Transcript Slide 1

www.getmed360.com
Agent Training Only
1
Agenda
 Overview
 Administrative Partners
 Carrier Partners
 Limited Medical Plan Benefits
 Association Benefits
 Policy Information
Agent Training Only
2
Why Sell GetMED 360?
 Top rated Insurance Companies
 Dr. office visit co-pays
 ER benefit for both injury and sickness – pays up to $1,000
 $5,000 per accident - excess accident medical expense
 $10,000 Critical Illness
 Weekly $$$
Benefits vary by state.
Agent Training Only
3
Product Overview
 GUARANTEED ISSUE – NO UNDERWRITING REVIEW
 Great for consumers that may not qualify for full comprehensive Major
Medical
 A reasonable alternative (not replacement) for consumers who cannot
afford more costly Major Medical programs
 The plans provide coverage for the common everyday expenses such as
doctor office visits, hospital, ICU and surgical expenses
Agent Training Only
4
Sponsored by UCAA
 United Consumer Awareness Association (www.unitedconsumer.org)
 A National Association
 Offers a benefit package of consumer discount products including:
 Doctor/Hospital network
 Call MD
 Tiered Dental and Vision
 3-Tier Rx
 Chiropractic
 24-hour nurses hotline
 And much more!
 More information about UCAA is available on the GetMed360 site
Agent Training Only
5
Administrative Partner: Patriot Health, Inc.
 Patriot Health is a member of the Cost Containment Group (CCG) of companies,
headquartered on Long Island, New York.
 Established in 1993, CCG services millions of families nationwide through various
health care related programs and networks.
 Patriot Health is a Managing General Underwriter (MGU) and Administrator for
Limited Medical Plans.
 They offer a single source for product development, networks, administration and
customer care.
 They combine multiple insurance carriers and networks to deliver the most
complete and highest value membership plans for the consumer.
Agent Training Only
6
GetMED 360 Benefit Components
In order to provide its
members with the
maximum benefit options
available in their particular
state, UCAA has
contracted with the
following carrier partners:
UCAA
Association
Guarantee Trust
United States Fire
Limited Medical
Guaranteed Issue
Hartford Life
Term Life
Guaranteed Issue
Accident Medical
Expense Benefit
(AME)
Accidental Death
& Dismemberment
(AD&D)
Agent Training Only
Presidential
AIG
Emergency Room
(ER) Benefit
Critical Illness (CI)
Benefit
7
Insurance Carrier: Limited Medical Benefit Plans
 United States Fire Insurance Company
 Fairmont Specialty is a registered trademark of United States Fire
Insurance Company
 Niche products (accident and health)
 A member of Crum and Forster group of companies
 Rated “A” Excellent by AM Best (as of 2009)
Agent Training Only
8
Medical Benefit Provisions
 There are no coordination of benefits with other plans
 There is a 30 day wait on sickness benefits
 Pre-X definition: A medical condition, injury or sickness, for which medical
advice, consultations, symptoms, care or treatment was recommended by a
doctor within 12 months prior to the effective date of coverage – will be
considered a pre-existing condition unless the loss incurred at least 12 months
after the effective date of coverage.
 There is a 12/12 pre-x on Hospital Confinement Charges, Surgery and
Anesthesia
 There is a 6/12 pre-x on the Emergency Room Benefit
 There is a 12/12 pre-x on the Critical Illness Benefit payable only after all valid
and collectible insurance for the same claim has been exhausted
Agent Training Only
9
Eligibility
 All Members and Spouses who are 18 to 65 years old. At age 65 the plan ends.
 Unmarried Children
 Under age 19
 Includes stepchild, foster, legally adopted, pending adoption
proceedings and natural child
 Up to age 24 if enrolled as fulltime student at accredited college or
university
 Newborn (born during coverage period) for 31 days
 Citizens or legal residents of the United States
 Must be a legal resident for 12 months
Agent Training Only
10
Provider Access (Beech Street)
 GetMed360 utilizes Beech Street – a National PPO network of providers
(www.beechstreet.com - choose the limited benefit plan link)





564,181 respected doctors
5,083 acute care hospitals
87,500 ancillary network providers
Practitioners in all 50 states!
Provider lookup 24/7 on GetMed360 site
 Utilizing Beech Street Network Providers
 Maximizes client savings
 Reduces out-of-pocket expenses
Agent Training Only
11
Provider Locator Screen
Agent Training Only
12
Plans Offered (varies by state)
Platinum MAX Platinum
Gold MAX
Gold
Silver
$250 and
$1000
$250 and
$1000
$250 and
$1000
$250 and
$1000
$250 and
$1000
Limited Med
Life
Accident
AD&D
ER
Critical Illness
Limited Med
Life
Accident
AD&D
ER
Limited Med
Life
Accident
AD&D
Critical Illness
Limited Med
Life
Accident
AD&D
Limited Med
Life
State variations and plan offerings will be displayed on the GetMed360 web site in
an easy to use format!
Agent Training Only
13
Plan Availability Screen
Agent Training Only
14
State and Product Availability
Agent Training Only
15
PLATINUM SERIES
Benefit
(PER INSURED)
Based on policy
annual period, not
calendar year
$250
$1000
Max $250
Max $1000
Hospital Confinement
31 days per year
$250 per day
$1000 per
day
$250 per day
$1000 per day
ICU/CCU
15 days per year
$1000 per
day
$2000 per
day
$1000 per day
$2000 per day
Surgery Benefit
$10,000 – 2 surgeries per insured per year
Inpatient / Outpatient
Anesthesia
25% of surgery
25%
Doctor Office Visit
5 visits per insured per yr
10 visits per family per yr
In Network:
Out of Network:
$20 co-pay
$40 benefit
Ambulance (Ground or Air)
1 trip per year
Wellness
2 visits per insured per yr
In Network:
Out of Network:
Diagnostic Lab/X-Ray
(DXL)
N/A
$100
N/A
$100
3 sittings
Term Life Insurance
N/A
$100
3 sittings
$1000
2 per insured/family
Excess Benefit
$5,000 - $100 deductible
Accidental Death &
Dsmemberment (AD&D)
Critical Illness (CI)
$100
$20 co-pay
$40 benefit
Emergency Room (ER)
Accident Medical (AME)
N/A
$15,000
Per covered insured
50% covered spouse
20% covered children
Agent Training Only
N/A
N/A
$10,000
$10,000
$10,000
16
GOLD SERIES
Benefit
(PER INSURED)
Based on policy
annual period, not
calendar year
$250
$1000
Max $250
Max $1000
Hospital Confinement
31 days per year
$250 per day
$1000 per day
$250 per day
$1000 per day
ICU/CCU
15 days per year
$1000 per day
$2000 per day
$1000 per day
$2000 per day
Surgery Benefit
Anesthesia
Doctor Office Visit
5 visits per insured per yr
10 visits per family per yr
Ambulance (Ground or Air)
Wellness
2 visits per insured per yr
$10,000 – 2 surgeries per insured per year
Inpatient / Outpatient
25% of surgery
25%
In Network:
$20 co-pay
Out of Network:
$40 benefit
1 trip per year
N/A
$100
In Network:
$20 co-pay
Out of Network:
$40 benefit
Diagnostic Lab/X-Ray
(DXL)
N/A
$100
3 sittings
Emergency Room (ER)
Accident Medical (AME)
Term Life Insurance
N/A
$100
$100
3 sittings
N/A
Excess Benefit
$5,000 - $100 deductible
Accidental Death &
Dismemberment (AD&D)
Critical Illness (CI)
N/A
$15,000
Per covered insured
N/A
50% covered spouse
20% covered children
Agent Training Only
N/A
$10,000
$10,000
$10,000
17
SILVER SERIES
Benefit
(PER INSURED)
Based on policy
annual period, not
calendar year
$250
$1000
Hospital Confinement
31 days per year
$250 per day
$1000 per day
ICU/CCU
15 days per year
$1000 per day
$2000 per day
Surgery Benefit
Anesthesia
Doctor Office Visit
5 visits per insured per yr
10 visits per family per yr
Ambulance (Ground or Air)
Wellness
2 visits per insured per yr
Inpatient / Outpatient
25% of surgery
$20 co-pay
Out of Network:
$40 benefit
1 trip per year
$100
$20 co-pay
$40 benefit
N/A
$100
3 sittings
N/A
Excess Benefit
Accidental Death &
Dismemberment (AD&D)
Term Life Insurance
N/A
In Network:
Out of Network:
Emergency Room (ER)
Critical Illness (CI)
25%
In Network:
Diagnostic Lab/X-Ray
(DXL)
Accident Medical (AME)
$10,000 – 2 surgeries per insured per year
N/A
N/A
Per covered insured
50% covered spouse
20% covered children
Agent Training Only
N/A
$10,000
18
Rates: Do not include a one time $99 enrollment fee
Plan
Individual
w/Spouse or
Child
Family
Platinum 250, Gold
250 or Silver 250
$199.90
$379.90
$499.90
Platinum Max 250 or
Gold Max 250
$229.90
$439.90
$559.90
Platinum 1000 or
Gold 1000
$299.90
$529.90
$729.90
Platinum Max 1000
Gold Max 1000
$329.90
$589.90
$789.90
Agent Training Only
19
Doctor Visits (Fairmont Specialty)
 Sickness or Accident -5 visits per individual per policy year or 10 per family.
 Doctor Office Visit co-pay is $20 – the member must utilize a Beech Street
provider.
 If all visits are used (5/10) the in-network provider discount will still apply.
 Out-of-network Doctor Office Visit Indemnity Reimbursement – maximum of
$40 per visit.
Agent Training Only
20
Wellness Visit (Fairmont Specialty)
 In-network Doctor Office Wellness Visit - for routine health examinations or
immunizations of Covered Persons.
 Co-pay is $20 per visit – 2 visits per person per year.
 The benefit does not cover any wellness testing, such as mammograms, PAP or
PSA Testing.
 Claims for wellness tests will be “re-priced” through Beech Street if a
network provider is used.
 Out-of-network Doctor Office Visit Indemnity Reimbursement – maximum of
$40 per visit.
Agent Training Only
21
Diagnostic, X-Ray & Lab (Fairmont)
 Coverage is provided when x-rays, laboratory and other diagnostic tests are
ordered or performed by a Doctor.
 Includes the services of a radiologist or radiology group and the services of
a pathologist or pathology group for interpretation of diagnostic tests or
studies that are Medically Necessary due to an Injury or Sickness
 There are a maximum of 3 sittings or draws per Covered Person per Policy Year.
 If the member stays in-network they can get their bill(s) re-priced before
the benefit is applied.
 If all sittings are used the in-network provider discount will still apply
 The payment amount is up to $100 per sitting/draw. Only available on the 1000
plan series.
Agent Training Only
22
Hospital Confinement (Fairmont)
 Sickness is payable after a 30 day waiting period.
 Injury is payable as of the effective.
 Benefits are payable from 1-31 days, up to $250 or $1,000 per day while confined
in a hospital semi-private room, as a result of a covered injury or sickness.
 Using a Beech Street facility will help lower out-of-pocket costs.
Agent Training Only
23
Hospital Confinement – ICU/CCU
(Fairmont)
 Benefits are payable for up to 15 days while confined in a hospital ICU/CCU, as a
result of a covered injury or sickness.
 The benefit is up to $1,000 or $2,000 per day depending on plan chosen.
 30 day waiting period for sickness
 Paid in lieu of hospital confinement benefit
 Using a Beech Street facility will help lower out of pocket costs.
Agent Training Only
24
Ambulance (Fairmont)
 Up to benefit amount of $100 Per Trip
 Medical Emergency only
 1 Trip per person per year
 Ground or Air
 This benefit is available in the 1000 plan series only
Agent Training Only
25
Surgery In/Out Patient (Fairmont)
 Benefits are payable up to $10,000 per surgery.
 Based off of CPT codes on a surgery schedule.
 2 surgeries per covered person per policy year.
 Sickness benefits are payable after a 30 day waiting period.
 Benefit Includes but is not limited to charges for:





Surgeon fees
Use of the operating and recovery room
Administration of drugs and medicines during surgery
Dressings, casts, splints
Diagnostic services including radiology, laboratory, or pathology performed
during time of surgery.
Agent Training Only
26
Surgery: GetMED 360 vs. RBRVS
 Surgical Benefit
 $10,000 Fairmont surgical schedule vs. RBRVS schedule

RBRVS – will pay just the cost of the surgical procedure (surgeon charges only)
based upon the RBRVS code in the covered persons county

GedMed360 – Surgical benefit is provided for use of the operating room and
recovery room, including the doctors charge for performing surgery. Benefit
also provided for medical services and supplies used in the performance of the
surgery. Includes, but not limited to:
 Administration of drugs and medicines during surgery
 Dressings, casts, splints
 Diagnostic services including radiology, laboratory, or pathology
performed during time of surgery
Agent Training Only
27
Sample Comparisons (Hillsborough County, Tampa, FL)
Surgery
CPT Code RBRVS GetMed360
Gall Bladder
47600
$817
$5,000
Arm Amputation
24920
$685
$2,500
Breast Reconstruction
19350
$896
$5,000
Repair: Heart Defects
33697
$2,086
$8,500
Aortic Valve Repair
33403
$2,163
$8,500
Fractured Finger
26720
$173
$1,000
Arterial Blockage
35472
$2,574
$10,000
Hysterectomy
58150
$930
$5,000
Triple By-Pass
33535
$2,191
$8,500
Appendectomy
44950
$595
$2,500
Agent Training Only
28
Anesthesia In/Out Patient (Fairmont)
 This benefit is payable at 25% of the surgery benefit
 Using an in-network provider will lower out-of-pocket costs
Agent Training Only
29
Emergency Room (Presidential)
Availability Varies by State
 Injury or Sickness 2 visits per year (individual/family)
 Benefit is payable up to $1,000
 Subject to a $100 deductible per visit
 There is a 6/12 Pre-ex
 There is a 30 day waiting period for sickness
Agent Training Only
30
AD&D (GTL)
Availability Varies by State
 If you are injured in a covered accident and the injury from such an accident
causes death or dismemberment within 365 days from the date of the accident,
the insurance company will pay the amount shown.
 If you sustain more than one such loss as the result of one Accident, the
insurance company will pay only one amount, the largest, to which you are
entitled.
 The benefit is $15,000 in states where available.
Agent Training Only
31
Excess Accident Medical Expense (GTL)
Availability Varies by State
 If you are injured in a covered accident and receive treatment from a physician
within 365 days from the date of the accident, the insurance company will pay
the amount shown for actual expenses, up to the maximum per accident. This
is an excess benefit so all other benefits must be used first.
 Subject to a $100 deductible per accident.
 Benefit amount is $5,000 per accident for all plans.
Agent Training Only
32
Guaranteed Issue Term Life (Hartford Life)
 Requires NO medical Exam or Tests!
 The benefit amount shown is paid to the beneficiary or beneficiaries in the
event of your death.
 Benefit payment is subject to the definitions, limitations, exclusions and other
provisions within the Certificate.
 Covered spouse benefit is 50% of benefit amount shown and dependent
benefit is 20% of benefit amount shown. Covered dependent child(ren) must
be at least 15 days or older to be eligible for coverage.
 Benefit amount is $10,000 in states where available.
Agent Training Only
33
Critical Illness (AIG)
Please see State Product Availability Chart
 The $10,000 Critical Illness Indemnity Benefit is payable for Insured and
covered Spouse
 Will be paid in addition to any other benefit in the Certificate
 Subject to a 12/12 Pre-Existing Condition Limitations
 A benefit is payable for any one of the following:






Invasive Cancer
Heart Attack
Stroke
Major Organ Transplant Surgery
Coma
End Stage Renal Failure
Agent Training Only
34
Plan Highlights: Association Benefits
 Doctor/Hospital Network (Beech






Street)
3-Tiered Rx Discount
Tiered Dental
Tiered Vision
Call MD
Chiropractic
Counseling
Agent Training Only
 24-Hour Nurses Hotline
 Elder Care
 Hearing
 Diabetic Supplies
 Fitness
 Holistic Care
 Much more consumer lifestyle savings
benefits!
35
Beech Street Top 100 Procedures Sample Savings
CPT
CPT Description
Contracted Rate
Average Billed Nationally
% Saved
11100
17000
17003
20610
36415
36416
71020
73630
76830
80048
80050
80061
81000
81001
81002
81003
82270
83036
84153
84443
85018
85025
86003
87086
87880
88142
88305
90466
90472
90669
90700
BIOPSY OF SKIN LESION
DESTROY BENIGN/PREMAL LESION
DESTROY 2-14 LESIONS
DRAIN/INJECT JOINT/BURSA
DRAWING BLOOD
COLLECTION CAPILLARY BLD SPEC
CHEST X-RAY
X-RAY EXAM OF FOOT
ECHO EXAM, TRANSVAGINAL
METABOLIC PANEL, BASIC
GENERAL HEALTH PANEL
LIPID PANEL
URINALYSIS, NONAUTO, W/SCOPE
URINALYSIS, AUTO, W/SCOPE
URINALYSIS NONAUTO W/O SCOPE
URINALYSIS, AUTO, W/O SCOPE
TEST FECES FOR BLOOD
GLYCATED HEMOGLOBIN TEST
PSA TOTAL
ASSAY THYROID STIM HORMONE
HEMOGLOBIN
AUTOMATED HEMOGRAM
ALLERGEN SPECIFIC IGE
URINE CULTURE, COLONY COUNT
STREP A ASSAY W/OPTIC
CYTOPATH C/VAG T/LAYER
TISSUE EXAM BY PATHOLOGIST
IMM ADMIN <8 YR PERQ SUBQ/IM
IMMUNIZATION ADMIN, 2+
PNEUMOCOCCAL VACC, PED<5
VACCINE, IM
$71.71
$52.92
$18.09
$73.18
$5.11
$4.74
$44.22
$36.72
$119.11
$14.37
$44.57
$23.39
$5.74
$5.74
$4.41
$3.97
$4.41
$17.21
$32.21
$29.56
$3.97
$13.68
$9.27
$14.12
$21.18
$13.68
$84.49
$15.04
$13.23
$89.24
$17.91
$125.57
$94.11
$23.72
$145.61
$26.38
$13.87
$85.34
$76.13
$249.99
$38.20
$111.37
$55.41
$17.03
$21.94
$13.35
$15.67
$15.45
$44.22
$74.13
$63.69
$14.46
$37.70
$19.53
$47.62
$31.51
$64.51
$154.16
$21.00
$16.84
$104.37
$44.45
42.9%
43.8%
23.7%
49.7%
80.6%
65.8%
48.2%
51.8%
52.4%
62.4%
60.0%
57.8%
66.3%
73.8%
67.0%
74.7%
71.5%
61.1%
56.5%
53.6%
72.5%
63.7%
52.5%
70.3%
32.8%
78.8%
45.2%
28.4%
21.4%
14.5%
59.7%
Agent Training Only
36
3-Tiered Prescription Drug “Discount”
•
This plan is accepted at over 50,000 participating pharmacies nationwide.
• Simply visit a participating pharmacy, present your membership card and pay
the pharmacy directly.
• To access list of pharmacies go to www.getmed360.com
• Tiers are based on 1 pill per day for 30 days.
• Tier 1: Drugs at up to a $10.00 maximum cost **
• Tier 2: Drugs at up to a $20.00 maximum cost **
• Tier 3: All other drugs are available for your benefit at negotiated rates.
• ** Please note that some participating pharmacies may charge beyond a
particular tier.
•
*Only a licensed physician can recommend or prescribe specific drugs to treat your specific
condition
Agent Training Only
37
Top 10 Drug Savings
Member’s
Saving
Percentage
Saved
Pharmacy
$30.78
$324.83
91%
DRUG SOURCE INC
$144.43
$22.60
$121.83
84%
DRUG SOURCE INC
45
$62.09
$5.63
$56.46
91%
SUPER 1 PHARMACY
Mental Health
240
$324.10
$41.97
$282.13
87%
TARGET
HYDROCODONE-APAP
10-650 TABLET
Analgesics
120
$155.77
$21.24
$134.53
86%
CITY MARKET
PHARMACY
LISINOPRIL
40 MG TABLET
Cardiovascular
60
$98.43
$9.49
$88.94
90%
BROWNS PARKSIDE
LLC
METFORMIN HCL
500 MG TABLET
Diabetic
$47.26
$4.00
$43.26
92%
TARGET
SERTRALINE HCL
50 MG TABLET
Mental Health
30
$117.36
$13.33
$104.03
89%
CITY MARKET
PHARMACY
SIMVASTATIN
40 MG TABLET
Antihypertensive
30
$151.2
$6.60
$144.6
96%
COSTCO
93%
LAWRENCE
BROTHERS
PHARMACY
Drug
Drug Category
ALPRAZOLAM
2 MG TABLET
Mental Health
180
$355.61
AMLODIPINE BESYLATE
10 MG TAB
Cardiovascular
60
ATENOLOL
100 MG TABLET
Cardiovascular
GABAPENTIN
300 MG CAPSULE
ZOLPIDEM TARTRATE
10 MG TABLET
Mental Health
Quantity Retail Price Discount Price
30
$148.59
Agent Training Only
$11.09
$137.5
38
Quality Vision Network (QVN)
 Tier 1

At select participating vision outlets, a no-charge eyeglass vision exam
is available once annually for every family member
 Prescription must be filled by the provider performing the nocharge exam if glasses are required
 Tier 2

You will also receive discounted rates of 10%-50% on eyeglasses, nonprescription sunglasses and contact lenses (excluding disposables) at
participating optical locations nationwide.
 Ophthalmology & LASIK

Save 20%-60% on medical eye exams and surgical procedures
including LASIK at participating ophthalmology locations.
Agent Training Only
39
Call MD

All members will receive 2 toll-free physician telephone consultations available 24/7
 You have access to a nationwide network of medical doctors and
registered nurses that are available to discuss your medical issues.
 You can access over-the-phone prescriptions (where permitted by law)
Agent Training Only
40
Dental Directory Services

Multi-tiered dental fee-for-service program
Tier 1
 At select participating schedule (A) Tier 1 general practitioners you will
receive:
 a no-charge exam and x-rays in conjunction with a paid annual cleaning
 Participating providers abide by a fee schedule of fixed payments for most
procedures savings are 20% to 60%
 Tier 2

A schedule (A) Tier 1 provider is not available in a given area, a secondary
provider is given to member that still provides 20%-60% discounts but does
not provide a free exam
 Tier 3

In the event a Tier 1 or Tier 2 provider is not available in your area, member
will call customer service for assistance in accessing a Tier 3 provider which
will provide them a discount
Agent Training Only
41
Tiered Chiropractic Program
 Save on testing procedures, support and orthotics supplement, massage and
other bodywork.
 Tier 1: save 20%-50% at participating providers on adjustments, therapy, x-
rays, exams and specialized procedures using a fee schedule of fixed
payments for most procedures.

First visit is $35 with adjustments thereafter at $20.
 Tier 2: Save 5%-20% at participating providers
Agent Training Only
42
24 Hour Counseling Hotline
•
You and your immediate family members have unlimited access to a Master’s
Level Therapist.
•
Toll-free number available 24/7
•
Free support and self-help group referrals and referrals to local licensed
therapist
•
All counselors have been specially trained to offer prompt, confidential
counseling.
Agent Training Only
43
24 Hour Nurse Hotline
•
Unlimited, Toll-Free, 24/7 Access to Registered Nurses.
•
Confidential service is available to help you become more knowledgeable
about healthcare services and more comfortable working in partnership with
your healthcare providers
•
You will receive information regarding, the treatment of common illnesses,
what to expect during medical testing, diagnostic and surgical procedures,
recently diagnosed medical condition, prescriptions, and over-the-counter
medical information.
Agent Training Only
44
Holistic Care
•
The Holistic Care Service provides a concierge approach to finding a
Holistic Care provider that will meet your specific needs.
•
A Customer Care Consultant will take your request for an Acupuncturist,
Massage Therapist, Dieticians and Naturopathic providers and call you back
with the nearest location.
•
Up to 20% savings on, all treatments and services. There is no limits on
number of visits.
Agent Training Only
45
Hearing Care
•
Beltone Features
•
Free hearing screening and 15% discount on Beltone hearing aides at
more than 1,300 Beltone locations.
• Lifetime care program includes complimentary hearing aid checkup,
free cleaning and inspection while under warranty and a 30 day refund
policy.
•
HearPO Features
•
20%-50% off audiology and hearing aid services at more than 1,400
participating HearPO providers.
• Comprehensive follow up for one year at no charge. 100% discount on
repairs and a 60 day refund policy
• Your hearing aid comes with a 12 month standard manufacturer’s
warranty. Modifications will be made without cost during warranty
should a change within hearing levels require different circuitry.
Agent Training Only
46
Elder Care
• Save on home health and long term care services, available for any
member for your family including grandparents!
• Save 10%-25% on home health aides, nursing homes, assisted living
facilities, Alzheimer’s special care units and respite care facilities.
(savings are available for new patients only)
• Toll free 24/7 advice hotline
Agent Training Only
47
Diabetic Supplies
• Save 10%-60% on Diabetic supplies
• This program provides special member pricing on most diabetic
supplies such as
• Test strips, glucose meters, lancing devices and lancets and
convenient free home delivery!
Agent Training Only
48
Fitness
 Enjoy 10%-50% off membership dues at over 1,000 locations
nationwide!
 Month to month memberships at top area fitness centers . ($10
administrative fee may apply upon cancellation)
 This program includes many franchises of Gold’s Gym, Bally’s
Fitness, Curves for Women and other chains as well as independent
fitness clubs.
Agent Training Only
49
Association Consumer Discount
 Consumer discount programs vary by plan but include:








Medical records software
Hotel savings
Rental car savings
Mortgage and Realtor discounts
Financial planning
Tax hotline
Roadside assistance
And many more
Agent Training Only
50
Effective Dates and Billing Dates
 If a member enrolls between the 1st and the 15th they will be effective on the 1st
of the following month. Initial charge occurs on the day of enrollment and
recurring charges occur on the 15th of every month there after.
 If a member enrolls between the 15th and the last day of the month they will be
effective the 15th of the following month. Initial charge occurs on the day
they enroll and recurring charges occur on the 1st of every month there after.
 Future effective date options are available up to 60 days.
 Payments can be made using Credit Card or by drafting a checking/savings
account – NO individual paper bills
 Group list bill available for 10 or more employees
Agent Training Only
51
Enrollment – Customer Info. Screen
Agent Training Only
52
Enrollment – Membership Type
Agent Training Only
53
Enrollment – Plan Selection
Agent Training Only
54
Enrollment – Billing Screen
Agent Training Only
55
Enrollment – Confirmation Screen
Agent Training Only
56
Enrollment – By Insurance Agent
Agent Training Only
57
Fulfillment Materials
 The insured will receive an email fulfillment with ID card, certificate,
schedule and benefit booklet instantly after enrollment submission.
 Fulfillment materials will be mailed direct to the insured within 24
hours after premium processing is verified.
Agent Training Only
58
Rules For Limited Medical Plan Sales
 DO NOT Represent Limited Medical Plans as:
 “Same as your employer plan”
 Just like “Major Medical”
 “Full Benefits”
 A “PPO”
Agent Training Only
59
Rules For Limited Medical Plan Sales
 Clearly explain the limited nature of the plan:
 This limited medical benefits plan:




Does Not Provide comprehensive medical coverage
Is a basic or limited benefits policy and is not intended to cover all
medical expenses.
Is not designed to cover the costs of serious or chronic illness.
Contains specific dollar limits that will be paid for medical services
which may not be exceeded. (if the cost of services exceeds those limits,
the beneficiary and not the insurer is responsible for payment of the
excess amounts)
Agent Training Only
60
Rules For Limited Medical Plan Sales
 Explain the key elements of:
 Guarantee Issue
 Pre-existing condition limitation
 30 day wait on sickness
 Go through the plan of benefits in detail with the consumer, including their
membership in the Association
 Explain how the Beech Street Network discount works
 Explain that the Rx card is a “discount” program
 Explain the claims submission process, billing, and customer service
 Explain the 30 day free look provision and how refunds work
 All agents soliciting sales and enrolling consumers must hold a valid
health insurance license in the state in which the consumer resides!
Agent Training Only
61
Administrative Partner: Patriot Health, Inc.
 Customer Care
 Members are encouraged to speak directly with a Patriot Representative.
 Dedicated consultants assist members with benefits, provider locater, and
coordination services.
 Members can contact Patriot’s toll free phone number Monday through
Friday, 9:00 AM until 7:00 PM (EST). 877-693-9095
Agent Training Only
62
Commissions
 Commissions are level on GetMED 360
 Checks are sent every Tuesday for all business with approved
payments through Monday. (new sales and renewals)
 Statements are sent via email.
Agent Training Only
63
Cancellation & Refund Policy
 A member may cancel at any time.
 Cancellation will be required in writing
 If an insured calls Patriot to cancel, they will be sent a form to sign. Once
the form is received, agent will be notified and copied. If agent can
conserve the case, and the consumer verifies in writing they wish to keep
the policy, Patriot will reinstate the policy back to the original effective
date, and premiums will be collected accordingly.
 If a member cancels within the first 30 days, the membership cost will be
refunded. The one time enrollment fee is non-refundable, except where
specified by state law. Those states are; AK,MD,NE,FL,SC, SD ,VT
 If a member cancels within 3 days from the enrollment date, the member will
be refunded the first month’s membership costs plus the one time enrollment
fee.
Agent Training Only
64
Policy Changes
 The insured or the agent can call or email Patriot to make changes for:
 Dependent status
 Plan changes
 Payment changes
 Address changes
Agent Training Only
65
Claim Processing
 Claims are processed by Administrative Concepts, Inc. (ACI) located in Wayne,
PA (Toll Free 888-293-9229)
 ACI is an industry leader in providing superior services for specialty insurance
products and a valuable resource to insurance companies and brokers
 Re-pricing for PPO discounts
 Claim payment
 Explanation of Benefits sent


Providers
Patients
 www.visit-aci.com
Agent Training Only
66
Web Site Features
 www.getmed360.com
 Plan and Benefit Availability by State with Rates
 Brochure and Sample Certificates
 Training Power Point
 FAQ’s
 Association Provider and Beech Street Links
 Enroll On Line for your Customer
 Agent Back Office


Track and manage business
24/7 access to client’s policy information
Agent Training Only
67
Agent Back Office
Agent Training Only
68
FAQ’s
Agent Training Only
69
Thank You and Welcome to GetMED 360
Agent Training Only
70