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Intro to premier care supplemental medical plan
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Intro to premier care supplemental medical plan


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  • 1. Supplemental Medical Expense Plan “PremierCare” Host Rodney MattosDirector of Sales
  • 2. Agenda Purpose of PremierCare Supplement Plan Key Advantages Explanation of the Benefits How to Use the Quote Sheet Commonly Ask Question
  • 3. Purpose of PremierCare* To offer an employer lower monthly premiums without reducing the employees overall medical benefits. To simplify the explanation of the Gap Plan to your clients. Simple and Easy *Available January 1, 2013, pending CA DOI approval.
  • 4. Our Product Paysa percentage of the members medical deductible and/or coinsurance, (or copays over $100) up to a calendar year amount. Similar to our dental plans. 50% 60% 70% 80% 90% 100% $500 to $500 to $500 to $500 to $500 to $500 to $10,000 $10,000 $10,000 $10,000 $10,000 $10,000
  • 5. Key Advantages Single Point of Contact: (Your Account Manager)  Supplemental Medical  Dental  Vision Easy Billing Reconciliation RX Rider  Pays the deductible on the RX plan  Separate benefit and maximum  Percentage must match Supplement Plan  Not available if 100% benefit is purchased. 50% 60% 70% 80% 90%$150 up $150 up $150 up $150 up $150 upto $2,000 to $2,000 to $2,000 to $2,000 to $2,000
  • 6. Key Advantages Package Discounts  New Business(all products new to Premier)  5% off Dental Manual Rate (And)  5% off Supplemental Medical  Currently a Premier Dental Customer  5% of Supplemental Medical No Limitations on Outpatient  The maximum applies for both inpatient and outpatient services
  • 7. Key Advantages  No Exclusions*  If the illness or injury is covered by the underlying medical plan, then it is a covered benefit with PremierCare. In regards to PPO plans, PremierCare only pays for In-Network Providers.*See brochure for complete details of coverage limitations
  • 8. Sample Benefit Summary Example of ABC CompanyCarrier Type PPO PremierCare Employee Out-of- Pocket 90%* to $7,000Annual Deductible IN-Network Only IN-Network Only IN-Network OnlyIndividual $5,000 90% $500Family $10,000 90% $1,000Outpatient/Prof ServicesPhysician Office Visit $45 Copay $0 $45 CopayPreventative Care No Charge N/A $0Rehabilitative Services 45% (after ded.) 90% of Charges 10%Lab, X-ray, other Test 45% (after ded.) 90% of Charges 10%Hospital ServicesInpatient Hospital 45% (after ded) 90% of Charges 10%Outpatient Surgery 45% (after ded) 90% of Charges 10%Emergency Room 45% (after ded) 90% of Charges 10%Mental HealthInpatient 45% (after ded) 90% of Charges 10%Prescription DrugsTier 1 $10 Copay N/A $10 CopayTier 2 $45 (after RX Ded) 90% of Ded $45 copay + 10% Ded.Tier 3 $65 (after RX Ded) 90% of Ded $65 + 10% of DedRX Deductible $500 90% 10%Max Out of Pocket $8,000 $1,000 $16,000 $2,000 * 90% of the Patients Responsibility
  • 9. How to Use the Quoting Sheet
  • 10. Enrollment Materials Employer Application Employee App PremierCare Rate Sheet .PDF Underlying Medical Plan Benefit Sheet First Months Investment
  • 11. Collateral Material Benefit Summary Brochure Employee Explanation Brochure
  • 12. Underwriting Guidelines Minimum of 5 employees or 20% whichever is greater Plan supplements fully insured HMO and PPO medical plans Age and dependent status are need to quote Plans are sold on an employer sponsored or voluntary basis Rates are guaranteed for 12 months PremierCares annual maximum benefit must be less than or equal to the Out of Pocket Limit of the underlying major medical plan. Ineligible Groups/Industries: Legal services with less than 25 enrolled employees, associations and multiple employer trusts.
  • 13. Our Biggest Question? MedicalCarriers won’t allow me to sell a medical gap plan next to their core plan?
  • 14. Our Suggestion If the medical carriers says you can not sell a medical gap plan next to their plan, we suggest the following:  Agree with them  Request a copy of the letter from the Department of Insurance stating that they can prohibit gap plans for their products.  You need this letter to protect yourself from brokers who may try to sell your clients gap plans in the future.  Thank them for their assistance  If you receive a letter from the Department of Insurance agreeing with their statement, please forward to us. We would love to share this with other partners in the business.
  • 15. Key Advantages(continued) Profit Sharing  PremierCare is offering up to 15% of the profits to their brokers. This benefit is available for our medical and dental products. Please requests our Profit Sharing brochure for complete details.
  • 16. For Additional Information Please contact your Local Account Executive or call Premier Access Insurance Company P: (888) 326-3210 E: