FIRSTChoice *Guaranteed Issue* Health

Report
FIRSTChoice
“Guaranteed Issue”
Health Insurance Plans
Underwritten by:
Central United Life Insurance Company
Marketed by:
BMC Agency, Inc.
This PowerPoint presentation is
intended strictly as a training tool
for licensed FIRSTChoice agents, as
well as an information source for
prospective agents to evaluate the
product. It is expressly forbidden to
be used in any sales situation or
public venue, in whole or in part.
BMC Agency, Inc. has a “ZERO
TOLERANCE” policy in which any
violation of this “Agent Eyes Only”
rule by any FIRSTChoice
representative may result in their
immediate termination
WITH CAUSE!
FIRSTChoice Guaranteed Issue Health Plans
Central United Life is a member of the
Manhattan Insurance Group, whose
Worksite strategy is to offer sound,
affordable products that meet the
demands of even the most
sophisticated of Policyholders. CUL has
focused on the acquisition of life,
accident and health insurance for
more than 20 years.
FIRSTChoice Guaranteed Issue Health Plans
Since the introduction of the first
“Guaranteed Issue” Health Insurance
supplement for individuals in 2003, BMC
Agency, Inc. has remained committed to
refining and revolutionizing the
individual health insurance marketplace.
This is why CUL chose BMC to assist in
the development and promotion of their
incredible FIRSTChoice series.
FIRSTChoice
Guaranteed Issue Health Plans
Who qualifies for
“Guaranteed Issue” Consideration?
Individuals age 18-64 who
work an average of 30+ hours
per week, their spouse ( if 18-64 )
and their children.
FIRSTChoice Guaranteed Issue Health Plans
Once issued, the plans are
GUARANTEED RENEWABLE
to age 65, so long as premiums are
paid when due. It is not necessary
to maintain ‘full time’ employment
status once a FIRSTChoice
plan is issued!
FIRSTChoice Guaranteed Issue Health Plans
How are Pre Existing Conditions treated?
Conditions for which an insured sought or
received medical treatment in the 12
months prior to application date, or which
manifest symptoms that would have
caused an ordinarily prudent person (a
person of average intelligence) to have done so
will not be covered for 12 months after the
effective date, whether or not they are
disclosed on the application.
FIRSTChoice Guaranteed Issue Health Plans
Are there any Ineligible Conditions or
Ineligible Occupations with FIRSTChoice?
NO!
Individuals 18-64 working an average of 30+
hours per week may apply regardless of their
Occupation or Pre-Existing conditions!
FIRSTChoice Guaranteed Issue Health Plans
Most FIRSTChoice plan designs include a unique
combination of features that provide significant
“front loaded” benefits when they are needed
the most. There are three separate benefits
designed to provide cash for the expense of the
hospital room when confined.
1) The Daily Room Benefit
2) The Indemnity Benefit
3) The First Hospital Confinement Benefit
FIRSTChoice Guaranteed Issue Health Plans
The Daily Room Benefit is
paid for up to 365 days per period
of confinement, currently
much longer than any competitor.
( Others are usually 30 or 31 days maximum )
FIRSTChoice Guaranteed Issue Health Plans
The Indemnity
Benefit is
paid on the first day of
hospital confinement
in any calendar year.
FIRSTChoice Guaranteed Issue Health Plans
The First Hospital Confinement
Benefit is paid during the first
period of hospital confinement of
any calendar year. Depending on
the plan selected, it can be as much
as $10,000 over the first 6 days,
in addition to any and all
other benefits!
FIRSTChoice Guaranteed Issue Health Plans
The First Hospital Confinement Benefit
in both the GOLD and PLATINUM plan
designs pays as follows:
Day 1: $1,000
If a period of confinement
Day 2: $1,000
lasts less than 6 days, the
Day 3: $2,000
balance of the benefit is
Day 4: $2,000
available for a subsequent
Day 5: $2,000
confinement for the same
Day 6: $2,000
condition, provided it occurs
within 6 months.
TOTAL: $10,000
FIRSTChoice Guaranteed Issue Health Plans
There are THREE important areas
that must be considered when
selecting which Guaranteed Issue
plans to market. We feel that the
FIRSTChoice Plan Series is superior to
the competition in all three!
1) PLAN DE$IGN
2) PREMIUM$
3) COMPEN$ATION
FIRSTChoice Plan Design
The FIRSTChoice PLATINUM Plan has
9 separate benefits,
including the 4 most significant, that
are equal to or superior to
ANY OTHER GUARANTEED ISSUE
plan currently available!
As of 7/27/10
Daily Room
Benefit
Intensive
Care
Surgery
Anesthesia
Wellness
X-Ray /
Labs
Maternity
OP Sickness
( Doctor's Office )
Emergency Room
Prescription
Medicine
Critical
Illness
Private Duty
Nursing
AD&D
Accident
Mental Health
FIRSTChoice
PLATINUM PLAN
$2,500 days 1,3, 4, 5,& 6
$1,500 day two
$500 days 7 - 365
$2,000/day
Up to 20 days/yr.
IN ADDITION to DRB
$10,000 Schedule
Unlimited Times
25% of Surgical benefit
$400 mammogram,
$200 PSA, $100 PAP
X
Covered as any illness
10 month wait
4 X $100 per insured
category+
Increases OP Sick. benefit
to $150
X
X
USA+ Secure
Advantage 2000
Core Value 1000 MAX
eHealthStarr
GetMed 360
AIM Health Max Plus
$2,000/day
Up to 31 days/yr
$1,000/day
Up to 30 days/yr.
$1,000/day
Up to 30 days/yr. Then 3x
$500/day
X
$1,000/day x 31
$2,000 first day +
$1,000/day for 100 days
per year
$1,000/day
Up to 15 days/yr.
$2,000 days 2-31
IN LIEU of DRB
$1,000/day
up to 5 days/yr.,
IN ADDITION to DRB
$100% of Medicare
100% of RBRVS not to $100% of Medicare RBRVS
RBRVS
exceed charges
25% of Surgical benefit 20% of Surgery benefit
20% of Surgery benefit
$30 X 1 visit/yr or $20
1 X $150/yr.
$100 x one visit/yr.
Copay "in network"
1 X CWE at DirectLabs
$75 X 5/yr.
3 visits/yr 100% coins. to
$1,000 annual max, shared
with Dr. Office benefit
X
X
X
$100% of Medicare
RBRVS
25% of Surgical benefit
$150 x 1 per year
X
Covered as any illness
12 month wait
$100 x 7 per year
$400 x 5/yr.
$75 X 5/yr.
Companion Life RX
benefit
X
4-Tiered Rx
Discount Rx
X
Discount Program
$20 copay X 5 in network
$40 X 5 out of network
Max of 2 visits to receive
Max of $1,000.yr.
$100 ded. per visit
X
X
$10,000
Generic Copay + Brand
Name discount card
$5,000
X
$250/day for
20 days/yr.
$30,000
% of $1,800 schedule +
4 X $200 per accident
X
X
X
X
X
X
$10,000
1 per year. $5000 $200 ded.
X
X
$5,000 annual max
$100 ded, then 80%
60 x $500/day Inpatient
10 x $25 Outpatient
X
X
X
X
X
X
60X $500/day inpatient
20 x $25 outpatient
60 x $500/day Inpatient
40 x $50 -75% Coins.
Outpatient
( Combined with Mental
Health benefit above )
$15,000
$5,000 less $100 ded. All
other benefits pay first.
X
X
X
$241.00/mo.
$300/trip, one trip/yr.
$370/mo.
$282.72/mo.
$334/mo.
1 x up to $100/yr.
$329.90
X
$349/mo.
Substance Abuse
Ambulance
PRICE
$10,000 Schedule
Max of 2 Times/yr.
25% of Surgical benefit
$20 Copay X 5 in network
$40 X 5 out of network
Up to $100 x 3/yr.
5 X $30 or $20 Copay
"in network"
1 per year up to $100
X
5 X $30 Copay, 100% coins.
to $1,000 annual max
$100 per visit,
1 visit per year
$2,000/day
Up to 15 days/yr.
X
As of 7/27/10
Daily Room
Benefit
Intensive
Care
Surgery
Anesthesia
Wellness
X-Ray /
Labs
Maternity
OP Sickness
( Doctor's Office )
FIRSTChoice
GOLD PLAN
USA+ Essential
Health 1000
Core Value 1000
eHealthStarr
Starr 500
GetMed 360
Platinum 250
Value Health Plan
Diamond Plan
$2,100 days 1,3, 4, 5,& 6
$1,400 day two
$400 days 7 - 365
$1,000/day
Up to 20 days/yr.
IN ADDITION to DRB
$5,000 Schedule
Unlimited Times
25% of Surgical benefit
$1,000/day
Up to 31 days/yr
$1,000/day
Up to 30 days/yr.
$500/day
Up to 30 days/yr.
$250/day x 31
$1,000/day
Up to 30 days/yr.
$2,000 days 2-31
IN LIEU of DRB!
X
X
$1,000/day
Up to 15 days/yr.
$3,000/day Up to 14 days/yr.
IN LEU of DRB!
$100% of Medicare RBRVS
80% of RBRVS not to
exceed charges
20% of Surgery benefit
$80% of Medicare RBRVS
$10,000 Schedule
Max of 2 Times/yr.
25% of Surgical benefit
$8,000 Schedule
1 X $150/yr.
$100 x one visit/yr.
$75 X 3/yr.
3 visits/yr 80% coins. to $1,000
annual max, shared with Dr.
Office benefit
X
$200 mammogram,
$100 PSA, $50 PAP
X
Covered as any illness
10 month wait
4 X $75 per insured category+
25% of Surgical benefit,
Max of $500
$30 X 1 visit/yr or $20
Copay "in network"
1 X CWE at DirectLabs
20% of Surgery benefit
20% of Surgical benefit
$20 Copay X 5 in network
$40 X 5 out of network
X
X
Discount
X
X
X
X
5 X $30 or $20 Copay "in
network"
$75 X 3/yr.
5 X $30 Copay, 100% coins. to
$1,000 annual max
$20 copay X 5 in network
$40 X 5 out of network
$75 X 5/yr.
X
Discount
Emergency Room
Increases OP Sick. benefit to
$112.50
1 per year up to $100
X
$75 per visit,
1 visit per year
Prescription Medicine
X
X
Discount Program
Critical
Illness
Private Duty Nursing
X
X
4-Tiered Rx
Discount Rx
X
Max of 2 visits to receive Max
of $1,000.yr.
$100 ded.
per visit
X
X
X
X
$150/day for
20 days/yr.
$20,000
X
X
X
X
X
$10,000
X
X
$15,000
X
1 per year. $5000 - $200
ded.
X
$5,000 annual max
$100 ded, then 80%
60 x $500/day Inpatient
10 x $25 Outpatient
X
$75/visit X 2 visits/yr.
60 x $250/day Inpatient
40 x $50 -75% Coins. Outpatient
$5,000 less $100 ded. All other
benefits pay first.
X
X
60X $500/day inpatient
20 x $25 outpatient
( Combined with Mental Health
benefit above )
X
X
X
$100/trip X 2 trips/yr.
$199.90
18-39= $85/mo * 4049=$180/mo.
50-59=$266/mo. * 6064=$288/mo.
AD&D
Accident
Mental Health
Substance Abuse
% of $1,800 schedule +
$150 per accident
X
X
Ambulance
PRICE
4X
300/ trip, max of 1 trip/yr.
$156/mo.
$245/mo.
$282.72/mo.
$241/mo.
X
FIRSTChoice Plan Design
Remember that all FIRSTChoice
plans are GUARANTEED
RENEWABLE POLICIES, not
certificates of some Group Master
policy or Association Plan.
This provides much greater
protection for the insureds!
FIRSTChoice Plan Design
FIRST Choice Plans are true
“Defined Benefit” plans. As
such, the stipulated benefit is
always paid in full, regardless
of the billed amount. There is
no “pays UP TO $$$” language
in FIRST Choice policies!
FIRSTChoice Plan Design
Unlike the competition, many of which
have no benefit for Intensive Care, or
pay it “in lieu” ( instead of! ) the DRB,
FIRSTChoice policies pay all Intensive
Care benefits IN ADDITION TO
any and all other benefits of the policy,
including the DRB. This is a HUGE
advantage to the policyholder!
FIRSTChoice Plan Design
Virtually ALL Guaranteed Issue Plans address
SURGERY in one of two ways. Many pay a
percentage, often 100%, of the Medicare
reimbursement rate ( RBRVS, or Resource Based
Relative Value Scale ). What many agents and
most clients do not realize is that this amount IS
NOT based upon the total cost of the procedure,
but simply on the amount charged by the
PRIMARY SURGEON ONLY! This does not include
the Operating Room, Suture Kits, dressings, etc.!
FIRSTChoice Plan Design
Another problem is this; at a time
when an estimated 46% of doctors
are threatening to boycott Medicare
over what they feel is inadequate
compensation, how will a client
under age 65, and not covered by
Medicare, compel their doctor to
accept this discounted amount?
FIRSTChoice Plan Design
The rest address Surgery with an
established Surgical Schedule,
usually with a maximum benefit of
$10,000. Often, the benefit from a
$10,000 Surgical Schedule will be
more than for the identical
procedure under a 100% RBRVS
Medicare Reimbursement rate!
FIRSTChoice Plan Design
One drawback to most plans
with Surgical Schedules is
that they tend to limit
coverage to one or two
surgical procedures per year,
maximum!
FIRSTChoice Plan Design
FIRSTChoice incorporates the
best of both, with a
$10,000 Surgical Schedule that
can be accessed an UNLIMITED
number of times each year, for
either inpatient or outpatient
procedures!
FIRSTChoice Plan Design
The FIRSTChoice benefit for
Anesthesia is the highest
percentage paid, 25% of the amount
paid for Surgery. Since our Surgical
Schedule will deliver more benefits
and do it more often than other
plans, the Anesthesia Benefit is
correspondingly higher as well!
FIRSTChoice Plan Design
Unlike the vast majority of
competitors, FIRSTChoice plans
provide benefits for MATERNITY,
both Natural Delivery as well as
Caesarian Section, effective 10
months after the policy
effective date!!
FIRSTChoice Plan Design
FIRSTChoice plans are the only
“Guaranteed Issue” plans
currently known to include
Private Duty Nursing benefits.
The Platinum Plan also has the
highest levels of AD&D
protection, $30,000!
FIRSTChoice Plan Design
The total paid for an Accident will
come from several different plan
benefits. They are:
1) Accident Rider
2) Specific Injury Rider
3) Surgery Schedule, with
Anesthesia
FIRSTChoice Plan Design
Accident Rider: Pays a (first dollar)
benefit for each accident.
Specific Injury Rider: Pays as
much as $1,800 per accident from a
(first dollar) schedule of procedures.
Surgery Schedule: Pays a (first
dollar) percentage of the Surgery
Schedule, plus 25%+ for anesthesia!
FIRSTChoice Plan Design
There are benefits absent from
FIRSTChoice that appear with
other Guaranteed Issue plans.
They include Prescription Drugs,
Outpatient Labs & X-Rays, Critical
Illness, and “Association Junk”
FIRSTChoice Plan Design
Prescription Drugs tend to
fall into one of two
categories,
Maintenance Drugs and
Occasional Drugs.
Let’s consider each!
FIRSTChoice Plan Design
Maintenance Drugs are taken
regularly, and are often available in
generic or generic equivalents.
Literally hundreds are available at
discount chains, often for $4.00
each, or less! These are less
expensive than when using a
discount drug card!
FIRSTChoice Plan Design
Maintenance Drugs can also be
very expensive. For that reason, ALL
BMC Agents are provided access to
a quality PPO repricing and
Discount Medical benefits card.
This optional benefit can reduce the
cost of procedures by 30%
and more!
FIRSTChoice Plan Design
Occasional Drugs are most
commonly Antibiotics, used
infrequently, and Pain Medication,
usually very inexpensive. We
believe it is less costly over time for
the client to ‘pay as you need’
these, as opposed to building in
costs that drive up plan premiums.
FIRSTChoice Plan Design
X-Rays and Lab tests are legitimate
medical procedures, but have
become abused as doctors
increasingly practice ‘defensive
medicine.’ We have chosen to avoid
coverage for these elements in favor
of additional coverage for expensive
confinements/procedures.
FIRSTChoice Guaranteed Issue Health Plans
Critical Illness plans normally require
even more scrutiny in underwriting
than Major Medical. To include CI
benefits within a Guaranteed Issue
program adds a disproportionately
high premium cost that we feel is
an ineffective use of our clients
premium dollars.
FIRSTChoice Plan Design
Prior to 2003, the only option for
“Uninsurable” clients was an
expensive ‘state pool’ or an
“Association Package” that featured
“discounts” on some medical
services, but mostly benefits
unrelated to Health Insurance.
FIRSTChoice Plan Design
Today, even though numerous
“Guaranteed Issue” plans exist that
feature solid Health Insurance
benefits, most plans are still littered
with movie tickets, rental cars,
Disney discounts, and vitamins.
With FIRSTChoice, you get quality
INSURANCE BENEFITS, period.
FIRSTChoice Plan Design
By limiting eligibility to employees
who work an average of 30+
hours/week, and avoiding marginal
benefits subject to abuse, we are able
to provide what we believe to be the
strongest package of “Guaranteed
Issue” benefits available in our
industry today!
FIRSTChoice Premiums
Ranging from the HSA Supplement for
less than a dollar a day, to the
PLATINUM plan design with the richest
benefits available in any Guaranteed
Issue chassis, FIRSTChoice plan designs
are available in a variety of
configurations, all of which are lower in
price than competitor plans with fewer
and smaller benefits!
FIRSTChoice COMPEN$ATION
Almost all “Guaranteed Issue” plans
today pay a ‘levelized’ commission, and
very few offer annualization.
FIRSTChoice plans provide ‘heaped’
first year commission with 6 months
advanced commissions available to
agents that qualify!
FIRSTChoice COMPEN$ATION
The highest commission levels
available from competitors for top
IMO/FMO contracts is
30% First Year Commission.
*********************************************************************************************************************
This same 30%, (with 8%
renewals), is what we pay
AGENTS with FIRSTChoice!
FIRSTChoice COMPEN$ATION
Higher Contracts can be earned
by General Agencies and
Managers with
active production teams.
Details are available from the
BMC Marketing Partner
that provided you with this
PowerPoint presentation!
BMC Agency, Inc. and CUL FIRSTChoice
STRONG BENEFITS!
************************************************************************************************************
Low Premiums!
***********************************************************************************************************
High Compensation!
**************************************************************************************************************
“The FIRSTChoice in
Guaranteed Issue Health Plans!”

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