First choice 2014 patriot series

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  • Smallest doesn’t seem or sound right…how about just a title slide
  • I think putting the benefit first followed by verbiage is better…
  • Centered Headings and moved amounts to second line …looks cleaner…removed reference to liberalized UW
  • Headline is confusing here…both paid plan designs…why not just say “Additional Benefits”
  • First choice 2014 patriot series

    1. 1. BMC FirstChoice Patriot Series Part of the Manhattan Insurance Group SmartChoice PORTFOLIO FirstChoice Defined Benefit Health Plans and Supplements Critical Protection and Recovery Critical Illness Plan PAID ( Personal Accident Indemnity Delivery ) Accident Plan
    2. 2. How the Best gets Better in 2014! * Still Guaranteed Issue, Guaranteed Renewable Policies! * Renamed as Patriot Series to avoid confusion with HCR “Metal” plans. * Redesign provides GREATER BENEFITS at LOWER PREMIUM! * New Critical Income and Accident Policies! * SmartChoice Options for maximum protection! * Improved Surgical Benefits!
    3. 3. FirstChoice Surgical Filing new surgical language to comply with the NAIC guidance. Target launch is 5/1/14 for: AL, AZ, AR, IL, KY, LA, MO, NC, NE, SC, TN, TX, OK, and WI. with many more to soon follow.
    4. 4. FirstChoice Surgical From: Surgical Schedules To: Covering inpatient medically necessary surgeries the same! Meaning: When confined to the hospital for a period of time and surgical procedure takes place, plan pays the surgical benefit for each day of the continuous confinement, up to 5 days per confinement, not just the days on which actual surgery takes place.
    5. 5. Overview * Detailed introduction of the ‘Old vs New’ plan designs in the FirstChoice Portfolio; * Review the new CPR Critical Illness plan and PAID Accident plans; and finally * Review claims examples featuring the Patriot Series base plans with optional PAID and CPR policies.
    6. 6. FirstChoice New Patriot Series Complete Plan! Benefit Platinum ( Original FC ) Complete ( Patriot Series) OP Sickness $100 / 4 per ins. Cat. $100 / 4 per ins. Cat. Hospital Injury Indemnity $200 / day Excluded with Patriot Series Accidental Death & Dismem. $30,000 Primary Ins. Excluded with Patriot Series Daily Room Benefit $500 / day $500 / day Indemnity Benefit $1,000 1st Hosp Con. $1,000 1st Hosp Con. Emergency Accident $200 / 4 per ins. category $250 / 4 per ins. category Private Duty Nursing $250/day 30 days per con. $250/day 30 days per con. Specified Injury Rider Schedule of Benefits Schedule of Benefits First Hospital Confinement $10,000 over 6 days $10,000 over 6 days Intensive Care $2,000/day 20 days per con. $3,000 /day 20 days per con. Surgery 10,000 Schedule $3,000 day X up to 5 days! Anesthesia 25% of Surgical Benefit $600 day x up to 5 days! Wellness Mammogram & PAP ANY wellness treatment
    7. 7. Old vs New! Here is how the new Complete Plan Covers Surgery as compared to the current Platinum Plan. Procedure Old Surgical Schedule Platinum New Surgical Benefit Diamond Set amount per procedure, up to a benefit max. Platinum + $10,000 $3,000 per day, up to 5 days, for continuous confinement in which surgery takes place Heart Bypass 100% of $10,000 = $10,000 $3,000 per day, up to 5 days Gall Bladder 30% of $10,000 = $3,000 $3,000 per day, up to 5 days Valvotomy, Aortic Valve 75% of 10,000 = $7,500 $3,000 per day, likely 5 days Appendectomy 20% of 10,000 = $2,000 $3,000 per day, likely 2-3 days, up to 5 days
    8. 8. Platinum (Old FirstChoice) Complete (New FirstChoice Patriot Series) Premium $217.63 / Month $187.50/ Month! Now, let’s look at the other design improvements! FirstChoice New Patriot Series Complete Plan!
    9. 9. FirstChoice New Patriot Series Standard Plan! Benefit Gold ( Old ) Standard (New) Hospital Injury Indemnity $150/day X Accidental D&D $20,000 primary insured X Daily Room Benefit $400 day $400 day Indemnity Benefit $700 1st Hosp Confinement $1,000 1st Hosp Confinem’t OP Sickness $75 / 4 per ins. cat. $75 / 4 per ins. cat. Specified Injury Rider Schedule of Benefits Schedule of Benefits Private Duty Nursing $150/day 30 days per con. $250/day 30 days per con. Emergency Accident $150/day 4 per ins. category $250/day 4 per ins. Cat. First Hospital Confinement $10,000 over 6 days $10,000 over 6 days Intensive Care $1,000/day 20 days per con. $2,000/day 20 days per con. Surgery $5,000 Schedule $2,000 day X up to 5 days! ER and Amb. Surgery Ctr. 150% of OP Sickness ($112.50) 25% of Daily Surg. ($500) Anesthesia 25% of Surgical Benefit $400 day x up to 5 days! Premium $156.71 $165.85
    10. 10. FirstChoice New Patriot Series Basic Plan! Benefits Old New Hospital Injury Indemnity $100 / day $100 / day Indemnity Benefit $500 / 1st Hospital Con. $500 / 1st Hospital Con. OP Sickness $25 / 4 per ins. category $50 / 4 per ins. category Specified Injury Rider Schedule of Benefits Schedule of Benefits Private Duty Nursing $200 / day, 30 days per con. $250/ day, 30 days per con. Emergency Accident $100 x 4 per ins. category $250 x 4 per ins. category First Hospital Confinement $5,000 over 6 days $5,000 over 6 days Intensive Care X $1,000 /day 20 days per con. Surgery $5,000 Schedule $1,000 day X up to 5 days! Anesthesia 25% of Surgical Benefit $200 day x up to 5 days! Premium $72.19 $65.90
    11. 11. FirstChoice Patriot Series “The Supplement” plan.
    12. 12. 1) Lower the DRB by $50 day, & increase Emergency Accident by exactly that same amount, $50 day. 2) Lower the Indemnity Benefit from $500 to $100 once per year. 3) ADD $1,000 Daily Surgical Benefit, and 4) ADD $200 Daily Anesthesia Benefit, and 5) ADD $500 day of Intensive Care Benefit, and 6) ADD $250 per day for Private Duty Nursing, and 7) ADD $25 /visit of Outpatient Sickness ( Dr. Office ), and 8) ADD benefits for ER, Wellness and Amb Surgery Center… How much additional premium would the changes be worth? If you could start with the current FirstChoice Super Supp, and then…
    13. 13. Old vs New Are the changes worth $1.47 per month? Benefit Old New Daily Room Benefit $100/day 365 days $50/day 365 days Indemnity $500 first day $100 first day First Hospital Confinement $5,000 over 6 days $5,000 over 6 days Specified Injury Rider $25 - $2,000 $25 - $2,000 Emergency Accident $200 X 4 per ins. category $250 X 4 per ins. category Surgery – Max 5 days X $1,000/day up to 5 days ER , Ambulatory Surg. Center X 50% of 1 day surgery benefit Anesthesia X 20% of surgical amount Wellness X Private Duty Nurse X $250/day 30 days per conf. ICU X $500/day 20 days per conf. Premium $42.68 $44.15
    14. 14. Let’s look at how the Old Super Supp and New Patriot “Supplement” would handle the same claims. Procedure Old New Heart Bypass, 6 days, 2 ICU DRB $600, + IND $500, + FHC $5,000 = $6,100 DRB $150, + IND $100, + FHC $5,000, + SURG $5,000,+ ANES $1,000, = ICU $1,000, + PDN $250 = $12,500 Valvotomy, Aortic 6 days, 2 ICU DRB $600, + IND $500, + FHC $5,000 = $6,100 DRB $150, + IND $100, + FHC $5,000, + SURG $5,000,+ ANES $1,000, = ICU $1,000, + PDN $250 = $12,500 Gall Bladder, 4 days, 0 ICU DRB $400, + IND $500, + FHC $3,000 = $3,900 DRB $200, + IND $100, + FHC $3,000, + SURG $4,000, + ANES $800 = $8,100 Appendectomy, 3 days, 0 ICU DRB $300, + IND $500, + FHC, $2,000 = $2,800 DRB $150, + IND $100, + FHC $2,000, + SURG $3,000 + ANES $600 = $5,850 For presentation purposes only
    15. 15. BMC FirstChoice Old vs NewPatriot Series Monthly Rates Complete/ Platinum Standard/ Gold Basic/ Trad.Supp Supplement/ Super Supp Employee $187.50/ $217.63 $165.85/ $156.71 $65.90 / $72.19 $44.15 / $42.68 Emp / Spouse $373.25 /$433.51 $325.95 / $311.67 $130.05 / $142.63 $86.55 / $83.61 Employee/Child $307.05 /$353.41 $269.50 /$255.92 $110.04 / $113.93 $73.30 / $66.46 Family $489.80 /$569.29 $431.60 /$410.88 $173.55 / $184.37 $115.20 / $107.39 * Greater Benefits * Better Flexibility, * Comparable Premium
    16. 16. SmartChoice Portfolio Offerings Critical Illness and Accidents!
    17. 17. Critical Protection and Recovery (CPR): * A critical illness policy with a modern design and many outstanding features. * Features premiums that are age banded, do not increase simply because of advancing age, and are Guaranteed Renewable for LIFE!
    18. 18. CPR Critical Health Events * Major Human Organ Transplant * Coronary Artery Bypass Surgery * Coma * Major Third-Degree Burns * Paralysis * End Stage Renal Failure * Heart Attack * Stroke and is available with or without coverage for Cancer!
    19. 19. CPR First Occurrence Benefit CUL will pay the selected amount for each Covered person under the policy when first diagnosed as having had a Covered Specified Health Event. Plan I Plan II Plan III $5,000 $7,500 $10,000
    20. 20. CPR Monthly Income Benefit * For ongoing financial recovery (regardless of disabled or not) * Plan pays an additional amount PER MONTH ( equal to 10% of the First Occurrence Benefit (FOB)) to the covered Person when a FOB has been paid. * First monthly payment begins one calendar month following the date the Covered Specified Health Event occurred for which FOB was paid. Payments will continue for 12 months! Plan I Plan II Plan III $500/mo for 12 months, Total $6,000 $750/mo for 12 months, Total $9,000 $1,000/mo for 12 months, Total $12,000
    21. 21. Plan pays an amount equal to 50% of the FOB if the Covered Person later has a reoccurrence of the first or another Covered Specified Health Event which occurs more than 365 days after FOB became payable No Lifetime Maximum! CPR Recurrence Benefit Plan I Plan II Plan III $2,500 $3,750 $5,000
    22. 22. CPR – Benefits Available in all Three Plans! Hospital Confinement Benefit: •Pays $300 for each day of Confinement for treatment of a Covered Specified Health Event. No lifetime Maximum! Ambulance Benefit: •CUL will pay this benefit for transportation to or from a Hospital due to a Covered Specified Health Event. Air Ambulance - $1,000 Ground Ambulance - $250 No Lifetime Maximum!
    23. 23. CPR – Benefits Available in all Plans! Transportation Benefit: * 50 cents per mile for noncommercial travel * Actual costs incurred for commercial travel (coach class plane, train, or bus fare) Plan pays this benefit if the local attending Physician prescribes special medical treatment that must be provided in a Hospital or medical facility that is located outside of a 75-mile radius of the residence of the Covered Person. No Lifetime Maximum Lodging Benefit: CUL will pay the actual charges incurred up to $70 per day. This benefit applies to the Covered Person or any one adult member of the Immediate Family when a Covered Person receives special medical treatment at a hospital outside of a 75 mile radius of the residence of the Covered Person. No Lifetime Maximum The CPR plan also includes Waiver of Premium after the Named Insured has been Totally Disabled for 60 days.
    24. 24. CPR Plan Highlights! * Guaranteed Renewable for LIFE! * Pays full benefit for * Coronary Artery Bypass Surgery! ( Most plans pay a fraction of their benefit for this procedure! ) * Option to include benefits for Cancer! * Excellent Benefits for REOCCURRENCE! * No Lifetime Maximums!
    25. 25. Underwriting * * The CPR application must be completed in full detail. * Anything revealed the HIV, AIDs, ARC family is a decline. * When applying for the version of CPR that does NOT include cancer, and when also applying for (or already owning!) any FirstChoice policy, the CPR plan WILL be issued! There will be a permanent exclusion for any Critical Health Event diagnosed in the prior 12 months before application.
    26. 26. Monthly CPR Rates Plan I 5,000 FOB Plan II 7,500 FOB Plan III 10,000 FOB 18-34 Individual $7.30 $9.70 $12.10 18-34 1 Parent Family $7.90 $10.50 $13.10 18-34 2 Parent Family $13.00 $13.10 $21.80 35-44 Individual $13.90 $18.50 $23.10 35-44 1 Parent Family $14.50 $19.30 $24.10 35-44 2 Parent Family $25.10 $33.90 $42.70 45-54 Individual $23.80 $31.70 $39.60 45-54 1 Parent Family $24.40 $32.50 $40.60 45-54 2 Parent Family $43.80 $59.20 $74.60 55-64 Individual $38.60 $51.50 $64.40 55-64 1 Parent Family $39.30 $52.40 $65.50 55-64 2 Parent Family $72.40 $96.60 $120.80 These are the rates for the Critical Care and Recovery plan that does not include benefits for Cancer.
    27. 27. PAID Accident Plan (Personal Accident Indemnity Delivery) State approvals as of 4/1/14
    28. 28. PAID Product Features * Helps you pay for out-of-pocket expenses * 24-hour or off-the-job only * Issue Ages 18-69 * Guaranteed Renewable to age 70 * Some benefits available for two-unit coverage
    29. 29. PAID Plan Benefits * Accidental Death + * Hospital Admission and Confinement + * Intensive Care Unit Benefit * Emergency Room Benefit * Air and Ground Ambulance * Emergency Dental * Lodging * Transportation * Surgery * Optional Wellness Benefits + These two benefits (Accidental Death & Accident Hospital Confinement) were removed from the FirstChoice plan designs with the introduction of the Patriot Series.
    30. 30. PAID Optional Annual Wellness Benefit Rider * Annual Physical Exam * Dental Exam * Flexible Sigmoidoscopies * PSA Test * Blood Screening Test * Ultrasounds * Mammogram * Eye Exam * Immunization * Pap Smear The Policy must be in force 12 months before this benefit is payable
    31. 31. Additional PAID Benefits Also Include: * Air Ambulance * Ambulance * Accidental Death * Accidental Death (Via Common Carrier) * Emergency Room Treatment * Hospital Admission * Hospital Confinement * Hospital ICU * Major Diagnostic Exams * Physicians Office/ Urgent Care * Blood, Plasma & Platelets * Burns * Emergency Dental * Dislocation (separated joint) * Fracture (broken bone) * Gunshot Wound * Laceration * Lodging * Eye Injury * Knee Cartilage (torn) * Transportation * Surgery These benefit amounts vary by plan selected.
    32. 32. Benefits Featured in Both PAID Plan Designs * Epidural Pain Management * Physical Therapy * Rehabilitation Unit * Prosthesis * Accidental Dismemberment * Appliances
    33. 33. Excellent features of PAID! * PAID is Guaranteed Renewable to age 70! * Issued from age 18-69! * There are no established ‘ineligible occupations’ that would restrict individual applications. (There are ineligible GROUPS for List Bill) * Bank Draft rates and List Bill rates are the same. * Benefits are PAID in addition to other coverage in force. Not true
    34. 34. Form HPACC13-24 Accident Policy Rate Schedule 24 Hour Coverage Off-the-Job Only Optional One Unit Two Units One Unit Two Units Wellness Rider Employee $18.33 $22.00 $15.50 $18.00 $3.00 Employee / Spouse $25.83 $32.00 $24.25 $29.25 $6.00 Employee / Child(ren) $25.83 $32.00 $24.25 $29.25 $6.00 Family $33.33 $42.00 $28.25 $35.00 $9.00
    35. 35. Examples of SmartChoice; FirstChoice, CPR and PAID premium packages Male or Female, 18-54, FirstChoice Complete $187.50 CPR, Plan III $39.60 PAID Accident $22.00 ( 24 Hour, Two Units ) --------------------------------- $249.10 Male or Female, Age 58 FirstChoice Supplement $44.15 CPR, Plan III $64.40 PAID Accident (Off Job) $18.00 ( 24 Hour, Two Units ) ------------------------------------ $126.55 Male or Female, Age 33 FirstChoice Standard $165.85 CPR, Plan III $12.10 PAID Accident $22.00 ( 24 Hour, Two Units ) --------------------------------- $199.95 Male or Female, Age 64 FirstChoice Standard $165.85 CPR, Plan III $64.40 PAID Accident $22.00 ( 24 Hour, Two Units ) ----------------------------------- $252.25
    36. 36. Let’s look at a few CLAIMS! FirstChoice, CPR and PAID (2 Units) premium packages Complete, CPR III, and PAID Accident. Heart Bypass, 7 day hospital confinement, 3 day ICU. MultiPlan PPO available for repricing. Daily Room Benefit, $500 day X 7 days = $3,500 Indemnity Rider = $1,000 First Hospital Confinement = $10,000 Surgical Rider, $3,000/day X 5 days = $15,000 Anesthesia, $600 day X 5 days = $3,000 ICU, 3 days X $3,000/day = $9,000 Total $41,500 ------------------------------------------------------------------ CPR III, First Occurrence $10,000 Monthly Income benefit $12,000 Hospital Confinement, 7 days X 300= $2,100 Total $24,100 ------------------------------------------------------------------- Grand Total = $65,600 PPO repriceing by MultiPlan would be available if a MultiPlan provider was used
    37. 37. Let’s look at a few CLAIMS! FirstChoice, CPR and PAID premium packages Femur fractured in a fall. FirstChoice Supplement, CPR and PAID, (2 units) Treated and released at Emergency Room, no inpatient confinement. FirstChoice Supplement Specified Injury Rider, fractured femur = $1,800 Emergency Accident Rider = $250 ER, reduction of femur, 25% Daily Surgical Benefit $200 Total = $2,250 ------------------------------------------------------------------------------------- PAID Accident Policy Ambulance = $100 ER Treatment = $200 Fractured Femur = $750 Total = $1,050 ---------------------------------------------------------------------------------------- Grand Total = $3,300
    38. 38. Let’s look at a few CLAIMS! FirstChoice, CPR and PAID premium packages Emergency bowel obstruction, colostomy, 21 days confinement, 12 in ICU. Subsequent stoma reversal. Basic Supplement. Phase I, FirstChoice Basic Plan, 21 days X $100/day = $2,100 ICU x 12 days x $1,000/day = $12,000 Indemnity Benefit Rider = $1,000 First Hospital Confinement = $5,000 Surgery = 5 days X $1,000/day = $5,000 Anesthesia = 5 days X $200/day = $1,000 Total, Phase I, $26,100 --------------------------------------------------------------------------------- Phase II 6 days confinement X $100/day = $600 Surgery = 5 days x $1,000/day = $5,000 Anesthesia = 5 days X $200/day = $1,000 Total, Phase II, $6,600 ------------------------------------------------------------------ Grand Total = $32,700* * This is an actual claim, experienced by an insured personal family member. In the real life example, the subsequent stoma reversal happened in the following plan year. Had this example reflected that actual claim, an additional Indemnity Benefit ($1,000) and FHC Benefit ($5,000) would have been payable, bringing the total paid by our FirstChoice Basic plan design to $38,700.

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