Always Care Introduction Presentation 2009


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2009 AlwaysCare Company Information and Benefit Offerings

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  • Always Care Introduction Presentation 2009

    1. 1. Listening, Learning, Responding and Caring
    2. 2. AlwaysCare Benefits, Inc. <ul><li>Home office based in Baton Rouge, LA </li></ul><ul><li>Dental, Vision, Hearing, Life & Disability </li></ul><ul><li>400,000+ covered members </li></ul><ul><li>Privately owned and operated </li></ul><ul><ul><li>Recognized by Inc Magazine as one of the fastest growing privately owned companies </li></ul></ul><ul><li>Customer first culture </li></ul>Confidential
    3. 3. Our goals <ul><li>Customer-first culture based on exceptional technology, service, flexibility, competitive plans and rates. </li></ul><ul><li>Best in class provider of ancillary benefits. </li></ul><ul><li>Single source for dental and vision benefits. </li></ul>Confidential
    4. 4. Strong membership growth (primary insureds) Confidential
    5. 5. Our metrics <ul><li>92%+ group retention </li></ul><ul><li>99%+ claims processing accuracy </li></ul><ul><li>95% of inquiries resolved on first contact </li></ul><ul><li>New groups implemented in 5 days (avg.) </li></ul><ul><li>95% overall Customer satisfaction rate </li></ul><ul><li>90%+ of survey respondents will recommend AlwaysCare to a family member or friend </li></ul><ul><li>Claim processing time: 4-5 business days </li></ul>Confidential
    6. 6. The AlwaysCare Target Market <ul><ul><li>Group Dental and Vision </li></ul></ul><ul><ul><ul><li>Available for groups of 2 or more </li></ul></ul></ul><ul><ul><ul><ul><li>Strong Niche: Blue collar and service type industries </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2-9 shelf plans and rates </li></ul></ul></ul></ul><ul><ul><ul><li>Average case size for block is 78 employees </li></ul></ul></ul><ul><ul><ul><li>Largest case 30,000 eligible </li></ul></ul></ul>
    7. 7. The AlwaysCare Difference Makers <ul><li>Online Services </li></ul><ul><ul><li>Website </li></ul></ul><ul><ul><li>AlwaysAssist </li></ul></ul><ul><ul><li>Consumerism & Transparency </li></ul></ul><ul><li>Account Management Services </li></ul><ul><ul><li>Enrollment assistance </li></ul></ul><ul><ul><li>Welcome calls/letters </li></ul></ul>
    8. 8. The AlwaysCare Difference Makers <ul><li>Consumer Driven Dental and Vision leader </li></ul><ul><ul><li>Dental </li></ul></ul><ul><ul><ul><li>Dual Choice (high/low offerings) – min. of 5 enrolled per plan </li></ul></ul></ul><ul><ul><ul><li>Carryover Benefit Rider – dental’s version of the HRA </li></ul></ul></ul><ul><ul><ul><li>Consumerism & Transparency via the web </li></ul></ul></ul><ul><ul><li>Vision </li></ul></ul><ul><ul><ul><li>Members drive their decisions of cost, convenience or choice </li></ul></ul></ul><ul><ul><ul><li>Online access for purchasing of contacts </li></ul></ul></ul>
    9. 9. Difference-Makers: Group Dental <ul><li>Plan Design Flexibility </li></ul><ul><ul><li>Choice of deductible options including $100 lifetime </li></ul></ul><ul><ul><li>Cosmetic Riders – bleaching, porcelain crowns </li></ul></ul><ul><li>Endosteal Implants </li></ul><ul><ul><li>Covered under major services </li></ul></ul><ul><ul><li>Available on all plans and case sizes </li></ul></ul><ul><li>Carryover Benefit </li></ul><ul><ul><li>Carrying over benefit dollars for future needs </li></ul></ul><ul><ul><li>One preventive visit per year required </li></ul></ul><ul><ul><li>Available for all group sizes </li></ul></ul><ul><li>Ease of Administration </li></ul><ul><ul><li>Employer determines contribution level </li></ul></ul><ul><ul><li>Paperless enrollment available </li></ul></ul>
    10. 10. Dental Details <ul><li>Optional Benefits </li></ul><ul><ul><li>Orthodontia </li></ul></ul><ul><ul><ul><li>Available for groups over 10 enrolled lives </li></ul></ul></ul><ul><ul><ul><li>Standard benefit includes an annual maximum as well as a lifetime maximum </li></ul></ul></ul><ul><ul><ul><li>$7-9 added to the EE+Child(ren) and Family Rate </li></ul></ul></ul><ul><ul><ul><li>Up to age 19 </li></ul></ul></ul><ul><ul><li>Higher Annual Maximums </li></ul></ul><ul><ul><ul><li>Available for groups over 10 enrolled lives - $1500 and $2000 </li></ul></ul></ul>
    11. 11. Dental Details <ul><li>DenteMax network </li></ul><ul><ul><li>80,000 providers nationwide </li></ul></ul><ul><ul><li>Passive/blind PPO model </li></ul></ul><ul><ul><li>Active PPO options available </li></ul></ul><ul><li>Participation guidelines </li></ul><ul><ul><li>2-9 75% of eligibles </li></ul></ul><ul><ul><li>10+ greater of 5 or 20% of eligibles </li></ul></ul><ul><ul><li>Rate bands 20-49%; 50-79% and 80% or higher </li></ul></ul><ul><li>Periodontics & endodontics </li></ul><ul><ul><li>Basic or major services </li></ul></ul><ul><li>Annual maximums </li></ul><ul><ul><li>$500, $750, $1000, $1200, $1500 and $2000 </li></ul></ul>
    12. 12. AlwaysDental – FAQ <ul><li>Waiting Periods </li></ul><ul><ul><li>No waiting period options available and standard for groups with 25 or more and 75% participation </li></ul></ul><ul><ul><li>12 month waits on major services only </li></ul></ul><ul><ul><li>Takeover credit available at the group level </li></ul></ul><ul><li>Missing Tooth Clause </li></ul><ul><ul><li>Prior like coverage covered if tooth extracted within the last 36 months </li></ul></ul><ul><ul><li>Or, covered after 36 months with AlwaysCare </li></ul></ul><ul><li>Usual & Customary </li></ul><ul><ul><li>70 th , 80 th or 90 th </li></ul></ul><ul><li>Network or No Network </li></ul><ul><ul><li>Passive model using the DenteMax network </li></ul></ul>
    13. 13. Dental Product Updates <ul><li>Wellness Benefit Enhancements </li></ul><ul><ul><li>Additional Cleaning for pregnant women in their 2nd or 3rd trimesters (Standard Benefit) </li></ul></ul><ul><ul><li>Members 40+ years of age who demonstrate risk factors for oral cancer or suspicious lesions are entitled to one adjunctive, pre-diagnostic test per year (Standard Benefit) </li></ul></ul><ul><ul><li>Members diagnosed with diabetes are eligible for 2 extra cleanings every twelve months (Optional Benefit) </li></ul></ul>
    14. 14. Dental Questions to Ask <ul><li>When and what age limits have you recently changed to your contract? </li></ul><ul><li>Have you made any changes to benefit frequencies? </li></ul><ul><li>Do you split up simple vs. complex periodontic/ endodontic procedures? </li></ul><ul><li>How do you handle UCR? Can you provide me your top 10 ADA codes? </li></ul>
    15. 15. Difference-Makers: Group Vision <ul><li>Two and Three Tier Network Plans </li></ul><ul><ul><li>Standard in and out-of-network plan with copay flexibility </li></ul></ul><ul><ul><li>Three tier Wal-Mart vision plan option </li></ul></ul><ul><li>Mail Order contact lenses via the web </li></ul><ul><ul><li>Use their contact benefit </li></ul></ul><ul><ul><li>Great discounts </li></ul></ul><ul><li>Materials-Only Plan Options with hearing rider </li></ul><ul><ul><li>Great add-on for medical plan that covers annual vision exam </li></ul></ul><ul><ul><li>High value and low cost </li></ul></ul>
    16. 16. Vision Details <ul><li>NVA and proprietary network </li></ul><ul><ul><li>22,000+ providers nationwide </li></ul></ul><ul><ul><li>Retail and independent practitioners </li></ul></ul><ul><li>Prescription fulfillment flexibility </li></ul><ul><ul><li>Site of annual exam does not have to dictate where prescription is filled </li></ul></ul><ul><ul><li>Consumer drives decision </li></ul></ul><ul><li>Contacts in lieu of lenses and frames </li></ul><ul><ul><li>Member receiving contacts must wait 12 months to receive lens or frame benefit and vice versa </li></ul></ul><ul><li>Benefit frequencies </li></ul><ul><ul><li>12/12/12/12; 12/12/24/12 and 12/12/24/24 </li></ul></ul><ul><ul><li>Date of service not policy or calendar year </li></ul></ul>
    17. 17. Vision Product Updates <ul><li>Simply need 5 enrolled if packaging with dental </li></ul><ul><li>3 year rate guarantees for 50+ enrolled </li></ul><ul><ul><li>5% load </li></ul></ul><ul><li>Costco added to the network </li></ul><ul><ul><li>Member will need to file claim on their own behalf </li></ul></ul><ul><li>Specialty lenses and material upgrades only for First Look Network </li></ul><ul><ul><li>Provides identified as Value Add (VA) or Service Plus (SP) on website </li></ul></ul><ul><ul><li>Lens Options: UV, scratch resistance and anti-reflective coating, tinting, polarized, polycarbonate, etc. </li></ul></ul><ul><ul><li>Second pair of glasses or contact lenses with preferred pricing </li></ul></ul>
    18. 18. Return On Investment <ul><li>Annual premium </li></ul><ul><ul><li>$83.76 </li></ul></ul><ul><ul><li>With Section 125 $71.20 </li></ul></ul><ul><ul><li>Copays: exam $10 and materials $10 </li></ul></ul><ul><ul><li>Total annual cost: $91.20 </li></ul></ul><ul><li>Annual benefit </li></ul><ul><ul><li>In-network: $50 annual exam + $50 lenses + $120 frames = $220 </li></ul></ul><ul><ul><li>Out-of-network: $35 annual exam + $50 lenses + $50 frames = $135 </li></ul></ul><ul><li>ROI </li></ul><ul><ul><li>In-network: Pay in $91.20 get $220 of benefit (save $128.80) </li></ul></ul><ul><ul><li>Out-of-network: Pay in $71.20 get $135 of benefit (save $63.80) </li></ul></ul>
    19. 19. AlwaysHearing – Delivering Value <ul><li>Hearing Model </li></ul><ul><ul><li>Traditional PPO plans – in and out-of-network benefits </li></ul></ul><ul><ul><li>Optional rider to dental and/or vision </li></ul></ul><ul><li>Benefit Highlights </li></ul><ul><ul><li>Covers hearing diagnostics </li></ul></ul><ul><ul><li>Allowance toward the cost of hearing aids </li></ul></ul><ul><ul><li>Free hearing diagnostics for Children </li></ul></ul><ul><ul><li>Significant discounts on hearing aids – 40%+ </li></ul></ul><ul><li>There is a need </li></ul><ul><ul><li>Affects 31.5 million Americans; 68% under 65 </li></ul></ul><ul><ul><li>iPod generation aging </li></ul></ul>
    20. 20. New Products <ul><li>Life/AD&D, STD and LTD </li></ul><ul><li>Partnering with GroupRe Plus (a The Hartford company) </li></ul><ul><li>Combined billing and package discounts will be available </li></ul><ul><li>Great addition to our Dental and Vision products </li></ul>
    21. 21. Group Life Insurance <ul><li>Basic Life </li></ul><ul><ul><li>Available for 10+ enrolled </li></ul></ul><ul><ul><li>Choice of coverage amounts </li></ul></ul><ul><ul><li>Flat amount, % of earnings or combination benefit schedule available </li></ul></ul><ul><li>Voluntary Life </li></ul><ul><ul><li>Available for 10+ enrolled </li></ul></ul><ul><ul><li>Increments of $10,000 </li></ul></ul><ul><ul><li>Guaranteed issue for greater of 10+ enrolled or 25% of eligibles (benefits based on size and participation) </li></ul></ul>
    22. 22. Short Term Disability <ul><li>STD </li></ul><ul><ul><li>Available for 10+ enrolled </li></ul></ul><ul><ul><li>Employer Paid, Contributory or Voluntary (10+ enrolled or 25%) </li></ul></ul><ul><ul><li>First Day Hospital Benefit </li></ul></ul><ul><ul><ul><li>Benefits commence on first day of hospital confinement or date of Outpatient Surgical procedure </li></ul></ul></ul><ul><ul><li>Elimination Period </li></ul></ul><ul><ul><ul><li>Accident as short as 0 </li></ul></ul></ul><ul><ul><ul><li>Illness 7 or higher </li></ul></ul></ul><ul><ul><li>Maximum Benefit Periods </li></ul></ul><ul><ul><ul><li>13, 26 or 52 weeks </li></ul></ul></ul><ul><ul><li>Weekly Benefit Amounts </li></ul></ul><ul><ul><ul><li>50%, 60%, 66 2/3% or flat amount not to exceed 66 2/3% </li></ul></ul></ul><ul><ul><ul><li>Max Benefit up to $2500 </li></ul></ul></ul><ul><ul><ul><li>Min Benefit $25 </li></ul></ul></ul>
    23. 23. Long Term Disability <ul><li>LTD </li></ul><ul><ul><li>Available for 10+ enrolled </li></ul></ul><ul><ul><li>Employer Paid, Contributory or Voluntary (10+ enrolled or 25%) </li></ul></ul><ul><ul><li>EAP service included </li></ul></ul><ul><ul><ul><li>Up to 5 visits per policyholder </li></ul></ul></ul><ul><ul><li>Elimination Period </li></ul></ul><ul><ul><ul><li>90 or 180 days (other options available) </li></ul></ul></ul><ul><ul><li>Definition of Disability Options </li></ul></ul><ul><ul><ul><li>2 year ‘own’ occ and ‘any’ occ thereafter (other options available) </li></ul></ul></ul><ul><ul><li>Monthly Benefit Amounts </li></ul></ul><ul><ul><ul><li>50%, 60%, 66 2/3% or flat amount not to exceed 66 2/3% </li></ul></ul></ul><ul><ul><ul><li>Max Benefit up to $6000 (other amounts available) </li></ul></ul></ul><ul><ul><ul><li>Min Benefit: amount is greater of 10% of group’s monthly benefit or $50 </li></ul></ul></ul>
    24. 24. Difference-Makers: Individual Dental <ul><li>True Dental Insurance </li></ul><ul><ul><li>Group-like features </li></ul></ul><ul><ul><li>Fee schedule plan design </li></ul></ul><ul><ul><li>Available for ages 19-64 </li></ul></ul><ul><ul><li>Enroll Online </li></ul></ul><ul><li>Freedom of Choice </li></ul><ul><ul><li>Select any dentist or one of our network dentist </li></ul></ul><ul><ul><li>Access to web-based tool with additional certified dentists </li></ul></ul><ul><li>Vision Benefit </li></ul><ul><ul><li>$35 allowance for annual vision exam </li></ul></ul><ul><ul><li>Mail order contact lenses via the web </li></ul></ul><ul><ul><li>Discounts on materials with Outlook Vision Network (10,000 vision centers) </li></ul></ul>
    25. 25. Difference-Makers: Web-Based Tools <ul><li>AlwaysAssist - Online Group Administration </li></ul><ul><ul><li>Adds and deletes of employees </li></ul></ul><ul><ul><li>View bills </li></ul></ul><ul><li>AlwaysAssist - Member Access </li></ul><ul><ul><li>Claims status </li></ul></ul><ul><ul><li>Print temporary and request additional ID cards </li></ul></ul><ul><ul><li>Dental Cost Estimator </li></ul></ul><ul><ul><li>Change of address </li></ul></ul><ul><ul><li>Track annual maximum and deductible levels </li></ul></ul><ul><li>AlwaysAssist - Providers </li></ul><ul><ul><li>Check eligibility </li></ul></ul><ul><ul><li>Verify benefits </li></ul></ul><ul><li>Dental Health Center - Consumerism Tools </li></ul><ul><ul><li>Provider locator of in-network and extended network certified providers </li></ul></ul><ul><ul><li>Frequently Asked Questions of Dentists and ‘Ask A Dentist’ </li></ul></ul>
    26. 26. <ul><li>Web Demo </li></ul><ul><li> </li></ul>
    27. 27. Difference-Maker: Quality Service <ul><li>Genuine caring people </li></ul><ul><li>Extended hours </li></ul><ul><ul><li>M-F 7:30 a.m. to 8:30 p.m. (CST) </li></ul></ul><ul><ul><li>Sat. 9:00 a.m. to 3:00 p.m. (CST) </li></ul></ul><ul><li>Customer first mentality </li></ul><ul><li>Numbers speak for themselves </li></ul><ul><ul><li>Average group stays with AlwaysCare for over 5 years </li></ul></ul><ul><ul><li>Persistency over 90% </li></ul></ul>
    28. 28. Questions & Answers <ul><ul><li>Thank You </li></ul></ul>