A gent  T raining  P resentation Agent Training  - October 2010 Insured by American Medical and Life Insurance (AMLI)
National Congress of Employers <ul><li>A national organization that represents the needs and concerns of America's growing...
Administrative Partner <ul><li>Benefit Transact  </li></ul><ul><li>Web site – 24/7 </li></ul><ul><li>On line contracting <...
Insurance Carrier <ul><li>American Medical and Life Insurance Company </li></ul><ul><li>Incorporated in 1964 in New York (...
Claims Administration <ul><li>TPA:  Hammerman and Gainor </li></ul><ul><li>Address: </li></ul><ul><ul><li>American Medical...
HIPAA Qualified? <ul><li>This plan is NOT HIPAA Qualified for providing creditable coverage certificates when leaving the ...
Product Overview <ul><li>The plans offer valuable association and insurance benefits for consumers who: </li></ul><ul><ul>...
Provider Access <ul><li>NCE Advantage utilizes the MultiPlan Network </li></ul><ul><ul><li>maximize the client’s savings <...
Eligibility  <ul><li>Association: </li></ul><ul><li>Dues paying members between ages 18 and 64 </li></ul><ul><li>Dependent...
States Available (28)  <ul><li>Alabama </li></ul><ul><li>Arkansas </li></ul><ul><li>Arizona </li></ul><ul><li>Delaware </l...
$5,000 $5,000 $5,000 $5,000 $5,000 On Primary Member Only Life Insurance Benefit (not insured by AMLI) $25 20 $25 20 $25 2...
Plan Rates One time enrollment fee is not included. $801 $669 $536 $499 $356 Member & Family (unlimited) $551 $462 $374 $3...
Plan Highlights <ul><li>Guaranteed Issue </li></ul><ul><li>First Dollar Coverage – No Co-pays </li></ul><ul><li>Creditable...
Benefit Highlights <ul><li>In-Patient Hospital Confinement </li></ul><ul><li>Preventive Care Tests </li></ul><ul><li>ICU/C...
Doctor Office Visits <ul><li>Covers charges for and require a doctor’s office visit due to injuries received in a covered ...
Preventive Care Tests Benefit <ul><li>Policy will pay the preventive care test benefit, shown on the certificate schedule,...
Diagnostic Lab and X-ray <ul><li>Medically necessary diagnostic tests and x-rays performed in a doctor's office, hospital ...
Inpatient Hospital Confinement <ul><li>Charges for a confinement in the hospital due to injuries received in a covered acc...
ICU/CCU <ul><li>Charges for a confinement in a hospital ICU/CCU due to injuries received in a covered accident OR sickness...
Surgery (Surgeon) <ul><li>If insured has a surgical procedure due to a covered accident OR sickness </li></ul><ul><li>Cove...
Maternity <ul><li>Delivery is paid under the surgery benefit </li></ul><ul><li>The maternity related expense would work th...
Anesthesia <ul><li>Anesthesia administered by a licensed anesthesiologist or certified registered nurse anesthetist </li><...
Accident  (N/A in TX) <ul><li>Benefit pays after the other policy benefits have been exhausted </li></ul><ul><li>If a Cove...
Inpatient Mental Health and Substance Abuse <ul><li>Each day of confinement if confined to a hospital or licensed institut...
Outpatient Mental Health and Substance Abuse <ul><li>Treatment received as an outpatient in an outpatient facility as a re...
NCE Association Discount Benefit Highlights <ul><li>Pharmacy Discount Card </li></ul><ul><li>$5,000 Life Insurance  (Prima...
NCE Consumer Discount Benefits Category Products/Services Typical Savings Pharmacy Prescription drugs Average 20% retail; ...
NCE Consumer Savings Benefits Beauty and Skin Care Aura Cacia, FamilyMeds, Gaiam ,MotherNature.com, SalonWish, Spa Finder ...
Medical Benefit Provisions <ul><li>Pre-Existing Conditions  </li></ul><ul><ul><li>Policies have  preexisting conditions li...
Limitations and Exclusions <ul><li>Benefits will not be paid for: </li></ul><ul><ul><li>Treatment, services or supplies wh...
Additional Limitations and Exclusions <ul><li>Benefits will not be paid for by sickness or injuries caused by (except as s...
Effective Date and Billing <ul><li>Effective dates are the 1st and 15 th  of each month </li></ul><ul><li>On line enrollme...
Fulfillment Materials <ul><li>Insured will receive an instant email when application is submitted, with a copy of their NC...
Sales Tips <ul><li>DO NOT Represent Limited Medical as: </li></ul><ul><ul><li>“Same as your employer plan” </li></ul></ul>...
Sales Tips <ul><li>Clearly explain the limited nature of the plan: </li></ul><ul><ul><li>“ This limited health benefits pl...
Sales Tips <ul><li>Clearly explain the limited nature of the plan – it is financial assistance, not complete coverage </li...
Agent Appointment <ul><li>An agent MUST be licensed in their resident state and any non-resident state in which the consum...
Member Services for Agents and Members Member Services Representatives are available from 8:30 a.m. CST to 5:30 p.m. CST b...
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Agent Training Presentation Agent Training - October 2010

  1. 1. A gent T raining P resentation Agent Training - October 2010 Insured by American Medical and Life Insurance (AMLI)
  2. 2. National Congress of Employers <ul><li>A national organization that represents the needs and concerns of America's growing small business workforce through advocacy, information and service </li></ul><ul><li>NCE is leading a campaign for tax reform, deregulation of small business, and building support for expanding health coverage and retirement planning </li></ul><ul><li>Includes valuable consumer benefits package   </li></ul>
  3. 3. Administrative Partner <ul><li>Benefit Transact </li></ul><ul><li>Web site – 24/7 </li></ul><ul><li>On line contracting </li></ul><ul><li>Each agent receives their own web site! </li></ul><ul><li>On line enrollment portal </li></ul><ul><li>Billing </li></ul><ul><li>Policy Fulfillment </li></ul><ul><li>Customer Service </li></ul><ul><li>Agent Back Office </li></ul><ul><ul><li>Manage your business </li></ul></ul><ul><ul><li>Email your clients </li></ul></ul><ul><li>Marketing materials </li></ul><ul><li>Pre-approved marketing pieces </li></ul>
  4. 4. Insurance Carrier <ul><li>American Medical and Life Insurance Company </li></ul><ul><li>Incorporated in 1964 in New York (Home Office NYC) </li></ul><ul><li>www.usamli.com </li></ul>
  5. 5. Claims Administration <ul><li>TPA: Hammerman and Gainor </li></ul><ul><li>Address: </li></ul><ul><ul><li>American Medical and Life Insurance Co. </li></ul></ul><ul><ul><li>P.O. Box # 1353 </li></ul></ul><ul><ul><li>Chicago, IL 60690 </li></ul></ul><ul><li>Member Services: </li></ul><ul><ul><li>(888) 264-1512 </li></ul></ul>
  6. 6. HIPAA Qualified? <ul><li>This plan is NOT HIPAA Qualified for providing creditable coverage certificates when leaving the program. (as of November 1, 2010) </li></ul><ul><li>AMLI WILL accept prior creditable coverage for members enrolling INTO the program. </li></ul><ul><li>Proof of prior creditable coverage should be faxed to the number on the NCE Advantage web site. </li></ul><ul><ul><li>No GAP in coverage for 63 days or less (may increase in some states) </li></ul></ul><ul><li>Members who enter this plan presenting a Certificate of Creditable Coverage will receive credit toward this plan’s pre-existing conditions limitation. </li></ul>
  7. 7. Product Overview <ul><li>The plans offer valuable association and insurance benefits for consumers who: </li></ul><ul><ul><li>May not qualify for full comprehensive major medical </li></ul></ul><ul><ul><li>Can not afford full comprehensive major medical </li></ul></ul><ul><ul><li>Looking to reduce the cost of current medical premium </li></ul></ul><ul><ul><li>A reasonable alternative (not replacement) for more costly Major Medical programs </li></ul></ul><ul><ul><li>GUARANTEED ISSUE – NO UNDERWRITING REVIEW </li></ul></ul>
  8. 8. Provider Access <ul><li>NCE Advantage utilizes the MultiPlan Network </li></ul><ul><ul><li>maximize the client’s savings </li></ul></ul><ul><ul><li>reduce out-of-pocket expenses </li></ul></ul><ul><li>All plans pay the same dollar amounts whether or not the network is utilized, and there is no reduction in benefits </li></ul><ul><li>If a network provider is used, the claim is electronically re-priced and a significant discount is realized by the insured </li></ul><ul><li>550,000 practitioners in all 50 states! </li></ul><ul><li>The link to find a provider 24/7 on line is available on the NCE Advantage website </li></ul>
  9. 9. Eligibility <ul><li>Association: </li></ul><ul><li>Dues paying members between ages 18 and 64 </li></ul><ul><li>Dependent children under the age of 19 </li></ul><ul><ul><li>No child only applications. A 19 year old cannot add a sibling as a dependent </li></ul></ul><ul><li>Members not eligible for Medicare </li></ul><ul><li>Insurance: </li></ul><ul><li>Member’s unmarried dependent children with proof of full time student status between the ages of 19 and 26 </li></ul><ul><li>Members not in full-time service of the Armed Forces (military) </li></ul><ul><li>Members that are legal residents of United States </li></ul><ul><li>Members not receiving disability benefits or Worker’s Compensation </li></ul>
  10. 10. States Available (28) <ul><li>Alabama </li></ul><ul><li>Arkansas </li></ul><ul><li>Arizona </li></ul><ul><li>Delaware </li></ul><ul><li>DC </li></ul><ul><li>Florida </li></ul><ul><li>Georgia </li></ul><ul><li>Hawaii </li></ul><ul><li>Idaho (Unified Life Insurance Company) </li></ul><ul><li>Illinois </li></ul><ul><li>Louisiana </li></ul><ul><li>Michigan </li></ul><ul><li>Mississippi </li></ul><ul><li>Missouri </li></ul><ul><li>Nebraska </li></ul><ul><li>Nevada </li></ul><ul><li>New Mexico </li></ul><ul><li>Ohio </li></ul><ul><li>Oklahoma </li></ul><ul><li>Pennsylvania </li></ul><ul><li>Rhode Island </li></ul><ul><li>South Carolina </li></ul><ul><li>Tennessee </li></ul><ul><li>Texas (No AME) </li></ul><ul><li>Virginia (Unified Life Insurance Company) </li></ul><ul><li>West Virginia </li></ul><ul><li>Wisconsin </li></ul><ul><li>Wyoming </li></ul>
  11. 11. $5,000 $5,000 $5,000 $5,000 $5,000 On Primary Member Only Life Insurance Benefit (not insured by AMLI) $25 20 $25 20 $25 20 $25 20 $25 20 Per Visit Maximum # of Visits Outpatient Substance Abuse $500 60 $500 60 $375 60 $250 60 $150 60 Per Day Maximum Days Inpatient Substance Abuse $25 20 $25 20 $25 20 $25 20 $25 20 Per Visit Maximum # of Visits Outpatient Mental Health $500 60 $500 60 $375 60 $250 60 $150 60 Per Day Maximum Days Inpatient Mental Health $100 80% $5,000 $100 80% $5,000 $100 80% $2,500 $100 80% $2,500 $100 80% $1,000 Ded (Per policy yr) Payment at Maximum Accident (Not available in Texas) 20% 20% 20% 20% 20% % of Surgery Anesthesia 100% Unlimited 80% Unlimited 80% Unlimited 70% Unlimited 50% Unlimited % of RBRVS* Annual Max Surgery $1,000 5 N/A N/A $750 10 $500 10 Per Day Maximum # of Days ICU/CCU $1,000 30 $1,000 30 $750 30 $500 30 $300 30 Per Day Maximum # of Days Hospital Confinement $75 5 $75 3 $50 3 $50 2 N/A Per Day Maximum Days Diagnostic Lab and X-ray $150 1 $150 1 $100 1 $50 1 $50 1 Per Visit Maximum Visits (Tests) Preventive Care Test $75 5 $75 3 $50 3 $50 3 $50 3 Per Visit Maximum Visits – PER INSURED Doctor Office Visits 1000 Plus 1000 750 500 300 Benefit Description (Maximums are Per Policy Yr) Benefit (PER INSURED)
  12. 12. Plan Rates One time enrollment fee is not included. $801 $669 $536 $499 $356 Member & Family (unlimited) $551 $462 $374 $349 $254 Member & Children (unlimited) $606 $508 $410 $383 $275 Member & Spouse $328 $279 $230 $216 $163 Member 1000 Plus 1000 750 500 300 MONTHLY RATES
  13. 13. Plan Highlights <ul><li>Guaranteed Issue </li></ul><ul><li>First Dollar Coverage – No Co-pays </li></ul><ul><li>Creditable Coverage Satisfaction for Pre-X for members entering the program </li></ul><ul><ul><li>No GAP in coverage for 63 days or less (may increase in some states) </li></ul></ul><ul><li>No Lifetime Maximum Benefit Amount </li></ul><ul><li>30-Day Free Look Period </li></ul><ul><li>On Line Enrollment </li></ul>
  14. 14. Benefit Highlights <ul><li>In-Patient Hospital Confinement </li></ul><ul><li>Preventive Care Tests </li></ul><ul><li>ICU/CCU Stays (most plans) </li></ul><ul><li>Doctor’s Office Visits (including specialists) </li></ul><ul><li>Diagnostic Laboratory and X-Ray </li></ul><ul><li>Accidents (not available in Texas) </li></ul><ul><li>Mental Health and Substance Abuse </li></ul><ul><li>Surgery with anesthesia rendered by a licensed </li></ul><ul><li>anesthesiologist or Certified Registered Nurse </li></ul><ul><li>Anesthetist (CRNA) </li></ul>
  15. 15. Doctor Office Visits <ul><li>Covers charges for and require a doctor’s office visit due to injuries received in a covered accident OR sickness </li></ul><ul><li>Includes Chiropractors (office visit only – manipulations are not covered under this benefit) </li></ul><ul><li>A Doctor or Physician means a legally qualified practitioner of the healing arts acting within the scope of his or her license and is not an Immediate Family Member </li></ul>
  16. 16. Preventive Care Tests Benefit <ul><li>Policy will pay the preventive care test benefit, shown on the certificate schedule, if any covered person incurs charges for and has one of only the following preventive care tests listed below performed per year: </li></ul><ul><li>Blood test for triglycerides </li></ul><ul><li>Bone marrow testing </li></ul><ul><li>Breast ultrasound </li></ul><ul><li>CA 15-3 (blood test for breast cancer) </li></ul><ul><li>CA 125 (blood test for ovarian cancer) </li></ul><ul><li>CEA (blood test for colon cancer) </li></ul><ul><li>Chest X-ray </li></ul><ul><li>Colonoscopy or virtual colonoscopy </li></ul><ul><li>Eye exam performed by a licensed optometrist or ophthalmologist </li></ul><ul><li>Fasting blood glucose test </li></ul><ul><li>Flexible sigmoidoscopy </li></ul><ul><li>Hemoccult stool analysis </li></ul><ul><li>Mammography (baseline and annual screenings) </li></ul><ul><li>PSA (blood test for prostate cancer) </li></ul><ul><li>Pap smear or Thin Prep Pap Test </li></ul><ul><li>Serum Protein Electrophoresis (blood test for myeloma) </li></ul><ul><li>Stress test on a bicycle or treadmill </li></ul><ul><li>Child Screening Services from birth to age 21 (if covered under the plan). Schedule set by the American Academy of Pediatrics </li></ul>
  17. 17. Diagnostic Lab and X-ray <ul><li>Medically necessary diagnostic tests and x-rays performed in a doctor's office, hospital or outpatient facility. E.g. MRI, CAT Scan, EKG. </li></ul>
  18. 18. Inpatient Hospital Confinement <ul><li>Charges for a confinement in the hospital due to injuries received in a covered accident or sickness </li></ul>
  19. 19. ICU/CCU <ul><li>Charges for a confinement in a hospital ICU/CCU due to injuries received in a covered accident OR sickness </li></ul><ul><li>A Hospital Intensive Care Unit that meets the definition above may include Hospital units with the following names: </li></ul><ul><ul><li>Intensive Care Unit </li></ul></ul><ul><ul><li>Coronary Care Unit </li></ul></ul><ul><ul><li>Neonatal Intensive Care Unit </li></ul></ul><ul><ul><li>Pulmonary Care Unit </li></ul></ul><ul><ul><li>Burn Unit </li></ul></ul><ul><ul><li>Transplant Unit </li></ul></ul>
  20. 20. Surgery (Surgeon) <ul><li>If insured has a surgical procedure due to a covered accident OR sickness </li></ul><ul><li>Covers cost of “primary surgeon charges” only </li></ul><ul><li>The procedure must be performed by a Physician and require anesthesia administered by a licensed anesthesiologist or certified registered nurse anesthetist </li></ul><ul><li>Outpatient is covered, but must require an anesthesia that meets the definition above </li></ul><ul><li>Reimbursements are based on the Medicare/RBRVS benefits schedule </li></ul><ul><li>Maternity is considered a surgery and is covered under this benefit. </li></ul>
  21. 21. Maternity <ul><li>Delivery is paid under the surgery benefit </li></ul><ul><li>The maternity related expense would work the same as any other illness. The provider bills would be processed under any benefit that qualifies. (surgery, x-ray, lab, as shown on the physician billing). The hospital stay would fall under the hospital benefits and paid according to the hospital benefit schedule. Any doctor office visits would fall under the doctor office visits benefit. </li></ul><ul><li>There is a surgical RBRVS schedule </li></ul><ul><li>Not subject to pre-x </li></ul><ul><li>Newborn is covered for 31 days </li></ul><ul><li>Insured must add newborn as a dependent within 31 days if they want coverage </li></ul>
  22. 22. Anesthesia <ul><li>Anesthesia administered by a licensed anesthesiologist or certified registered nurse anesthetist </li></ul><ul><ul><li>Does not cover basic anesthesia administered by a doctor (mole removal, etc.) </li></ul></ul><ul><li>Payable as a percentage (20%) of the surgical allowance </li></ul>
  23. 23. Accident (N/A in TX) <ul><li>Benefit pays after the other policy benefits have been exhausted </li></ul><ul><li>If a Covered Person is injured in a Covered Accident, this Accident Medical Benefit will cover any remaining expenses, not covered by the policy according to the Schedule of Benefits and Policy Provisions </li></ul><ul><li>Costs must be incurred within 90 days of accident or injury </li></ul><ul><li>Benefits paid for: </li></ul><ul><ul><li>Hospital Room and Board (General Nursing) </li></ul></ul><ul><ul><li>Hospital Services and Supplies </li></ul></ul><ul><ul><li>Operating and Recovery Room </li></ul></ul><ul><ul><li>Physician Charges, Private Duty Nurse </li></ul></ul><ul><ul><li>Diagnostic tests, x-rays, lab </li></ul></ul><ul><ul><li>Anesthetic and Prescription Drugs </li></ul></ul><ul><ul><li>Rental of Durable Medical Equipment </li></ul></ul><ul><ul><li>Artificial limbs, eyes and other prosthetic devices </li></ul></ul><ul><ul><li>Casts, splints, trusses, crutches and braces </li></ul></ul><ul><ul><li>Oxygen and rental of equipment for oxygen </li></ul></ul><ul><ul><li>Physiotherapy given by a licensed physical therapist </li></ul></ul>
  24. 24. Inpatient Mental Health and Substance Abuse <ul><li>Each day of confinement if confined to a hospital or licensed institution to provide treatment for mental illness or substance abuse </li></ul><ul><li>There are mental and substance abuse providers in the MultiPlan network </li></ul>
  25. 25. Outpatient Mental Health and Substance Abuse <ul><li>Treatment received as an outpatient in an outpatient facility as a result of mental illness or substance abuse </li></ul><ul><li>There are mental and substance abuse providers in the MultiPlan network </li></ul>
  26. 26. NCE Association Discount Benefit Highlights <ul><li>Pharmacy Discount Card </li></ul><ul><li>$5,000 Life Insurance (Primary Member) </li></ul><ul><ul><li>Term Life (Lincoln National) </li></ul></ul><ul><ul><li>Guaranteed Issue, no waiting period </li></ul></ul><ul><li>Vision, Dental and Hearing </li></ul><ul><li>Alternative Care </li></ul><ul><li>Wellness </li></ul><ul><li>Long-Term Care Services </li></ul><ul><li>Infertility Treatment </li></ul>
  27. 27. NCE Consumer Discount Benefits Category Products/Services Typical Savings Pharmacy Prescription drugs Average 20% retail; 50% mail order Vision Care Optometry, laser vision correction, mail-order products 5 - 50%, Annual exams for $40 max Laser vision correction: 5-15% Dental care General and cosmetic dentistry, orthodontics, specialty care 10-35% Alternative Care Chiropractic, acupuncture, massage therapy, naturopathy 20% Wellness Weight management, smoking cessation, fitness equipment 10-50% Long-term Care Services Nursing and assisted living facilities, home health care, hospice/respite, homemaker and personal care 5-30% Hearing Hearing aids Lower of 30% off MSRP or $300 off total retail price Infertility Treatment Reproductive endocrinology, IVF 5-20%
  28. 28. NCE Consumer Savings Benefits Beauty and Skin Care Aura Cacia, FamilyMeds, Gaiam ,MotherNature.com, SalonWish, Spa Finder Books and Other Media Free Spirit Publishing, Gaiam, HealthJourneys, McGraw Hill Professional, Memory Lane Family and Household ActiveForever, Allergy Control Products, CareGifters, Cirrus Healthcare, Familymeds, Gaiam, Memory Lane, Online Organizing Fitness Clubs & Activities Anytime Fitness, Global Fit, LivingFit, My Gym Fitness Equipment & Apparel Big Fitness, Champion Apparel, Danskin, Foot Solutions, Gaiam, Heart Rate Monitors USA, NordicTrack, Pedometers USA, Pro Form, Sierra Trading Post, Walkstyles, Weider Life Management ActiveForever, eGetgoing, Gaiam, HealthJourneys, LivingEasy, LivingFit, LivingSmart, McGraw-Hill Professional, OnlineOrganizing.com, Pathway Genomics Medical Supplies and Equipment ActiveForever, CareGifters, FamilyMeds, Foot Solutions, Medical Products Direct Nutrition Eden Foods, FamilyMeds, Frontier Natural Products Co-op, Ideal Health, MotherNature.com, Octavia Tea, Vital Choice Seafood Pet Care Allergy Control Products, FamilyMeds, Gaiam, MotherNature.com, Sierra Trading Post Relaxation Resources Aura Cacia, Gaiam, Healing Rhythms, Health Journeys, LivingEasy, MotherNature.com, SalonWish, Spa Finder Senior Care ActiveForever, Allergy Control Products, CareGifters, FamilyMeds, Medical Products Direct, Memory Lane Smoking Cessation Cirrus Healthcare, FamilyMeds, Free and Clear, LivingFree, Quit Smart Vision Care Eyeglasses.com, VisionDirect Weight Management Ideal Health, Jenny Craig, LivingFit, LivingLean, McGraw Hill Professional, NutriSystem, Structure House, ThinkLight
  29. 29. Medical Benefit Provisions <ul><li>Pre-Existing Conditions </li></ul><ul><ul><li>Policies have preexisting conditions limitations . Preexisting conditions are not covered until the policy has been in effect for more than twelve (12) months. A preexisting condition is a condition, physical or mental, regardless of cause or condition, for which medical advice, diagnosis, care or treatment was recommended, or received from a physician within a six month period preceding the effective date of coverage of a covered person. </li></ul></ul><ul><ul><li>Those who enter the plan presenting a Certificate of Creditable Coverage will receive credit towards this Plan's preexisting conditions limitations. </li></ul></ul><ul><ul><li>Information of where to send Certificate of Creditable Coverage is provided on the web site. </li></ul></ul>
  30. 30. Limitations and Exclusions <ul><li>Benefits will not be paid for: </li></ul><ul><ul><li>Treatment, services or supplies which: </li></ul></ul><ul><ul><ul><li>Are not Medically Necessary </li></ul></ul></ul><ul><ul><ul><li>Are not prescribed by a Doctor as necessary to treat Sickness or injury </li></ul></ul></ul><ul><ul><ul><li>Are experimental/investigational in nature, except as required by law </li></ul></ul></ul><ul><ul><ul><li>Are received without charge or legal obligation to pay </li></ul></ul></ul><ul><ul><ul><li>Is provided by an immediate family member </li></ul></ul></ul>
  31. 31. Additional Limitations and Exclusions <ul><li>Benefits will not be paid for by sickness or injuries caused by (except as specifically provided for in the policy) </li></ul><ul><ul><li>Dental Procedures </li></ul></ul><ul><ul><li>Alcoholism or Drug Addiction </li></ul></ul><ul><ul><li>Mental Illness </li></ul></ul><ul><ul><li>Elective Procedures and Cosmetic Surgery </li></ul></ul><ul><ul><li>Felony or Illegal Occupation </li></ul></ul><ul><ul><li>Manipulations of the Musculoskeletal System </li></ul></ul><ul><ul><li>Suicide, Attempted Suicide or Self-Inflicted Injuries </li></ul></ul><ul><ul><li>War or Act of War </li></ul></ul><ul><ul><li>Worker’s Compensation </li></ul></ul>
  32. 32. Effective Date and Billing <ul><li>Effective dates are the 1st and 15 th of each month </li></ul><ul><li>On line enrollment must be submitted by the 20 th of the prior month to obtain a first of the month effective date and the 5 th of the same month for a 15 th effective date </li></ul><ul><li>Payments can be made via credit card or EFT </li></ul><ul><ul><li>Visa, MC, Discover, Amex </li></ul></ul><ul><li>Future drafts will occur 10 days prior to effective date month. </li></ul>
  33. 33. Fulfillment Materials <ul><li>Insured will receive an instant email when application is submitted, with a copy of their NCE Benefits Package and ID Cards </li></ul><ul><li>AMLI will mail a separate package including a schedule of benefits. The certificate of coverage will be available on line and information on how to download and access the certificate will be in the AMLI welcome letter </li></ul>
  34. 34. Sales Tips <ul><li>DO NOT Represent Limited Medical as: </li></ul><ul><ul><li>“Same as your employer plan” </li></ul></ul><ul><ul><li>Just like “Major Medical” </li></ul></ul><ul><ul><li>No “deductibles” or “co-payments” (sounds too much like a major med plan) </li></ul></ul><ul><ul><li>“Full Benefits” </li></ul></ul><ul><ul><li>A “PPO” </li></ul></ul>
  35. 35. Sales Tips <ul><li>Clearly explain the limited nature of the plan: </li></ul><ul><ul><li>“ This limited health benefits plan does not provide comprehensive medical coverage. It is a basic or limited benefits policy and is not intended to cover all medical expenses. This is not designed to cover the costs of serious or chronic illness. It 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.” </li></ul></ul>
  36. 36. Sales Tips <ul><li>Clearly explain the limited nature of the plan – it is financial assistance, not complete coverage </li></ul><ul><li>Explain the key elements of: </li></ul><ul><ul><li>Guarantee Issue </li></ul></ul><ul><ul><li>Accepting Certificate of Creditable Coverage for new members </li></ul></ul><ul><ul><li>Plan will not issue Certificate of Creditable Coverage for members leaving </li></ul></ul><ul><ul><li>Pre existing condition limitation </li></ul></ul><ul><li>Go through the plan of benefits in detail with the consumer, including the affiliation with the NCE Association </li></ul><ul><li>Explain how the discount network works (do not quote specific savings percentages!) </li></ul><ul><li>Explain the claims submission process, billing, and customer service </li></ul><ul><li>Explain the 30 day free look provision </li></ul>
  37. 37. Agent Appointment <ul><li>An agent MUST be licensed in their resident state and any non-resident state in which the consumer “resides” </li></ul><ul><li>A licensed and appointed agent must be the person personally making the sale </li></ul><ul><li>Agents must pay their own appointment fee </li></ul><ul><li>All agents need to provide proof of E&O coverage </li></ul>
  38. 38. Member Services for Agents and Members Member Services Representatives are available from 8:30 a.m. CST to 5:30 p.m. CST by phone or email You may leave a Voicemail – and your call will be returned within two business hours
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