 or more employees enrolling.

All counties

There is no minimum

Yes—BEST Life's Vision Indemnity plan is available to allstates in the country

There are no restrictions on which states can receive out-of-state coverage. BEST Life's Stand Alone Vision plan is available to all states within the country

Out-of-State employees can enroll on the Stand AloneVision plan, which is an Indemnity plan availablethroughout the United States.

Rates are based on the NV Employer Zip code

None

PlanExam/Lenses/Frames/ContactsPlan A 12/12/12/12 monthsPlan B 12/12/24/12 monthsPlan C12/12/24/24 monthsPlan D12/24/24/24 monthsPlans come with the choice of $0, $10 or $25 deductible, and contact lenses maybe covered in lieu of frames and lenses or in addition to frames and lenses.






VI

SI

ON

Employees

Dependents

Employees

Dependents






Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE



Union/Non-union?

Minimum group size

CARVE OUTS*






Group Size

Rate Guarantee



118


EmployerSponsored 5+

50%

N/A

N/A

Bundled: 2+, Stand alone: 5+

0%

N/A

N/A

Claims payments are based on a per service maximum

Voluntary Plans5+

Yes

60% participation of eligible employees. On groupswhere employer contributes 100% requires 100%

participation of eligible employees.

5+

1 year

N/A

20% participation of eligible employees

N/A

Yes—if group has a carve out in place with prior vision carrier

Yes—if group has a carve out in place with prior vision carrier

No

Minimum of 10 employees or more enrolling, if previously insured this way

There are no waiting periods for BEST Life's StandAlone Vision plan

No

These employees are not eligible unless written with medical

No

Yes

Yes—for groups enrolling less than 5 employees

119


The Camden Insurance AgencyVision Plan of AmericaAn affiliate of



Avesis Nevada Insured Vision Plan Counties:

PRODUCTS OFFERED








Avesiswww.avesis.comPlan #905

Plan A -12/12/12/12

Exam - each 12 months

S/V, B/F, T/F lenses - each 12 months

Frames - up to $150 retail ($50 wholesale) - each 12 months

Contact lenses - $130 each 12 months in lieu of materials

Progressive Lenses - each 12 months -20% off UCR + $50 credit

All Counties

N/A

Minimum 5 enrolled for employer-paidMinimum 10 enrolled for voluntary

Yes—nationally

All states covered

Insured Vision Plan only

Single rate for all areas

Employer paid groups: minimum employer contribution of75% or 50% if tied to medical

Avesis Insured Vision Plan: In-networkPlan B -12/12/24/12




Contact lenses - $130 in lieu of materials

Progressive Lenses - each 12 months -20% off UCR + $50 credit.

Plan C -12/24/24/24




Contact lenses - $130 each 24 monthsin lieu of materials

Progressive Lenses - each 24 months -20% off UCR + $50 credit

Insured Vision Plan Network

Indemnity Network

Exam: $45

SPECTACLE LENSES:Standard Single Vision $ 35.00Standard Bifocal $ 45.00Standard Trifocal $ 55.00Standard Lenticular $ 120.00Progressive $ 45.00Specialty Lenses Corresponding Standard Lens reimbursement

FRAME: $40.00

CONTACT LENSES:Elective $ 130.00Medically Necessary: $ 250.00

All reimbursement amounts listed above are up to the posted dollar amount.

LASIK:$150 plus 25% (In-network)$150 in lieu of all other services (Out-of-Network)

Avesis Insured Vision Plan: Out-of-network


The Avesis Insured Vision Plan is brought to you by CamdenInsurance, an affiliate of Vision Plan of America, and isunderwritten by Fidelity Security Life. Policy #VC-16; Form M9059

N/A

VI

SI

ON

Camden Broker Services 213-616-0640

Commissions 213-616-06403255 Wilshire Blvd., #1610Los Angeles, CA 90010

Avesis Claims/Member Services 800-522-0258

Avesis Eligibility Dept.-Adds/Terms Fax 213-384-0084

Avesis Customer Care Department Fax 866-871-1632

120


The Camden Insurance AgencyVision Plan of AmericaAn affiliate of

Employees

Dependents

Employees

Dependents






Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE



Union/Non-union?

Minimum group size

CARVE OUTS*






Group Size

Rate Guarantee



N/A

N/A

N/A

5 - employer-paid10 - voluntary

75% of employer-paid or 50% if tied to medical

0% for voluntary


N/A


N/A

No

No

No

Yes

No

5+ employer-paid10+ voluntary

5+ employer-paid10+ voluntary

Each 15 days

10+ voluntary

No waiting periodsNo pre-approvals*

*Except for medically necessary contact lenses

No

5+ employer-paid

2 years

Limitations: This plan is designed to cover eyeexaminations and corrective eyewear. It is alsodesigned to cover visual needs rather than cosmeticoptions. Should the member select options that are notcovered under the plan, as shown in the schedule ofbenefits, the member will pay a discounted fee to theparticipating Avesis provider. Benefits are payable onlyfor services received while the group and individualmember's coverage is in force.

Exclusions: There are no benefits under the plan forprofessional services or materials connected with andarising from: 1) Orthoptics of vision training; 2)Subnormal vision aids and any supplemental testing;3) Plano (non-prescrlption) lenses, sunglasses; 4) Twopair of glasses in lieu of bifocal lenses; 5) Any medicalor surgical treatment of eye or support structures; 6)Replacement of lost or broken lenses, contact lensesor frames, except when the member is normallyeligible for services; 7) Any eye examination orcorrective eyewear required by an employer as acondition of employment; 8) Services or materialsprovided as a result of Workers Compensation Law, orsimilar legislation, required by any governmentalagency whether Federal, State or subdivision thereof.



PRODUCTS OFFERED







HMO Network

PPO Network

Indemnity Network

121






All counties. Discounts provided for non-member providers

N/A

N/A

Non-voluntary-100%; Modified voluntary-75%; Voluntary-no requirements

EyeMed provider

Varies; depends where group plans are available; see stateavailability chart

N/A

Employer

See multi-location guidelines

Customer Service, Bilingual Support,& Broker Services800-518-4510


Claims866-939-3633


EyeMed

N/A

N/A

HMOAdvantage Vision

VI

SI

ON

122


Employees

Dependents

Employees

Dependents






Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE



Union/Non-union?

Minimum group size

CARVE OUTS*






Group Size

Rate Guarantee



N/A

Hourly minimum of 30 hours

Management

Yes—the employees to be covered must be clearlyidentified by collective bargaining agreement

2

2-4

100%

2-50

12 Months

Yes

No


See guidelines

Yes

Yes

Plan Limitations/Exclusions■ Orthoptic vision training, subnormal vision aids, and any

associated supplemental testing■ Medical and/or surgical treatment of the eye, eyes, or supporting

structures■ Corrective eyewear required by an employer as a condition of

employment■ Services provided as a result of any Worker's Compensation law,

or similar legislation, or required by any governmental agency orprogram whether federal, state or subdivisions thereof

■ Plano non-prescription lenses and non-prescription sunglasses(except for 20% discount)

■ Services or materials provided by any other group benefitproviding for vision care

Secondary Purchase DiscountAdditional Savings After You’ve Exhausted Your Plan’s Annual Benefits!■ Members may utilize this discount once the initial plan has been

exhausted■ The Secondary Purchase Discount is included at no additional cost■ Members will receive a 20% discount on remaining balance at

participating providers beyond plan coverage, which may not becombined with other discounts or promotional offers, and thediscount does not apply to the EyeMed provider’s professionalservices or to disposable contact lenses

■ Retail prices may vary by location

25%

0Benefit Choices:■ Two comprehensive plan designs to choose from■ Wide selection of lens options■ Designer frames at affordable prices■ Discounted fees for Lasik or Partial Radial Keratotomy

(PRK) vision correction from participating providers■ Annually renewing benefits

Extensive Provider Network■ Offered through EyeMed Vision Care■ Featuring LensCrafters, the #1 optical retailer in the U.S.■ Thousands of participating providers at more than 800

stores nationwide■ Vision exams through fully credentialed optometrists and

opthalmologists

5+

100%

50%

N/A

N/A



PRODUCTS OFFERED

123



www.vsp.com

Vision and Voluntary Vision







Vision coverage is available throughout the state

Yes—contact your Word & Brown representative

Customer & Broker Services949-553-1616

Adds/TermsFax 949-553-1898


BOR ChangesFax 515-235-5538

Claims800-247-4695


All states available through Request-A-Quote except forMaryland and Vermont. Contact your Word & Brown representative

Indemnity. Vision is not available in Maryland or Vermont.

Rates are based on NV employer zip code with nodifference in rates for other locations

Yes—see Special Considerations

VI

SI

ON

Employees

Dependents






Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Voluntary

GROUP SIZE

GROUP SIZE



Union/Non-union?

Minimum group size

CARVE OUTS*






Group Size

Rate Guarantee



124


Yes

Yes

Yes

10 enrolled lives

Yes

No

Yes

Yes

No

10 to 150

N/A

Waiting periods do not apply.

No

12 months

25%

N/A

25%

N/A

10-150

0 to 100%

0 to 100%

N/A

10-150

Employees

Dependents

Non-Contributory

100%

N/A

Employees

Dependents1. Contacts are only available if medically necessary.

2. Contact lens benefit is in lieu of the lens and frame,when contacts are chosen.

3. Annual enrollment period applies.

4. For groups over 150 lives, please contact yourWord & Brown representative.

5. Retirees are not eligible for coverage.

6. Members are eligible for a vision discount plan, theVSP Access Program, at no extra cost.






PRODUCTS OFFERED









HMO Network

PPO Network

Indemnity Network

125


VI

SI

ON

Vision Rider

N/A

Yes

75%

N/A

N/A

NV Zip code

No

N/A

N/A

N/A

N/A

N/A

N/A

Customer Service, Bilingual Support,& Broker Services 800-863-7515



ClaimsSaint Mary’s Health PlansClaims/Member Services1510 Meadow Wood LaneReno, NV 89502

Employees

Dependents

Employees

Dependents

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE



CARVE OUTS*






Group Size

Rate Guarantee



126



Are 1099 employees allowed?Yes

Any ineligible industries?No


Wage & tax reports required?Yes


Hourly/Salary?None

Management/Non-management?None

Union/Non-union?None

Minimum group sizeNone

2

No

12 months

100%

N/A

2-50

N/A

N/A

N/A

None

100%

N/A

90th percentile

None

127





PRODUCTS OFFERED









PPO Network

Indemnity Network

HMO Network

N/A

Yes—as long as the company is based in Nevada

Customer Service, BilingualSupport & Broker Services866-616-4888800-521-3605


Claims800-521-3605


Directory Informationwww.enrollwitheyemed/access or 866.723.0596

Employer Paid: minimum 75% of eligible Voluntary: No minimum participation required

None

The same plan is the same as the employers plan

Neither

See Certificate of Benefits for full guidelines, restrictions andlimitations

All

N/A

www.enrollwitheyemed.com/access

N/A

N/A


VI

SI

ON

Eye Examination Silver Gold PlatinumPlan #9657974 Plan #9657941 Plan #9657925

Frequency Once Every 12 Months Once Every 12 Months Once Every 12 MonthsCopay $10 $10 $0

Eyeglass LensesFrequency Once every 24 Months Once Every 12 Months Once Every 12 Months

Co-Pay $20 $10 $0 Frames

Frequency Once every 24 Months Once Every 12 Months Once Every 12 MonthsCo-Pay $0 $0 $0

128


Employees

Dependents

Employees

Dependents


Are 1099 employees allowed?Yes—as long as they work full-time and exclusivelyfor one employer. Must be approved by HealthEdgeprior

Any ineligible industries?None


Wage & tax reports required?No—but we deserve the right to request one

Employees

For Dependents

% of Total Cost:

RATING INFORMATION


PARTICIPATION

Contributory

Non-Contributory

GROUP SIZE

GROUP SIZE





Union/Non-union?Yes

Minimum group sizeGroup: A minimum of 75% of eligible employeesmust participate

Voluntary: No minimum participation required

CARVE OUTS*






Group Size

Rate Guarantee



2-99

See Brochure for pricing

No

2 years

NoneN/A

N/A

N/A

N/A

N/A

N/A

50% of lowest Premium

N/A

N/A

N/A

N/A

N/A 1) 5% discount when enrolling in dental and vision together

Small Group Proposal RequestNevadaEmail quotes to [email protected] or fax to 800.700.6744

$5,000

Broker Name

Agency

Address

City , NV Zip

Broker License #

Phone ( )

Fax ( )

Email Address

Check if new address

Company Name

Address

City , NV Zip

1. Nature of Business

2. More than one Location?

If yes, where?

3. Number of full-time employees (30+ hours/week)

4. Number of part-time employees (less than 30 hours/week)

5. Any employees paid by commission (and/or) paid as independent contractors? (FORM 1099)

6. Any COBRA participants previously employed by you?

7. % of costs to be paid by Employer:

% of Employee costs % of Dependent Costs

8. Type of Employees to be quoted:

9. Employees living Out-of-State?

10. Desired Effective Date:

Yes No

Yes No

Yes No

Yes No

(If yes, indicate on Census located on reverse side)

All Management Hourly

Salary Non-Union

(If yes, indicate Zip Code on Census located on reverse side)

Broker Information

Business / Group Information

WNV5015.9.09

Word & Brown – Southern Nevada | Northern NevadaToll Free 800.606.4996 | Fax 800.700.6744 | Email quotes to: [email protected]

Proposal Type

Plan Design – Selections For PPO PlansMost Popular Plans

$0$25$45

DeductibleAmount*

CoinsuranceAmount*

Out-of-Pocket Amount*

Rx Deductible Amount*

$10$30

$15$35

$20$40

$0$1,000$2,500

$250$1,150$3,000

$500$1,500$3,500

$750$2,000$4,000

$6,000 $8,000 $10,000

$0$1,750$3,000

$500$2,000$3,500

$1,000$2,250

$1,500$2,500

$4,000 $4,500

$5,000 $5,800 $6,000 $7,500

Current Health Plan

Current Premium

Current Plan Type(s)

Current Coverage Information

HMO PPO POS EPO

Delivery Options

Pick-up – Las Vegas

50% 60% 70% 80%90% 100%

Fax to: ( )

Email to:

Have Representative call me at: ( )

Mail complete proposal

$0$500

$50 $100 $200

PhysicianOffice VisitCopay*

Build A Plan * Selections are for in-network only

Summary Proposal–Summary of benefits and rates

Medical Benefit TypeAll

Custom Proposal–Details of benefits and rates

HMO

PPO

POS

Indemnity

$8,000 $10,000 $15,000

$15,000

Product TypeMedical (All) Dental

Vision

Life

AetnaAllied

Best LifeIACStarmark

Saint Mary’sAnthem

Email quotes to [email protected]

or fax to 800.700.6744

Company Name:

Name Age or DOBGender Spouse(Y/N)

# ofChildren

COBRA(Y/N)

Home Zip Code

Life Only(Y/N)

Broker Name:

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

CensusSpouse

Age or DOB

Benefits

wordandbrown.comWNV5081A.1.09

Current Coverage

Hospital Copay

Office Visit

Rx

Chiro

Employee

Spouse

Children

Family

Ded.

DeductibleOV Copay

Hospital/Co-insurance

Rx

EE’s on PPO (Identify on census)Co-Ins.

DeductibleOV Copay

Hospital/Co-insurance

RxEE’s on POS(Identify on census)

HMO Current HMO Renewal PPO Current PPO Renewal POS Current POS Renewal

HMO PPO POS

Rates

Large Group Proposal RequestNevada

Broker Code (if known) Broker License #

Phone ( )

Fax ( )

Email Address

Assistant’s Name

Commission Requested % BOR:

Special Instructions

Broker Name

Brokerage

Address

City , NV Zip

Check if new address

Pick-up

Mail complete proposal Fax to: ( )

Medical

Request proposals for:

Vision Dental Life

Email to:

Broker Information

Proposal Delivery Options

Select the rating tier option for your group:

Total Group Premium for Current Medical Coverage:

Total Group Premium for Current Medical Renewal:

2 tier 3 tier: EO, E+1, E+2

$

$

4 tier: EO, ES, EC, EF

Rating Tiers

Yes No

10801 West Charleston Blvd., #520, Las Vegas, NV 89135 | Toll Free 800.606.4996 | Fax 800.700.6744 | [email protected]

Business/Group Information

Effective Date Requested

Renewal Date

Nature of Business

SIC Code Yrs. in Business

Has company filed bankruptcy in last 7 years?

# of EE’s on payroll # of Eligible EE’s*

Employer Contribution:

Current Carrier # of years

Prior Carrier # of years

Reason for Quote

Workers’ Comp? # without Workers’ Comp

# of part-time EE’s waiting period

# of EE’s currently enrolled in your group medical coverage

# of EE’s currently covered by their spouse’s medical coverage

# of dependents currently enrolled in your group medical coverage

# of COBRA currently enrolled in your group medical coverage

# of early retirees # of 65+ retirees

# out of state # out of country

Company Name

City , NV Zip

Yes No

% of $ for Employee (specify type)

% of $ for Dependent: (specify type)

Include waivers with quote?

Yes No

Yes No

†COBRA participants must be listed on the census. Current carrier should be contacted for a more accurate count.

# of Enrolled EE’s Number of COBRA†

*Eligible employees are permanent, active, full-time employees working a minimum of 30 hours per week. Thefollowing classifications are NOT eligible: employees working less than 30 hours per week, leased employeesseasonal employees, 1099, union, board members, retirees, COBRA participants or surviving spouses.

Detailed information for medical questions with a response of “yes”

Employee Name

Condition/Diagnosis: Date diagnosed:

Medications and Treatments: Is this condition ongoing?

Physician’s prognosis Pending treatments

Details:

Employee Name

Condition/Diagnosis: Date diagnosed:

Medications and Treatments: Is this condition ongoing?

Physician’s prognosis Pending treatments

Details:

Have any eligible enrollees:

1. Been hospitalized during the last 12 months?

2. Been Diagnosed with or being treated for cancer, brain tumor, blood disease, heart disease or heart disorder, stroke, (AIDS), AIDS-related conditions, nervous system disorder, mentalcondition, liver/kidney disease, birth defect, transplant, or any other medical condition?

3. Received medical benefits in excess of $25,000 in the last 12 months for any condition other than those listed above?

Are any eligible enrollees:

4. Currently pregnant? If yes, provide total number of pregnancies:

5. Currently expecting a multiple birth? If yes, provide total number of enrollees:

6. Currently disabled? If yes, provide total number of disabled:

Please answer the following questions to the best of your knowledge regarding all eligible enrollees (employee, dependents,COBRA, owners/partners). If any on the response is “yes,” provide details as indicated below:

Medical Questions

Yes No

Please fax completed request to: 800.700.6744Group Census must be created in Excel Spreadsheet file format

and e-mailed as an attachment to: [email protected]

I certify that the information provided on this Proposal Request is true and correct to the best of my knowledge:

Broker Signature Print Name Date

Yes No

Yes No

Yes No

Yes No

Yes No

Census must include:• Gender• DOB or age• Spouse coverage (Yes or No) • Number of children • Employee zip code • Current coverage type (HMO, PPO, POS)• COBRA enrollee information

Total Replacement

Replacing

Misc.

Proposal Scenarios Requested

Only

GA Rep Name & Office

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Documents

Word & Brown—Health Plan Reference Guide for … · 2010-02-16 · Aflac ... we recommend that you verify ... emergency room physician must meet the carrier’s definition of a