Transcript Preparing For Your Presentation

Assurant Affordable Health Access
& 9/1/08 Enhancements
presented by RSD Greg Loerzel
Agenda
•Assurant Affordable Health Access
• EASE- Test Drive
•One Decreasing Deductible
• Patient Care
• Rates take a DIVE!
• Tele-DOC
• KeyMed
Assurant Affordable
Health Access (IMployee )
SM
The health insurance solution
for employees’ individual needs
Assurant Affordable Health
Access
• Assurant Affordable Health Access
limited-benefit plans
• Solution for rising cost of health care
• Individual medical for employees
(full-time, part-time, seasonal, contractors)
and employee family members
• Offers alternative to group coverage
Who is in the market for
Assurant Affordable Health
Access?
This initiative is focused on two specific market opportunities.
Health Insurance Coverage of the Nonelderly Population, 2005
Employers likely to drop
coverage
Employer sponsorship of
coverage continues to
decline as a result of rising
premiums. The smaller
the business, the greater
the trend.
Uninsured
18%
257.4M
1
Working Uninsured
While many of the
uninsured are poor or
near poor, nearly 35%
could afford health
insurance.
Medicaid
16%
Employer
Sponsored
61%
Private NonGroup
5%
1. Kaiser Commission on Medicaid and the Uninsured.
The Uninsured: A Primer, Key Facts about Americans
without Health Insurance. The Henry J. Kaiser Family
Foundation. October 2006.
Limited-Benefit Product
Overview
Three limited-benefit plans:
• Health Access Plan A
—No medical questions
• Health Access Plans B or C
—Limited medical questions
Limited-benefit plans provide:
• An affordable option compared to major
medical plans
• Coverage for certain services up to a set dollar
amount
• Calendar year maximums
Health Access Product
Overview
• Available in IA, IL, MI, MO, MS, PA, SC, TN, WY
• No benefit waiting periods
• Based on consumer research, covers what is
important to employees
—Doctor office visits and prescription drugs
—Preventive care and immunizations
• Network discounts
• Affordable
• Portable
• Optional benefits such as Dental-Vision
Discount Plan, Dental Insurance and Cancer
Benefit
Health Access Plan A Overview
• No medical questions
• Eligibility rules apply
— Applicants through age 63 are eligible
— Not employer-sponsored
— Health Advocates Alliance Membership (some states)
• Benefits for every day needs
• Easy to apply for:
—
—
—
—
—
—
No underwriting
No pre-existing condition limitations
No ratings
No special exception riders
No condition-specific deductibles
No modified benefit endorsements
Health Access Plan A
Doctor Office Visits
Client pays copay and the plan pays 100% of the
remaining cost of an eligible office visit including
wellness, examination, consultation, evaluation,
development of a treatment plan, immunizations
and allergy shots.
Prescription Drug
Client pays copay and plan pays 100% up
to a maximum of $750 per calendar year
• $25 (Primary Care and Retail Health
Clinic)
• $35 (Specialist)
• Limit 4 office visits
• Plan pays $150 max per office visit
• No deductible or coinsurance
• $10/$50 (Generic/Brand)
• Plan pays up to $750 max per calendar
year
• No deductible or coinsurance
Outpatient Diagnostic Imaging
and Laboratory Services
• Plan pays up to $250 benefit for x-ray
and lab only
• No deductible or coinsurance
Surgical Services
• Must be performed during an office visit
• Plan pays $250 max per calendar year
• No deductible or coinsurance
Health Access Plan A – Premium
Rates
Age Bands
0-17
18-30
31-40
41-50
51-64
Primary
$34
$40
$43
$48
$61
Primary & Spouse
NA
$80
$86
$96
$122
Primary w/1 child
NA
$74
$77
$82
$95
Primary w/2 or more
children
NA
$121
$124
$129
$142
Primary & Spouse
with 1 child
NA
$114
$120
$130
$156
Primary & Spouse
with 2 or more
children
NA
$166
$172
$182
$208
Health Access Plans B or C Product Overview
• Limited medical questions
• Applicants through age 63 are eligible
• Inpatient, outpatient and prescription drug
benefits
• Easy to apply for:
— Accept/Reject application
— No ratings
— No special exception riders
— No condition-specific deductibles
— No modified benefit endorsements
Health Access Plans B or C
PLAN B
Doctor Office Visits
Client pays copay and the plan pays 100% of
the remaining cost of an eligible office visit
including wellness, examination,
consultation, evaluation, development of a
treatment plan, immunizations and allergy
shots.
Prescription Drugs
•
•
•
•
PLAN C
$25 (Primary Care, Specialist & Retail Health Clinic)
Limit 4 office visits
Plan pays $150 max per office visit
No deductible or coinsurance
• $10/$50/$75
• $10/$50/$75
• Plan pays up to $250 in
benefits
per calendar year
• No deductible or coinsurance
• Plan pays up to $750 in
benefits per calendar year
• No deductible or coinsurance
• $200 deductible
• 80%/20% coinsurance up to
$500 in benefits per
calendar year
• $200 deductible
• 80%/20% coinsurance up to
$1,000 in benefits per
calendar year
Surgical Services
• Inpatient and Outpatient
• Up to scheduled benefit
amount
• Up to $100,000 in benefits
per calendar year (based on
schedule)
• No deductible or coinsurance
• Inpatient and Outpatient
• Up to scheduled benefit
amount
• Up to $200,000 in benefits
per calendar year (based on
schedule)
• No deductible or coinsurance
Assistant Surgeon
• Up to 20% of amount paid for surgery
Client pays copay and plan pays 100% up to a
maximum of $250 or $750 per calendar year
Outpatient Medical Services
Includes outpatient hospital, surgical center
or urgent care facility and diagnostic
imaging and laboratory services,
chemotherapy, and radiation performed
during an office visit or as outpatient.
(Generic/Preferred Brand/
Non-Preferred Brand)
(Generic/Preferred Brand/
Non-Preferred Brand)
Health Access Plans B or C
PLAN B
PLAN C
Ambulance
(Ground/Air)
• Up to $100 ground/$1,000 air — per trip, up to two trips per calendar
year
Emergency Room
• Up to $250 in benefits for each of two
each of two
visits per calendar year
• $100 emergency room fee
• Fee waived if admitted
• No deductible or coinsurance
Up to $750 in benefits for
visits per calendar year
$100 emergency room fee
Fee waived if admitted
No deductible or coinsurance
Inpatient Benefit
Facility Charges
• Up to $750 in benefits per day
for sickness
• Up to $1,000 in benefits per day
for injury
• 80%/20% coinsurance up to
$100,000 in benefits per
calendar year
• No deductible
• Up to $2,000 in benefits per day
for sickness
• Up to $4,000 in benefits per day
for injury
• 80%/20% coinsurance up to
$200,000
in benefits per calendar year
• No deductible
Other Non-surgical/
Non-facility Inpatient
Services
• Considered under the inpatient per day maximum
• Coinsurance applies
• No deductible
Life Insurance
• Up to $10,000 benefit included for primary
Lifetime Maximum
• $ 1 Million
Network and Discounts
• The Health Access plans are not PPO plans
• Passive discounts through MultiPlan
—www.MultiPlan.com/assurant
• Choice of doctors and hospitals
• No out-of-network fees
• LabCard Select (LabOne) offers discounts on
covered outpatient laboratory services
—www.LabCardSelect.com
• Additional Discount Opportunities
—www.assuranthealth.com/corp/ah/
customers/findancillary provider
Rates
• Simplified rating
— Not gender rated
— Not area rated
— Not rated for risk class
— No smoker status
— Has very broad age bands
— Based on age of primary applicant
• Examples
— Plan A: 28-year-old woman w/ one child —
Monthly rate = $74
— Plan B: 40-year-old husband and wife — Monthly
rate = $194
— Plan C: 30-year-old single man — Monthly rate =
$104
Competitors’ Limited-Benefit
Plans
Other Carriers’
Assurant Health
Application Fee
No Application Fee
Waiting period
Benefits start day one
• Doctor Office Visit Copays
— Reimbursement — Insured pays
everything upfront and insurer
then reimburses
• Doctor Office Visit Copays
— Insured has health insurance
card
— Insured pays copay and then
plan pays
• Prescription Drug Coverage
— Insured pays copay and
then plan pays
Insureds can go to any doctor
• Prescription Discount Card
— Receives discounts rather
than actual coverage
Designated Networks for Doctors
No discounts after benefit maximums Discounts still apply even after
are met
benefit maximums are met
Two Quoting Options
• Online Quoting
— Access through home page of
www.assuranthealthsales.com under IMployee
— Quote plans and optional coverage together
— Print quote and submit with Enrollment Form
• Rate Sheet
— Convenient to submit with paper Enrollment Form
— Please follow the instructions on the rate sheet
when submitting to avoid delays
Enrollment Forms
• New, simple, and consumer-friendly Enrollment Forms
• Easy submission — fax your paper Enrollment Forms
to underwriting (instructions are on form) along
with a quote or rate sheet
— Health Access Plan A Enrollment Form
— Health Access Plan B or C Enrollment Form
— Complete Enrollment Form in its entirety for fast
service
• State-specific Enrollment Forms are on Find A Form
(www.assuranthealthsales.com)
• Packets including both Enrollment Forms, rate sheets
and tip sheets can be ordered from supply
Effective Date Rules
• Options are 1st or 15th of the month
—This is to simplify the List Bill process
• How to know which to choose:
—Enrollment Form signed date 1st-15th
= 1st of the next month
—Enrollment Form signed date 16th–31st
= 15th of the next month
—Example: Enrollment Form signed on 7/29
= first effective date available of 8/15
Assurant Affordable Health
Access
• Quoting
– EASE
– Manual Rate Sheets
– NO desktop software capabilities
•we will need to use EASE also
Health Sales Site – Launch the
IMployee tools
Click here to
proceed
Import a Group
1. Enter the following
if you know it:
-Business Name
-Business State
-Last Saved Date
2. Click Search
to return
results
3. Next Click on
the Business
Name to proceed
No Group Quote? Set-up a Business
Enter the following:
-Business name
-ZIP Code
-Number of employees
-Effective Date
Click next to
proceed
Employee Information Dashboard - Create a Quote –
To create a quote for Joe
click here
Create a Quote
Select a plan
type and click
‘Next’
Plan Information
Select the plan and
payment frequency
Click next once
plan information
is selected
Effective Date Rule
If the effective date
originally selected does not
meet the business rules
you are presented with
new options
Click ‘Update
Effective Date’
to proceed
Select your plan
Select the plan
information and
click ‘Next’
A Summary of the Quote
‘Start New Quote
takes you back to
the employee
information screen.
Click ‘Next’ to
continue
EASE - Take a Test
Drive
Take a Test Drive
• Experience EASE in a training
environment
– No worries
– Quote and Submission
– Works exactly the same
– Available 24x7
www.assuranthealthsales.com
Home Page
www.assuranthealthsales.com
Take A Test Drive
One Decreasing Deductible
Best for Clients Who:
• Value benefits provided with
OneDeductible Plan
• Understand savings advantages of a high
deductible
• Want to be rewarded for long-term
loyalty to plan
• Don’t want to be penalized for using
insurance plan
Features of OneDeductible
• Individual Deductible of $2,850 or
higher
• Family Deductible of $5,700 or higher
• 100% Coinsurance
• Available with or without a Health
Savings Account (in Georgia, available
only with an HSA plan)
One Decreasing Deductible
• Plan deductible credits issued two times
per year
• Deductible credits automatically applied
• Each deductible credit is 10% of the
original plan deductible
• Credits awarded in January and July
• Clients may never pay their full
deductible again!
Here’s an example:
Deductible
$5,000
x 10%
Deductible credit $ 500
Twice annually
x
2
$1,000 credit each year!
To Receive Deductible Credits:
• Policy must be effective for at least two
months
• Plan deductible has not been satisfied for
year; (deductible will reset and credits
resume in following year)
• One Decreasing Deductible has not
decreased below minimum levels;
(deductible minimums ensure compliance
with federal HSA requirements)
The Decreasing
Deductible
Example: $5,000 Single Deductible
The effective
deductible will go as
low as:
$1,500 Single
$3,000 Family
$4,000
$3,000
Accumulating Credits
$2,000
One Decreasing
Deductible
$1,000
Jul-1
2
Jan12
Jul-1
0
Jan11
Jul-1
1
Jan10
uctib
le
Jan09
Jul-0
9
$0
Ded
$3,500 Single
$7,000 Family
As deductible credits
accumulate, the effective
deductible decreases!
$5,000
$1,500
Assurant Health applies
deductible credit up to:
If a Claim Occurs:
Example: $5,000 Single Deductible
Effective Plan
deductible:
$2,500 Single
Assurant Health applies
deductible credit up to:
$2,500 Single
$6,000 Claim
Example: $6,000 Claim
Occurs in March, 2011
$5,000
$4,000
$3,000
• Deductible credit covers
remaining $2500 of
deductible. In total, plan
pays $3500 for claim.
$2,000
$1,000
11
12
Jan-
Jan-
0
Jul-1
10
Jan-
9
Jul-0
09
Jan-
tible
$0
Ded
uc
$2,500
• Customer pays only
$2500 for deductible
• Deductible will reset and
credits resume in January
2012
Recap—One Decreasing
Deductible
• Applies to OneDeductible plans with
100% coinsurance and deductibles of
$2,850 (individual) or $5,700 (family) or
higher
• Rewards clients with 10% Deductible
Credit
• Reduces deductibles down to:
– $1,500 for an individual
– $3,000 for a family
Available in
•
•
•
•
•
•
•
•
•
•
•
Arkansas
Alabama
Arizona
California
Colorado
DC
Florida
Georgia
Idaho
Iowa
Illinois
•
•
•
•
•
•
•
•
•
•
•
Indiana
Louisiana
Maryland
Michigan
Missouri
Montana
Nebraska
North Carolina
Ohio
Oklahoma
Pennsylvania
•
•
•
•
•
•
South Carolina
Tennessee
Texas
Virginia
Wisconsin
Wyoming
Patient Care
Patient Care is an independent advocacy company and is not affiliated
with Assurant Health.
Background
Research shows that consumers:
• Are often confused by the health care
system
• Respond favorably to having access to an
independent health care advocate
• Found this more appealing than our well
received multi-year rate guarantees
Interest in Healthcare Advocate
by Current Deductible
Interest regarding the Healthcare Advocate among consumers who currently
have a high deductible is greater than with consumers who have a lower
deductible.
+11.2%
+9.0%
+14.2%
30
25
21.7
20
Top 3 Box
•
17.6
15.9
15
8.6
10
5
7.5
4.7
0
<$500
$501-$2,000
>$2,000
$126 / $129 Premium
No Healthcare Advocate
Assurant Health Proprietary Information
6
Yes Healthcare Advocate
Source: 2008 Rx Benefit Conjoint
Patient Care Overview
• Experienced national leader in independent health
care advocacy services
• Provides a point of contact who serves as:
– An Advocate — working with insureds to answer
questions, help reduce frustration and confusion,
and better understand their health care benefits
– A resource — providing cost and quality information
to better inform insureds
– A problem solver — working with health care
entities to work through issues — thus taking
customers out of the middle
Unique Service Provides Value
Compare Costs
• Prior to a procedure or test, an Advocate can compare
costs for services of 2-3 network providers
• Customers can choose the most cost-effective care
and may reduce the amount they pay out-of-pocket
Provide Quality Data
• Number of procedures performed per year
• Complication rate
• Safe practice standards
• High-risk procedure capabilities
• Specialist staffing in ICU
Helps customers become better
health care consumers
Sample Cost Comparision
Costs vary
more than
$600!
Costs vary
more than
$2,800!
Knowing the costs up front can help clients
choose the most cost-effective care!
Sample of Quality Data
Patient Care Availability
• Patient Care services are available to
customers covered by Individual Medical,
KeyMed, Short Term Medical, and Real Choices
plans with effective dates
July 1, 2008 and later.
• Also available with Assurant Affordable Health
Access Plans with August 15 effective dates
and later.
Patient Care Fulfillment
Materials
Magnet
Welcome Letter
Brochure
HIPAA Letter
Patient Care does not determine medical
necessity or provide clinical advice.
Patient Care Fulfillment
Mailings
Policies with 7/1/08 effective dates:
• Issued prior to 7/1/08
– Patient Care kit mailed separately
• Issued after 7/1/08
– Patient Care kit mailed with policy packet
Point-of-Sale Pamphlet
• Highlights Patient Care’s
services ─ especially the costsaving features
• Cost-saving features especially
helpful for clients with high
deductible plans
• Pamphlet can be ordered
from Supply (Form 29895) or
downloaded from
www.assuranthealthsales.com
Rate Reductions
New! Rate Reductions
• Sizeable reductions in Colorado, Maryland,
Michigan, Montana, and Wisconsin
(eastern)
• Reductions ranging from10%—47%
• Rates vary by plans—CoreMed and HSAs
most competitive in many markets
• Maintained 2 and 3 year rate guarantees
• Applies to all deductibles and coinsurance
options
Double-digit rate reductions
• Reductions state-wide for all deductible
and coinsurance options
– Colorado—reduced 22% to 44%
– Maryland—reduced 12% to 28%
– Michigan—reduced 12% - 47%
– Montana—reduced 15% - 36%
• Targeted area reductions
– Eastern Wisconsin—reduced up to 10% 20%
Other Rate Reductions
•
•
•
•
•
•
•
Alaska: -5%
Arkansas: Fort Smith, Pine Bluff -10%
Iowa: Des Moines, Cedar Rapids -5%
Indiana / Kentucky: Evansville-Henderson -5%
Louisiana: New Orleans, Lafayette, Alexandria -5%
Oklahoma: Fort Smith -10%
Pennsylvania: Sharon -10%; Reading, Williamsport,
Erie, Altoona -5%
• Texas: Odessa-Midland, Tyler, Longview-Marshall, El
Paso, Abilene, Waco -5%
Reductions by plan
• 12%-28% lower rates
• 21%-25% lower rates
& SaveRight HSA
• 12%-25% lower rates
• 12%-20% lower rates
on CoreMed
on One Deductible
on MaxPlan
on RightStart
Maryland Rate Example
Individual Medical
Company
Assurant Health
Golden Rule
Plan Name
CoreMed
Copay Select
Deductible
$1,500
$1,500
Coinsurance
80%
80%
Premium
$504.52
$513.80
Baltimore zip 21001, Male 42 standard rate, Female 42 Preferred Rate,
2 children, $35 copay, no facility fees
Pennsylvania Rate Examples
Individual Medical
Company
Assurant Health
Golden Rule
Plan Name
CoreMed
Copay Select
Deductible
$1,500
$1,500
Coinsurance
80%
80%
Premium by zip code
19609 Reading
16601 Altoona
16501 Erie
18101 Allentown
$275.12
$258.85
$279.23
$296.80
$420.65
$449.12
$449.12
$415.90
Male 42 Preferred rate, Female 42 Preferred rate
Tele-Doc
9/1 and later effective dates
*TelaDoc doesn’t replace a primary care physician—
but when a physician isn’t available, TelaDoc is there.
TelaDoc—Convenient
• Access 24 hours a day, 365 days a year
• Clients call toll free or go online
• Medical records stored securely
and available online
– Client can update
– Client can share with
their doctor
• Available for patients
12 years and older
TelaDoc—Credible
• State-licensed, board-certified primary
care physicians
• Live and work in the U.S.
• Average 14 years experience
• Detailed credentialing process
• Physicians know when to treat
and when to refer
• More than one million members
• In surveys, 95% of callers would:
– Use service again
– Recommend it to others
TelaDoc—Cost-effective
• With MaxPlan
SM
and CoreMed
SM
Plans
– Three FREE consultations per person each year
– $35 fees for additional consultations are covered
subject to deductible and coinsurance
• Pay securely by credit card, debit card, or
electronic payment
• With OneDeductible Plans
– $35 consultation fees are covered subject to
deductible and coinsurance
• Pay securely by credit card, debit card, or
electronic payment
All terms, limits, and conditions
of the Assurant Health contract apply.
How it works
TelaDoc Physicians:
• Provide diagnosis
• Recommend treatment
• Prescribe short-term medication*
• Examples of common conditions
physicians consult and treat:
– Sinusitis/respiratory
infections
– Urinary tract infections
– Allergies
• Answer medical questions
• When appropriate, prescribe
convenience (limited-quantity)
refills*
*TelaDoc does not prescribe DEA-controlled substances.
How it works
Consultation process*—a TelaDoc physician:
• Reviews medical record
• Calls client—typically within an hour
• Recommends treatment or refers client to
primary care physician
• Updates medical record
• Prescribes a short-term medication, if
appropriate
– TelaDoc calls the prescription in to
client’s pharmacy
out
disclosure.
* Prior to contacting TelaDoc, client fills
medical history
TelaDoc
• Assurant Health is the first national IM carrier
to offer plans with TelaDoc Medical Services
• Available with MaxPlan, CoreMed, and
OneDeductible plans
• Available with new business effective
September 1, 2008, and later
• Not available on plan designs with an Office
Visit Copay option
• Not available in CT, FL, GA, ID, KY, MN, MT,
NH, NV, OK, OR, SC, or TN
KeyMed
SM
Assurant Health impaired risk
health plan
The KeyMedSM plan provides limited benefits and has both specific annual and per condition benefit limits.
This is not a major medical insurance plan and is not a replacement for one. Applicants are individually
underwritten and some individuals may not qualify.
New State Availability for July 26
7 States ─ effective date July 27
AK, ID, KS, MD,
ND, NM, WV
KeyMed is already available in AL, AR, AZ, CO, DE, FL, IA,
IL, IN, LA, MI, MO, MS, NC, NE, OH, OK, PA, SC, SD, TN,
TX, WI, WY
KeyMed
SM
• Underwriting enhancements
– No additional underwriting load added
for most apps reporting hypertension
– Positive impact for 85% of hypertension
apps
– Improved approach on applying ratings
to multiple conditions
• Counter-offers
– KeyMed plan offered to major medical
declines where appropriate
KeyMed Availability
SM
NH
WA
VT
MT
ME
ND
MA
OR
MN
ID
NY
WI
SD
RI
MI
WY
IA
NE
IL
NV
UT
IN
OH
DE
WV VA
CO
CA
CT
NJ
PA
KS
MO
DC
KY
NC
TN
AZ
NM
OK
MS
KeyMed available
KeyMed available July 26
Individual Medical plans not available
SC
AR
AL
GA
AK
LA
TX
FL
HI
MD
Thank you!
Thank you for attending!
Your Regional Sales Office
Greg Loerzel, RSD
[email protected]
1.800.215.TIME(8463)
*Follow up materials will be sent to the email you used
during registration*
[email protected]