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Purple cow 2012 (medical button)


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Purple cow 2012 (medical button)

  1. 1. 2012Medical 18pg
  2. 2. Purple Cow 2012 Value Proposition 2 More VALUE…Purple Cow gives you all 3 of today’s majoremployee benefits in 1 package, designedto provide multiple layers of protection: Group Life: P50,000 – P1,000,000 Group Accident: P50,000 – P1,000,000 Group Health: P10,000 – P200,000 You can get MORE benefits for ALL of your staff
  3. 3. Purple Cow 2012 EB Primer 3What are the most common EB? • Paid vacations, 75% • Health insurance, 61% • Paid sick leave, 59% • Disability insurance, 41% • Education reimbursement, 39% • Pension plan, 30% • Life insurance, 29% • Dental insurance, 24% - Small Business Poll on Compensating Employees (NFIB, US: 2003)All 4 insurance benefits are offered by Purple Cow
  4. 4. Purple Cow 2012 EB Primer 4 What makes Insurance ‘sulit?’• LIFE INSURANCE provides you with instant cash in the event of death or total and permanent disability; (.25% of population between 18-65)• ACCIDENT INSURANCE provides you with instant cash in the event of accidental death or disablement; (10% of inpatient & outpatient cases)• HEALTH INSURANCE (medical insurance or HMO) protects you from losing money in the event of sickness or accident. (10% inpatient / 300% outpatient) Insurance saves you from losing your money
  5. 5. Purple Cow 2012 Benefits 5 3 Major Employee Benefits LIFE – ACCIDENT – HEALTH 3a. MEDICAL HMO1. LIFE INSURANCE 3b. Optional DENTAL HMO 3c. Optional APE2. ACCIDENT INSURANCE 3d. WELLNESS PROGRAM
  6. 6. Purple Cow 2012 Benefits 6 Benefit Summary LIFE – ACCIDENT – HEALTH1. Life = 5x MBL 13. Access to all major hospitals & clinics2. Terminal Illness = up to 50% of 5x MBL 14. 100% Pre-Existing Conditions coverage3. Total & Perm. Disability Income = 5x MBL 15. 100% Congenital Conditions coverage4. Accidental Death = 5x MBL 16. 100% Special Procedures coverage5. Murder = 5x MBL 17. Benefits on top of Philhealth6. Accidental Disablement = __% of 5x MBL 18. Pooled Employee utilization7. Assault = __% of 5x MBL 19. Separate Dependent utilization8. Medical = HMO buffet of benefits 20. Optional Dental = HMO buffet of benefits9. Combined inpatient & outpatient limits 21. Optional APE = choice of mobile or clinic10. Max. Benefit Limits per disability per year 22. Free Wellness Program11. HMO patient for no-cash-out 23. Same benefits for Dependents12. Private patient for HMO reimbursement 24. Access through Social Media
  7. 7. Purple Cow 2012 Benefits 7 3a. Medical HMO (nationwide)ASIANLIFE (8,205 affil. MD, 383 hospitals, 428 clinics) TERMS & CONDITIONS1. Traditional HMO buffet of benefits 1. Instant rates, regardless of size2. Combined inpatient & outpatient limits 2. No franchising required3. Max. Benefit Limits per disability per year 3. No utilization report required4. HMO patient for no-cash-out 4. No individual applications required5. Private patient for reimbursement (HMO rate) 5. Minimum group size = 106. Access to all major hospitals & clinics 6. Minimum mode of payment = monthly7. 100% Pre-Existing Conditions coverage 7. Pooled Employee utilization to spread risk8. 100% Congenital Conditions coverage 8. Split Dependent utilization to reduce cost9. 100% Special Procedures coverage 9. Buy now, pay later10. Benefits on top of Philhealth 10. 1st year Virgin promo rate, if applicable+Principals 18yo-65yo; Dependents 30dy-22yo / 18yo-65yo +Same rates for Dependents in 2012 Medical HMO benefits are covered on top of Life & Accident benefits
  8. 8. Purple Cow 2012 Benefits 8 3a. Medical HMO… PRE-EXISTING CONDITIONS (Dreaded) PRE-EXISTING CONDITIONS (Non-Dreaded)1. Blood dyscrasias 1. Asthma, pleural effusion or other chronic airway obstruction conditions2. Benign / malignant new growths 2. Benign cyst / tumor and malignant conditions3. Chronic cardiac / cardio-vascular diseases 3. Chronic gynecologic conditions4. Collagen / connective diseases 4. Hemorrhoids and other chronic colonic and ano-rectal illnesses5. Diseases of the immune system 5. Diseased tonsils requiring surgery, cataracts & other opthalmo-otolaryngologic conditions6. Chronic hepatobiliary diseases 6. Pathological abnormalities of nasal septum and turbinate7. Neuro-surgical / neurological conditions 7. Sinus condition requiring surgery8. Chronic pulmonary diseases 8. Chronic neurologic conditions9. Chronic genito-urinary diseases 9. Calculus cholecystitis / cholelithiasis and/or urolithiasis10. Chronic gynecological conditions 10. Chronic conditions of the genitourinary system11. Chronic gastrointestinal conditions 11. Polyps, ulcers, liver cirrhosis and other chronic gastrointestinal diseases12. Endocrine abnormalities 12. Endocrine illnesses13. Antibiotic / chemotherapy-resistant diseases / bactemia / septicemia 13. Seizure disorders14. Chronic opthalmo-otolaryngologic diseases 14. Moderately to far advanced tuberculosis15. Chronic musculo-skeletal diseases 15. Chronic musculo-skeletal malignancies16. Pathological / accidental fractures 16. Malignancies of the blood and bone marrow17. Illnesses / injuries necessitating the use of isolation room / ICU or other IC facilities 17. Hypertension, coronary artery disease / myocardial ischemia, cerebrovascular accident and other chronic cardiac diseases18. Accidental injuries19. Second and third degree burns 18. Collagen / connective tissue diseases20. Surgical procedures requiring application / use of prosthesis for immediate treatment 19. Diseases of the immune system21. PEC (except congenital ones) subject to the provision on ‘PEC’ in this Agreement [waived] Dreaded & Non-Dreaded PEC are covered 100% up to MBL
  9. 9. Purple Cow 2012 Benefits 9 3a. Medical HMO… SPECIAL PROCEDURES or NEW MODALITIES OF TREATMENT1. Lithotripsy 11. Sclerotherapy2. Arthroscopic procedures 12. Physical & speech therapy3. Laparoscopic procedures 13. Angiography4. Laser therapy (excludes use for correcting vision) 14. Nuclear technologies5. Nuclear / radioactive isotope scans 15. Thallium scintigraphy6. Cost of artificial limbs, joint prosthesis and heart 16. CT scan / MRIvalve prosthesis 17. Pulmonary perfusion scan 18. Endoscopy7. Other new modalities of treatment for conditions withestablished etiologies and used as alternatives to 19. Bone densitometry scanconventional or traditional procedures 20. Anti-nuclear anti-body (ANA)8. Dialysis 21. C-reactive protein (rheumatic & complications)9. Chemotherapy 22. Lupus cell exam10. Radiation oncology / therapeutic radiology 23. Sleep therapy Special Procedures or New Modalities of Treatment are covered 100% up to MBL
  10. 10. Purple Cow 2012 Benefits 10 3a. Medical HMO… EXCLUSIONS1. Expenses that should be taken care of by any government programs such as Philhealth 13. Illnesses / injuries attributable to the plan member’s own misconduct / gross negligence / immoral habits, and willful and unnecessary exposure to danger or2. Services rendered or supplies provided free of charge health hazards3. Additional hospital charges and/or professional fees resulting from a plan member taking 14. Self-inflicted injuries including, but not limited to, any form of suicide attempta room accommodation more than his R&B limit (excesses and/or incremental costs)4. Maternity and maternity-related conditions and/or complications except those benefits that 15. Sexually transmitted disease, AIDS, rehabilitative treatment for alcoholism andmay be provided by the (optional) Maternity benefit drug abuse5. Sterilization of either sex or reversal of such, artificial insemination, sex change, 16. Acquisition of prosthetic appliances, artificial aids, durable equipment, surgicallyconsultation/confinement regarding fertility implanted devices and external prosthetic devices except those that are explicitly covered and enumerated in the ‘Special Procedures or New Modalities of Treatment’6. Non-recommended confinement, convalescent / domiciliary / custodial care, rest cures provision of this agreement7. Dental-related cases except those that may be provided by the Dental Benefits and to the 17. Organ transplant-expense relating to organ donation of the donating party/partiesextent that are necessary for the repair or alleviation of damage caused solely by accidentalinjury sustained (and not caused by the plan member) 18. Executive check-ups, unless explicitly provided in the master policy, and/or confinements purely for diagnostic purposes, as well as non-recommended8. Circumcision, cosmetic / aesthetic procedures except re-constructive surgery to treat confinementsfunctional defects due to a covered disease and/or accidental injury9. Psychiatric disorders, psychosomatic conditions, treatment for any mental or nervous 19. Take-home medicines, unless optional ‘Reimbursement of Prescribed Medicines’disorders, illness / injury / condition / complication arising from the plan member’s excessive benefit is provided, and vaccines, except for first doses of either anti-venom, anti-alcohol intake and/or use of regulated/prohibited drugs rabies or anti-tetanus used for emergency treatment10. Illnesses and/or injuries arising from the plan member’s participation in brawls, riots, 20. Medico-legal fees including the cost of Medical Certificates that a plan membercommission of a crime, violation of ordinances, or the like may require for any purpose it may serve him or her11. Illnesses / injuries resulting from conditions of war or sustained from combat-related 21. Congenital disease / deformity that is evident to the plan member at birth and/oractivities can be clinically determined to be congenital [waived] 22. Medical / surgical procedures and/or diagnostic tests that are experimental in12. Illnesses / injuries resulting from the plan member’s active participation in hazardous nature and/or not generally accepted by the medical profession such as, but not limitedactivities such as, but not limited to, bungee jumping, hang-gliding, scuba diving, to, iridology, chiropractic services, and acupuncturemountain/wall climbing, and professional sports
  11. 11. Purple Cow 2012 Competitive Advantages 11 Why Purple Cow? 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
  12. 12. Purple Cow 2012 Competitive Advantages 12 Why Purple Cow?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
  13. 13. Purple Cow 2012 Competitive Advantages 13 Why Purple Cow? 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
  14. 14. Purple Cow 2012 Competitive Advantages 14 Why Purple Cow? 100% Congenital Conditions: You get 100% coverage up to MBL forCongenital Conditions such as mitral valveprolapse, rheumatic heart disease & hernia.You are covered for most HMO plans) since birth (Unlike medical conditions
  15. 15. Purple Cow 2012 Competitive Advantages 15 Why Purple Cow? 100% Special Procedures: You get 100% coverage up to MBL for Special Procedures such as arthroscopy,laparoscopy, chemotherapy, P/T & MRI.You are covered for most HMO plans) of treatment (Unlike newer modalities
  16. 16. Purple Cow 2012 Competitive Advantages 16 Why Purple Cow? 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
  17. 17. Purple Cow 2012 Competitive Advantages 17 Why Purple Cow? Medical HMO Network: You can get inpatient and outpatient treatment from 8,205 affiliated doctors, 383 hospitals, and 428 clinics nationwide. (Unlike some HMO plans)You can go to MMC/ SLMC/ CSMC/ AHMC/ TMC/ Healthway
  18. 18. Purple Cow 2012 Summary 18 ♠ What’s in it for…Employees? EE Features EE BenefitsA complete Employee Benefits package You get more financial security fromthat can make you financially secure Purple Cow than from any other HMOLife INS, Accident INS, Medical HMO, You won’t need to get any moreOptional Dental HMO & Optional APE insurance benefits for yourselfNationwide Medical & Dental networks, You can use any accredited hospitalinclusive of all major hospitals & clinics or clinic for medical or dental treatmentChoice of doctor as a Private Patient for You can see your own doctor and getinsurance reimbursement at HMO rates reimbursed the rate of an HMO doctor100% Pre-Existing, 100% congenital, You are covered for existing illnesses,& 100% Special Procedures coverage natal conditions, & special proceduresEmployee Benefits on top of Philhealth You get full HMO + Philhealth benefitsAccess to benefit information through You can take charge of your ownC3 on & Facebook health, and know before you go1 health card for every employee You can avail anytime, anywhere