Supplemental Medical Expense Plan “PremierCare” Host Rodney MattosDirector of Sales
Agenda Purpose of PremierCare Supplement Plan Key Advantages Explanation of the Benefits How to Use the Quote Sheet Commonly Ask Question
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.
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
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
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
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
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
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.
Our Biggest Question? MedicalCarriers won’t allow me to sell a medical gap plan next to their core plan?
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.
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.
For Additional Information Please contact your Local Account Executive or call Premier Access Insurance Company P: (888) 326-3210 E: Sales@Premierlife.com www.premierlife.com