Purple cow 2012 (medical button)


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Purple cow 2012 (medical button)

  1. 1. It's more FUN in Purple Cow! 18pg 2012 Medical
  2. 2. <ul><li>Purple Cow gives you all 3 of today’s major employee benefits in 1 package, designed to provide multiple layers of protection: </li></ul><ul><ul><li>Group Life: P50,000 – P1,000,000 </li></ul></ul><ul><ul><li>Group Accident: P50,000 – P1,000,000 </li></ul></ul><ul><ul><li>Group Health: P10,000 – P200,000 </li></ul></ul>More VALUE… 1 You can get MORE benefits for ALL of your staff Purple Cow 2012 Value Proposition
  3. 3. <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 by Purple Cow 3 - Small Business Poll on Compensating Employees (NFIB, US: 2003) Purple Cow 2012 EB Primer
  4. 4. 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 disablement; (10% of inpatient & outpatient cases) </li></ul><ul><li>HEALTH INSURANCE (medical insurance or HMO) protects you from losing money in the event of sickness or accident. (10% inpatient / 300% outpatient) </li></ul>Insurance saves you from losing your money 4 Purple Cow 2012 EB Primer
  5. 5. 1 Purple Cow 2012 Benefits ACCIDENT 2. ACCIDENT INSURANCE a. Accidental Death * Murder b. Accidental Disablement * Assault HEALTH 3. MEDICAL HMO * 19,401 MD, 382 hospitals, 426 clinics 4. Opt. DENTAL HMO * Basic 10: 790 dentists, 659 clinics 5. Opt. Annual Physical Exam * Basic 5: mobile or clinic 6. Health & Wellness Program * up to 2x/yr; tailored to utilization report LIFE 1. LIFE INSURANCE * Terminal Illness Rider * Total & Perm Disability Income LIFE – ACCIDENT – HEALTH Benefits Overview
  6. 6. 2 Purple Cow 2012 Benefits 18. Pooled Employee utilization 6. Accidental Disablement = __% of 5x MBL 13. Access to Big 5 Hospitals & Healthway 1. Life = 5x MBL 23. Same benefits for Dependents 11. HMO patient for no-cash-out 24. Access through Social Media 12. Private patient for reimbursement (HMO rate) 14. 100% Pre-Existing Conditions coverage 2. Terminal Illness = up to 50% of 5x MBL 20. Opt. Dental = HMO buffet of benefits 8. Medical = HMO buffet of benefits 22. Health & Wellness Program (up to 2x/yr) 21. Opt. APE = choice of mobile or clinic 19. Separate Dependent utilization 17. Benefits on top of Philhealth 16. 100% Special Procedures coverage 15. 100% Congenital Conditions coverage 10. Max. Benefit Limits per disability per year 9. Combined inpatient & outpatient limits 7. Assault = __% of 5x MBL 5. Murder = 5x MBL 4. Accidental Death = 5x MBL 3. Total & Perm. Disability Income = 5x MBL LIFE – ACCIDENT – HEALTH Benefits Summary
  7. 7. 7 Purple Cow 2012 Benefits 9. Buy now, pay later 9. 100% Special Procedures coverage TERMS & CONDITIONS 8. Split Dependent utilization to reduce cost 8. 100% Congenital Conditions coverage +Same rates for Dependents in 2012 +Principals 18yo-65yo; Dependents 30dy-22yo / 18yo-65yo 10. Benefits on top of Philhealth 7. 100% Pre-Existing Conditions coverage 5. Minimum group size = 10 5. Private patient for reimbursement (HMO rate) Medical HMO benefits are covered on top of Life & Accident benefits 10. 1 st year Virgin promo rate, if applicable 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. Access to Big 5 hospitals & Healthway 4. HMO patient for no-cash-out 3. Max. Benefit Limits per disability per year 2. Combined inpatient & outpatient limits 1. Traditional HMO buffet of benefits ASIANLIFE (19,401 doctors, 382 hospitals, 426 clinics) 3a. Medical HMO (nationwide)
  8. 8. 8 Purple Cow 2012 Benefits 18. Accidental injuries Dreaded & Non-Dreaded PEC are covered 100% up 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. Purple Cow 2012 Benefits 9 10. Radiation oncology / therapeutic radiology 9. Chemotherapy Special Procedures or New Modalities of Treatment are covered 100% up to MBL 14. Nuclear technologies 4. Laser therapy (excludes use for correcting vision) 23. Sleep therapy 20. Anti-nuclear anti-body (ANA) 7. Other new modalities of treatment for conditions with established etiologies and used as alternatives to conventional or traditional procedures 21. C-reactive protein (rheumatic & complications) 18. Endoscopy 15. Thallium scintigraphy 22. Lupus cell exam 19. Bone densitometry scan 17. Pulmonary perfusion scan 16. CT scan / MRI 13. Angiography 12. Physical & speech therapy 11. Sclerotherapy 6. Cost of artificial limbs, joint prosthesis and heart valve prosthesis 3. Laparoscopic procedures 8. Dialysis 5. Nuclear / radioactive isotope scans 2. Arthroscopic procedures 1. Lithotripsy SPECIAL PROCEDURES or NEW MODALITIES OF TREATMENT 3c. Medical HMO…
  10. 10. 10 Purple Cow 2012 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 3d. Medical HMO…
  11. 11. 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 Why Purple Cow? Purple Cow 2012 Competitive Advantages
  12. 12. 3 Major Employee Benefits in 1 Plan: You get Group Life, Accident & Health ( medical HMO, optional dental HMO, optional APE, and Wellness) – all in 1 plan. (Unlike most HMO plans) You get all the Employee Benefits you will ever need 3 Why Purple Cow? Purple Cow 2012 Competitive Advantages
  13. 13. 100% Pre-Existing Conditions: You get 100% coverage up to MBL for Pre-Existing Conditions such as cancer, hypertension, diabetes & asthma. (Unlike most HMO plans) You are covered for dreaded & non-dreaded diseases 6 Why Purple Cow? Purple Cow 2012 Competitive Advantages
  14. 14. 100% Congenital Conditions : You get 100% coverage up to MBL for Congenital Conditions such as mitral valve prolapse, rheumatic heart disease & hernia. (Unlike most HMO plans) You are covered for medical conditions since birth 7 Why Purple Cow? Purple Cow 2012 Competitive Advantages
  15. 15. 100% Special Procedures : You get 100% coverage up to MBL for Special Procedures such as arthroscopy, laparoscopy, chemotherapy, P/T & MRI. (Unlike most HMO plans) You are covered for newer modalities of treatment 8 Why Purple Cow? Purple Cow 2012 Competitive Advantages
  16. 16. 9 Benefits on Top of Philhealth : Your HMO limits are on top of Philhealth , so you won’t be needing as much MBL: Benefits = Philhealth + MBL (not just MBL). (Unlike most HMO plans) You get full HMO benefits on top of Philhealth benefits Why Purple Cow? Purple Cow 2012 Competitive Advantages
  17. 17. Medical HMO Network : You can get inpatient, outpatient & ER treatment from 19,401 affiliated doctors, 382 hospitals, and 426 clinics nationwide. (unlike some HMO plans) You can go to MMC/ SLMC/ CSMC/ AHMC/ TMC/ Healthway 19 Why Purple Cow? Purple Cow 2012 Competitive Advantages
  18. 18. 1 <ul><li>What’s in it for… Employees ? </li></ul>Purple Cow 2012 Summary You get full HMO + Philhealth benefits Employee Benefits on top of Philhealth You can take charge of your own health , and know before you go Access to benefit information through C3 on www.purplecow.ph & Facebook You can use any accredited hospital or clinic for medical or dental treatment Nationwide Medical & Dental network s, inclusive of all major hospitals & clinics You can see your own doctor and get reimbursed the HMO doctor’s rate Choice of doctor as a Private Patient for insurance reimbursement at HMO rates You are covered for existing illnesses, natal conditions, & special procedures 100% Pre-Existing, 100% congenital, & 100% Special Procedures coverage You can avail anytime, anywhere 1 health card for every employee You won’t need to get any more insurance benefits for yourself Life INS, Accident INS, Medical HMO, Optional Dental HMO & Optional APE You get more financial security from Purple Cow than from any other HMO A complete Employee Benefits package that can make you financially secure EE Benefits EE Features