Purple cow 2011 (medical)


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Purple cow 2011 (medical)

  1. 1. What is the purpose of EB ? <ul><li>“ The purpose of EMPLOYEE BENEFITS is to increase the economic security of employees.” </li></ul><ul><ul><li>Wikipedia </li></ul></ul><ul><li> </li></ul>EB can help your employees become financially secure 2 Purple Cow 2011 EB Primer
  2. 2. <ul><ul><ul><ul><ul><li>Paid vacations, 75% </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Health insurance, 61% </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Paid sick leave, 59% </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Disability insurance, 41% </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Education reimbursement, 39% </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Pension plan, 30% </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Life insurance, 29% </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Dental insurance, 24% </li></ul></ul></ul></ul></ul>What are the most common EB ? All 4 insurance benefits are offered in Purple Cow! 3 - Small Business Poll on Compensating Employees (NFIB, US: 2003) Purple Cow 2011 EB Primer
  3. 3. What makes Insurance ‘sulit?’ <ul><li>LIFE INSURANCE provides you with instant cash in the event of death or total and permanent disability; (.25% of population between 18-65) </li></ul><ul><li>ACCIDENT INSURANCE provides you with instant cash in the event of accidental death or disability; (10% of inpatient & outpatient cases) </li></ul><ul><li>HEALTH INSURANCE (Medical / Dental HMO and/or INS ) protects you from losing money in the event of sickness or accident, and treats you as well (if HMO). (10% inpatient / 100% outpatient) </li></ul>All insurance can make or save you money in multiples 4 Purple Cow 2011 EB Primer
  4. 4. Why get the Purple Cow ? <ul><li>The Purple Cow is UNIQUE: it’s not just an HMO plan, but all the 3 major Employee Benefits rolled into one plan; </li></ul><ul><li>The Purple Cow is a good SELLING tool: it has all the features & benefits our Clients say they want or need; </li></ul><ul><li>The Purple Cow makes a great PROPOSITION: Employee Benefits = Financial Security; therefore, More Employee Benefits = More Financial Security. </li></ul>Purple Cow Employee Benefits = more financial security! 6 Purple Cow 2011 EB Primer
  5. 5. 1 Purple Cow 2011 Benefits ACCIDENT 2. ACCIDENT INSURANCE a. Accidental Death * Murder b. Disability * Assault HEALTH 3. MEDICAL HMO * 21,519 MD, 352 hospitals, 358 clinics 4. DENTAL HMO * 775 dentists, 645 clinics 5. Opt. Annual Physical Exam * 124 hospitals, 241 clinics, 31 mobile 6. Health & Wellness Program * 2x/year; tailored to utilization report LIFE 1. LIFE INSURANCE * Total & Perm. Disability Income LIFE – ACCIDENT – HEALTH Benefits Overview
  6. 6. 2 Purple Cow 2011 Benefits 18. Dental = HMO (775 dentists / 645 clinics) 6. Assault = __% of 5x MBL 24. Same benefits for all Dependents 23. Same benefits for all Employees 22. Health & Wellness Program 2x/year 21. Opt. APE = designated or mobile clinic 20. 1 permanent filling, 2 oral prophylaxes, etc. 19. Dental access to major malls in Metro-Manila 17. Opt. Outpatient Reimb. for meds, dental, vision 16. Special procedures = 30%/100% of MBL 15. Benefits on top of Philhealth 14. 100% Congenital Conditions coverage 11. HMO patient for no-cash-out 10. Max. Benefit Limits per disability per year 12. Private patient for reimbursement (HMO rate) 13. 100% Pre-Existing Conditions coverage 9. Combined inpatient & outpatient limits 8. Access to Big 5 Hospitals & Healthway 7. Medical = HMO (21,519 MD / 352 hospitals / 358 clinics) 5. Accidental disability = __% of 5x MBL 4. Murder = 5x MBL 3. Accidental death = 5x MBL 2. Total & perm. disability income = 5x MBL 1. Life = 5x MBL LIFE – ACCIDENT – HEALTH Benefits Summary
  7. 7. 7 Purple Cow 2011 Benefits TERMS & CONDITIONS 8. Separate Dependent utilization to reduce cost 8. Benefits on top of Philhealth +Same rates for Dependents in 2011 +Principals 18yo-65yo; Dependents 30dy-21yo / 18yo-65yo 10. Opt. Outpatient Reimb. for meds, dental, vision 9. Special Procedures = 30%/100% of MBL 7. 100% Congenital Conditions coverage 10. 1 st year Virgin promo rate, if applicable 5. Minimum group size = 10 5. Access to Big 5 Hospitals and Healthway Medical HMO benefits are covered on top of Life and Accident benefits 9. Buy now, pay later 7. Pooled Employee utilization to spread risk 6. Minimum mode of payment = monthly 4. No individual applications required 3. No utilization report required 2. No franchising required 1. Instant rates, regardless of size 6. 100% Pre-Existing Conditions coverage 4. Private patient for reimbursement (HMO rate) 3. HMO patient for no-cash-out 2. Max. Benefit Limits per disability per year 1. Combined inpatient & outpatient limits ASIANLIFE (21,519 MD / 352 hospitals / 358 clinics) 3a. MEDICAL HMO (nationwide)
  8. 8. 8 Purple Cow 2011 Benefits 18. Accidental injuries All Dreaded & Non-Dreaded PEC are covered 100% to MBL 19. Diseases of the immune system 18. Collagen / connective tissue diseases 17. Hypertension, coronary artery disease / myocardial ischemia, cerebrovascular accident and other chronic cardiac diseases 16. Malignancies of the blood and bone marrow 15. Chronic musculo-skeletal malignancies 14. Moderately to far advanced tuberculosis 13. Seizure disorders 12. Endocrine illnesses 11. Polyps, ulcers, liver cirrhosis and other chronic gastrointestinal diseases 10. Chronic conditions of the genitourinary system 9. Calculus cholecystitis / cholelithiasis and/or urolithiasis 8. Chronic neurologic conditions 7. Sinus condition requiring surgery 6. Pathological abnormalities of nasal septum and turbinate 5. Diseased tonsils requiring surgery, cataracts & other opthalmo-otolaryngologic conditions 4. Hemorrhoids and other chronic colonic and ano-rectal illnesses 3. Chronic gynecologic conditions 2. Benign cyst / tumor and malignant conditions 1. Asthma, pleural effusion or other chronic airway obstruction conditions PRE-EXISTING CONDITIONS (Non-Dreaded) 19. Second and third degree burns 20. Surgical procedures requiring application / use of prosthesis for immediate treatment 17. Illnesses / injuries necessitating the use of isolation room / ICU or other IC facilities 6. Chronic hepatobiliary diseases 21. PEC (except congenital ones) subject to the provision on ‘PEC’ in this Agreement [waived] 16. Pathological / accidental fractures 15. Chronic musculo-skeletal diseases 14. Chronic opthalmo-otolaryngologic diseases 13. Antibiotic / chemotherapy-resistant diseases / bactemia / septicemia 7. Neuro-surgical / neurological conditions 8. Chronic pulmonary diseases 12. Endocrine abnormalities 2. Benign / malignant new growths 1. Blood dyscrasias 3. Chronic cardiac / cardio-vascular diseases 5. Diseases of the immune system 9. Chronic genito-urinary diseases 10. Chronic gynecological conditions 11. Chronic gastrointestinal conditions 4. Collagen / connective diseases PRE-EXISTING CONDITIONS (Dreaded) 3b. MEDICAL HMO…
  9. 9. 9 Purple Cow 2011 Benefits SPECIAL PROCEDURES – 100% of MBL 4. Sclerotherapy 4. Laser therapy (excludes use for correcting vision) 14. C-reactive protein (rheumatic & complications) 13. Anti-nuclear anti-body (ANA) 10. Pulmonary perfusion scan 7. Other new modalities of treatment for conditions with established etiologies and used as alternatives to conventional or traditional procedures 11. Endoscopy 8. Thallium scintigraphy 5. Physical & speech therapy 12. Bone densitometry scan 16. Sleep therapy 9. CT scan / MRI 7. Nuclear technologies 6. Angiography 3. Radiation oncology / therapeutic radiology 2. Chemotherapy 15. Lupus cell exam 1. Dialysis 6. Cost of artificial limbs, joint prosthesis and heart valve prosthesis 3. Laparoscopic procedures For the above special procedures, the remaining 70% of your Maximum Benefit Limit per disability per year can be used for conventional treatment of the same condition (unlike other HMO’s which exclude conventional treatment after a special procedure, and limit special procedures to 1x/year). 5. Nuclear / radioactive isotope scans 2. Arthroscopic procedures 1. Lithotripsy SPECIAL PROCEDURES – 30% of MBL 3c. MEDICAL HMO…
  10. 10. 10 Purple Cow 2011 Benefits 3. Non-prescription lenses and frames 2. Dental 2. Dental procedures not included in the dental HMO plan 3. Vision EXCLUSIONS Optional OUTPATIENT REIMBURSEMENT Rx Medicines, Dental & Vision are covered on top of Medical & Dental HMO benefits +Outpatient Reimbursement for Rx Meds, Dental & Vision benefits within 15 working days of receipt of all documents. +Reimbursement for Rx Meds covers treatment for any covered sickness or accident. +Reimbursement for Dental covers the same schedule of benefits as the dental HMO, but with your choice of dentist for full reimbursement up to your aggregate limit. +Reimbursement for Vision covers tests for visual acuity and prescription lenses. +The annual aggregate limit for all Rx meds, dental and vision benefits together = 1/10 th your Max. Benefit Limit. 1. Vitamins, supplements and/or non-BFAD approved medicines, herbal medicines, and other medicines that have no legal BFAD-approved therapeutic claims 1. Rx Medicines 3d. MEDICAL HMO…
  11. 11. 11 Purple Cow 2011 Benefits 17. Organ transplant-expense relating to organ donation of the donating party/parties 7. Dental-related cases except those that may be provided by the Dental Benefits and to the extent that are necessary for the repair or alleviation of damage caused solely by accidental injury sustained (and not caused by the plan member) 6. Non-recommended confinement, convalescent / domiciliary / custodial care, rest cures 18. Executive check-ups, unless explicitly provided in the master policy, and/or confinements purely for diagnostic purposes, as well as non-recommended confinements 8. Circumcision, cosmetic / aesthetic procedures except re-constructive surgery to treat functional defects due to a covered disease and/or accidental injury 22. Medical / surgical procedures and/or diagnostic tests that are experimental in nature and/or not generally accepted by the medical profession such as, but not limited to, iridology, chiropractic services, and acupuncture 12. Illnesses / injuries resulting from the plan member’s active participation in hazardous activities such as, but not limited to, bungee jumping, hang-gliding, scuba diving, mountain/wall climbing, and professional sports 19. Take-home medicines, unless optional ‘Reimbursement of Prescribed Medicines’ benefit is provided, and vaccines, except for first doses of either anti-venom, anti-rabies or anti-tetanus used for emergency treatment 2. Services rendered or supplies provided free of charge 14. Self-inflicted injuries including, but not limited to, any form of suicide attempt 1. Expenses that should be taken care of by any government programs such as Philhealth 3. Additional hospital charges and/or professional fees resulting from a plan member taking a room accommodation more than his R&B limit (excesses and/or incremental costs) 16. Acquisition of prosthetic appliances, artificial aids, durable equipment, surgically implanted devices and external prosthetic devices except those that are explicitly covered and enumerated in the ‘Special Procedures or New Modalities of Treatment’ provision of this agreement 5. Sterilization of either sex or reversal of such, artificial insemination, sex change, consultation/confinement regarding fertility 9. Psychiatric disorders, psychosomatic conditions, treatment for any mental or nervous disorders, illness / injury / condition / complication arising from the plan member’s excessive alcohol intake and/or use of regulated/prohibited drugs 20. Medico-legal fees including the cost of Medical Certificates that a plan member may require for any purpose it may serve him or her 10. Illnesses and/or injuries arising from the plan member’s participation in brawls, riots, commission of a crime, violation of ordinances, or the like 21. Congenital disease / deformity that is evident to the plan member at birth and/or can be clinically determined to be congenital [waived] 11. Illnesses / injuries resulting from conditions of war or sustained from combat-related activities 15. Sexually transmitted disease, AIDS, rehabilitative treatment for alcoholism and drug abuse 13. Illnesses / injuries attributable to the plan member’s own misconduct / gross negligence / immoral habits, and willful and unnecessary exposure to danger or health hazards 4. Maternity and maternity-related conditions and/or complications except those benefits that may be provided by the (optional) Maternity benefit EXCLUSIONS 3e. MEDICAL HMO…
  12. 12. 2 Ways to Access Healthcare : you can see an HMO doctor for free, or your own doctor for reimbursement at the HMO rate – each time you avail. (Unlike most HMO plans) You can see your own doctor, cheaper 2 Competitive Advantage #2: Purple Cow 2011 Why Purple Cow?
  13. 13. 3 Major Employee Benefits in 1 Plan: you get Life, Accident & Health (medical HMO , dental HMO, optional APE, and Wellness program) – all in one plan. (Unlike most HMO plans) You get all the Employee Benefits you will ever need 3 Purple Cow 2011 Why Purple Cow? Competitive Advantage #3:
  14. 14. 100% Pre-Existing Conditions: you get 100% Pre-Existing Conditions coverage, up to MBL, for cancer, hypertension, diabetes, asthma, etc. (Unlike most HMO plans) You are covered for dreaded & non-dreaded diseases 6 Purple Cow 2011 Why Purple Cow? Competitive Advantage #6:
  15. 15. 100% Congenital Conditions : you get 100% Congenital Conditions coverage, up to MBL, for mitral valve pro-lapse, rheumatic heart disease, hernia, etc. (Unlike most HMO plans) You are covered for medical conditions since birth 7 Purple Cow 2011 Why Purple Cow? Competitive Advantage #7:
  16. 16. 8 Purple Cow 2011 Why Purple Cow? Benefits on Top of Philhealth : your HMO limits are on top of Philhealth , so you won’t need as much MBL. Your Benefits = Philhealth + MBL, not just MBL. (Unlike most HMO plans) You get full HMO benefits on top of Philhealth benefits Competitive Advantage #8:
  17. 17. Medical HMO Network : you can get inpatient, outpatient and emergency treatment from 21,519 doctors, 352 hospitals, and 358 clinics nationwide. (unlike some HMO plans) You can go to MMC/ SLMC/ CSMC/ AHMC/ TMC/ Healthway 14 Purple Cow 2011 Why Purple Cow? Competitive Advantage #14:
  18. 18. Optional Outpatient Reimbursement: you can reimburse up to an aggregate limit of 1/10 th your Maximum Benefit Limit for Rx Medicines, Dental & Vision. (Unlike all HMO plans) You can get the best perks of medical insurance as well 18 Purple Cow 2011 Why Purple Cow? Competitive Advantage #18:
  19. 19. Same Benefits for Dependents : Dependents can get the same benefits, terms and conditions as Employees (as well as the same costs in 2011). (Unlike most, if not all, HMO plans) Your Dependents are treated like Employees 19 Purple Cow 2011 Why Purple Cow? Competitive Advantage #19: