Thank you for taking the time to meet with me today. I look forward to discussing your health care needs and feel confident that I can help you identify a solution that gives you the protection you need — and at a price that is within your budget.
You probably have several questions including why you should listen to my advice as opposed to obtaining coverage directly through the Exchange, or another health insurance broker.
Let me propose an outline to follow during our discussion today that will hopefully address that question — as well as any others you might have. Does that sound fair?
NOTE: Wait for customer response
First, I would like to take a few minutes to introduce myself and HealthMarkets Insurance Agency, the company I represent.
Then I would like to go over a series of questions with you in order to better identify your health insurance needs.
From there we can look at a variety of plans that will help you understand the options that are available to you.
Before we begin, I want to emphasize that there is no additional cost to work with me to get any of the plans you might choose, including the plans you can purchase on the Exchange. Each carrier sets their premium and that price is the same, regardless of how you obtain it.
As an added value to you, I can help you apply for any coverage you choose and then monitor the applications as they go through the approval process.
Of course, as part of this process, I will help you determine whether or not you qualify for a healthcare subsidy from the government and assist you in obtaining that benefit if you qualify.
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SLIDE 4: HealthMarkets Insurance Agency The company I represent is called HealthMarkets Insurance Agency and we are licensed to do business in all 50 states and the District of Columbia. We are unique in the health insurance marketplace because we don’t represent just one carrier. We can help you consider products from a number of recognized and trusted carriers. In many cases we find that a combination of products, from different companies provides the best solution to fit individual needs.
SLIDE 6: Portfolio of Carriers Most people like to have choices when they shop for insurance. As I mentioned earlier, we have a large portfolio of products from many of the most recognized and trusted companies in the industry. It is important to note that not every carrier shown here offers products on the Exchanges or offers the type of insurance product that you may be interested in. But because of HealthMarkets’ unique approach, you can see that I can provide you with many solutions from numerous well-known companies.
SLIDE 7: Best for Your Budget You invited me here to help you examine health care options. And that will be the focus of our discussion today. Once I have an understanding of your family’s needs and budget, I can show you different options that can give you the protection you need at a price you can work within your budget. It’s likely that we’ll combine different insurance products for a solution that best fits your needs. In many situations the use of complimentary products can offer more affordable options. Just like gears in a machine turning together to make the machine work, we often find that the combination of insurance products may provide a better solution. As we begin looking at solutions, I’ll explain why that works so well.
SLIDE 8: Life is Full of Milestones and Surprises Life is full of changes, special events and surprises. There are special events like marriage or the birth of a child. And sometimes there are surprises, like an unexpected injury or accident. At HealthMarkets, we do more than simply sell health insurance. We help people get the protection they need to keep pace with life’s changes. We want to help you protect your health, but we also want to help protect your income and your family. We call this comprehensive approach Protection for Life. We work to find solutions that protect your health, your income and family — come what may.
SLIDE 9: The Protection You Need at 30… Would you agree that our insurance needs change over time? What we need at 30 will be different than what we need at 45 and at 65?
One of my goals is to make you a long-term client, not just a customer for today. After we determine the best solution for you today, I would like to meet with you on a regular basis to make sure that your coverage stays consistent with your needs as they change.
And finally, if I’ve done a good job meeting your needs, I hope you’ll personally recommend both the HealthMarkets approach and me to others you think would benefit from the products and service I offer.
SLIDE 5: Health Care Reform One of the primary services I provide is to help my clients better understand the Affordable Care Act and what it means to them. As I mentioned earlier, if you are eligible for a health insurance subsidy, I can show you the product options available through the [federal or state] Exchange and assist you in obtaining a subsidy and the coverage best suited for you and your family.
SLIDE 11: Affordable Care Act The new health care law, sometimes called “ObamaCare” was passed by Congress in 2010. There are several protections under Health Reform you should be aware of:
• Lifetime limits are prohibited and annual limits are restricted on most covered benefits • You can't be refused insurance or charged more because of a pre-existing condition • Children up to age 26 may remain on a parent’s policy • Preventive services must be covered and cannot have cost-sharing • Many people are now eligible for help with their health insurance premiums through tax credits called subsidies • All individual and small group health plans are required to include certain “essential health benefits.” Those benefits include coverage on ambulatory patient services; emergency services; hospitalization; maternity and newborn care; and more.
The Health Insurance Marketplace (federal and state-operated insurance exchanges) opened on October 1, 2013. The federal or state exchange is the official website for people to purchase qualified health insurance policies.
You should note that the ACA does not require anyone to purchase health insurance through an Exchange, although subsidies will only be available for plans sold there. We can talk about plans that are available both on an Exchange and off an Exchange when I explain a little more about the subsidies or tax credits.
SLIDE 12: The Metal Plans (On Exchange) To help with out-of-pocket costs, which have been a big issue in health care, the ACA set new limits for 2014 . These limits help cap exposure for consumers to approximately [$6,000 for an individual and $12,000 for families.] (This is going to change slightly for 2015. 6,600 individual / 13,2000 family) These limits will be indexed to average premium growth in future years.
The ACA now also requires that all plans on an Exchange must design their cost-sharing (deductibles, copays, coinsurance) to fit into specific levels of coverage. This is where the term “Metal Plans” comes from as the government created several levels based on metals. They are:
Bronze Level – Plan covers approximately 60% of expected costs Silver Level – Plan covers approximately 70% of expected costs Gold Level – Plan covers approximately 80% of expected costs Platinum Level – Plan covers approximately 90% of expected costs
A Bronze plan generally has the lowest monthly premium but the highest out-of –pocket expenses up to the annual maximum. We will use these levels to help us compare your options and choices today.
SLIDE 14: Fact Finding Let’s spend a few minutes determining the type of health insurance benefits you are looking for. Remember, the Exchanges were created to help individuals and small businesses purchase health insurance coverage in an online retail setting. However, the ACA does not require anyone to purchase health insurance through an Exchange, however subsidies are only available there.
We’ll also determine if you are eligible for a subsidy as subsidies are even available to people with higher incomes — for example, tax credits are available for a four-person family whose income is up to $94,200. But that amount may be fairly small. We’ll also discuss other options besides health insurance alone that can offer greater financial protection.
NOTE: Fill out HealthMarkets Fact Finder with client. Based on the preferences discuss with your client, take them through the “If This, Then That” decision tree that you learned during Sales Training. This exercise will help your client see more clearly why their decisions lead them to a specific metal level plan.
Now that I have a better understanding of your specific needs, let’s take a few minutes to see if we can find a plan that can help with out of pocket expenses associated with an illness or accident.
SLIDE 16: High Cost of Health Care & Bankruptcy A significant medical event can create financial problems that go beyond paying your doctor or hospital. Did you know that a previous study showed that illness and medical bills contribute to more than 62% of all bankruptcies. And of those filing, almost 78% had health insurance.
Even outside of bankruptcy, it’s been estimated that about 56 million adults — that’s more than 20 percent of the population between the ages of 19 and 64 — will still struggle with health-care-related bills this year*.
Having health insurance doesn't buffer you against potential financial problems. In addition to health insurance, you need other forms of insurance coverage in order to help with out of pocket expenses.
*NOTE: For reference on the above statistic — Medical Bills Are the Biggest Cause of US Bankruptcies: Study; CNBC June 25, 2013.
SLIDE 15: Supplemental Insurance When I first introduced the idea of Protection for Life I said that we wanted to help you obtain a plan that would protect your health, your income and your family. Even with health insurance an accident or illness can still create financial burdens.
If wondering where the money will come from to pay the deductible, the co-insurance or simply replace your income could keep you up at night, supplemental plans can help. Supplemental plans can pay cash benefits directly to you if you are sick or injured. Let’s take a few minutes to see if any of these plans fit your Protection for Life needs.
SLIDE 18: Life Insurance The last component I recommend for a comprehensive Protection for Life approach is Life Insurance.
Would it surprise you to learn that 70% of Americans with dependent children would have trouble paying their bills within 3 months if the bread-winner died? And, 40% of them would be immediately in jeopardy.
How long could your family pay the bills if something happened to you?
SLIDE 10: Protection for Life — 3 Primary Components Protection for Life is a comprehensive approach to insurance and the cornerstone is always a solid health insurance policy. A good major medical policy covers the cost of doctor visits, hospitalizations and prescription drugs. Major medical insurance pays the bill for those who provide care to you and your family.
However, our Protection for Life approach is designed to include protection that can help cover lost income and out of pocket expenses and even 24/7 access to healthcare professionals over the phone or internet. By supplementing your health insurance, you can get coverage that pays cash benefits directly to you for covered illnesses and injuries. Knowing that you have money you can use to help pay your mortgage, your car payment and other bills is a major relief when you’re faced with unexpected health issues. Even though you might be sick or injured, you won’t need to worry about how you’ll be able to put food on the table.
The final piece to Protection for Life is to help cover you if the unthinkable happens. If you don’t survive an accident or illness, your family needs additional protection. Our Protection for Life approach is designed to include at least a $50,000 term life insurance policy. You can choose to upgrade this policy to $100,000 or even more if you wish.
I want to help you protect your health, your income and your family. As I get to know your needs better, we can develop a Protection for Life plan that fits within your budget, but gives you much wider coverage than just health insurance alone.
Do you have any questions at this time?
If not, let’s take a few minutes to learn a little more about The Affordable Care Act.
SLIDE 13: Fact Finder With some Health Reform discussion as background, and as your licensed agent, I want to give you a good Protection for Life plan as we work towards your decision. [I like to refer to myself as a benefits advisor because I can guide you through the many benefit options available as we build this Protection for Life plan.]
NOTE: Fill out HealthMarkets Fact Finder with the client
SLIDE 20: Customized Protection for Life Solution
Thank you for working with me through all of these recent questions. It helps me understand your unique situation and will allow me to design some alternatives that will give you the protection you need at a price you can afford..
Give me few minutes to pull some comparison quotes together. Next I will show you two or three different solutions that will not only give you the health care coverage you are looking for, they will give you what we call Protection for Life…covering your health, your income and your family.
Wall of Protection: Health, Income, and Life Insurance