Select Benefits Proposal GI for Sample GAP. Situs State - Ohio

Transcription

1 Select Benefits Proposal GI for Sample GAP Situs State - Ohio This proposal was prepared on 12/4/2012 and is valid for 3 months from date quoted. This proposal is not intended as a contract. Contract provisions, exclusions, and limitations will be subject to Symetra Select Benefits policy provisions. If there is any conflict between this proposal and a subsequently issued policy, the policy will prevail. The agent or broker does not have the authority to bind nor modify the terms of this offer without prior written approval of Symetra Life Insurance Company. Select Benefits is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA and is not available in all U.S. states or any U.S. territories. Symetra and the Symetra Financial logo are registered service marks of Symetra Life Insurance Company. LG /08

2 At-A-Glance Symetra Financial Corporation Symetra Life Insurance Company 5 Facts CEO Tom Marra CFO Margaret Meister Ticker Symbol NYSE: SYA Headquarters Bellevue, Wash. Financial Stability Employees 1,250 Customers 1.6 million Distribution Benefit Consultants Financial Institutions Agents and Advisors $29.5 billion in assets as of Sept. 30, ,2 $195.8 million in 2011 net income 1 $2.0 billion in 2011 total revenues 1 Recognized Industry Performance Top-40 U.S. life insurance company based on admitted assets. 6 Ward s 50 top-performing insurance company for 2012, based on financial performance. 7 Market leader in medical stop-loss insurance, according to Standard & Poor s (S&P). 8 Sound Financial Strength Ratings Financial strength ratings are impartial, third-party opinions that assess the ability of the company to meet its obligations to policyholders. Financial strength ratings 9 for Symetra Life Insurance Company: A.M. Best A Excellent (3 rd highest of 16) Standard & Poor s A Strong (6 th highest of 21) Moody s A3 Good (7 th highest of 21) Disciplined Balance Sheet Focus Our balance sheet reflects our rigorous risk management and strict asset-liability standards. 95% of our fixed-income portfolio is in high-quality assets, such as investment-grade bonds. Portfolio Composition 85.9% Fixed Maturities 10.7% Commercial Mortgage Loans 2.2% Equities and REITs 3 1.2% Other 4 Fitch A+ Strong (5 th highest of 21) Products and Services Annuities Solutions that provide guaranteed lifetime income and tax-deferred growth. Employee Benefits Solutions to help employers attract and retain a quality workforce. Life Insurance Financial products to help families recover from personal loss and build legacies Established life insurance business. Pioneered medical stop loss. Began selling annuities through banks. Passed the $30 billion mark of life insurance in force. Became an independent company Symetra Financial Corporation. Began trading on the NYSE under the ticker symbol SYA. Not a bank or credit union deposit or obligation Not insured by any federal government agency Not FDIC or NCUA/NCUSIF insured Not guaranteed by any bank or credit union May lose value LMC /12

3 Established in 1957, Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation. Life insurance and annuities are issued and employee benefit plans are insured by Symetra Life Insurance Company, th Avenue NE, Suite 1200, Bellevue, WA 98004, and are not available in all U.S. states or any U.S. territory. 1 All financial figures for Symetra Financial Corporation are reported on a GAAP basis. Historical financial information has been restated to reflect retrospective adoption of a new accounting standard for deferred acquisition costs on Jan. 1, As of Sept. 30, 2012, liabilities were $25.9 billion and stockholders equity was $3.6 billion. 3 Included in trading marketable equity securities. 4 Limited partnerships, policy loans and other investments. Symetra Financial Corporation th Avenue NE, Suite 1200 Bellevue, WA Symetra is a registered service mark of Symetra Life Insurance Company. 5 Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation. 6 Symetra Life Insurance Company, Best s Review, Top 200 U.S. Life/Health Writers (July 2012). 7 Symetra Life Insurance Company, Ward Group, Top 50 Life-Health Companies (July 2012). 8 Symetra Financial Corp. and Life Insurance Subsidiaries, Standard & Poors (May 2011). 9 Dates of last ratings updates or affirmations are as follows: A.M. Best Oct. 28, 2011; Standard & Poor s Feb. 21, 2012; Moody s Dec. 5, 2011; and Fitch Sept 24, 2012.

4 The Advantages of Select Benefits product overview First-dollar coverage that reduces the financial impact of an employee s out-of-pocket exposure. A Plan for Today s Market Select Benefits helps employers provide health insurance to employees who cannot afford, or do not qualify for, participation in a major medical plan. It may also be used to enhance a current plan with supplemental coverage or to fill gaps from a high-deductible major medical plan. In any case, this first-dollar coverage reduces the financial impact of an employee s out-of-pocket exposure. As a hospital/fixed indemnity product, Select Benefits is generally exempt from the health care reform provisions of the Patient Protection and Affordable Care Act (PPACA). We continue to offer flexibility and cost advantages to employers seeking to provide coverage to their employees at a premium rate they can afford. Highlights Flexibility of Plan Design. Our plans are designed to meet the needs of each and every group. We can customize monthly and hourly plans based on the unique budget and benefit needs of individual employers and their employees. Cost Control. Employers decide which benefits to offer, who is eligible to participate and how much they will contribute to the plan. Hassle-Free Quoting. There is no need to provide detailed information on eligible employees prior to contracting. Rates are not based on demographics, industry or geographic location. Visit to get started. Dependable Administration. One of the reasons policyholders re-enroll year after year is the responsive and personable service they receive from Select Benefit Administrators, our in-house administration provider. Patient Advocacy Program. Free assistance with a full range of health care and insurance issues is available to enrolled participants, their spouse, dependents, parents and parents-in-law. LGS /11

5 product overview Plan Components Available Benefits 1 There are a number of medical benefits for the employer to choose from when creating a custom plan design. These include, but are not limited to: doctor s office visits outpatient diagnostic labs and X-rays hospital stays and inpatient admission surgeries (including anesthesia and outpatient facility charges) accident coverage In addition, employers may elect to include: life insurance coverage short-term disability 2 critical illness benefits vision dental and more Ask your Select Benefits representative for a full list of available benefits and work with them to design a plan to suit your needs and your budget. All plans include (at no additional charge) a survivor benefit, pharmacy discount program and patient advocacy program. Billing Options Monthly Hourly Premium billed at a fixed monthly rate. Premium and benefits are based on the number of hours worked/paid each month. Current month s coverage is determined by hours worked/paid the previous month. Rate Options Composite Employee + all eligible dependents at one rate. Tiered Separates pricing for employees and their dependents. Minimum Participation Requirements The greater of five enrolled employees or 10% of all eligible employees. For more information or to request a proposal, please contact your Select Benefits representative. Symetra Life Insurance Company th Avenue NE, Suite 1200 Bellevue, WA Symetra and the Symetra Financial logo are registered service marks of Symetra Life Insurance Company. Select Benefits is not a replacement for a major medical policy or other comprehensive insurance. It is designed to cover benefits at a preselected fixed dollar amount. Coverage may be subject to exclusions, limitations, reductions, and termination of benefit provisions. Select Benefits is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA 98004, and is not available in all U.S. states or any U.S. territory. 1 Benefits are not available in all states. Please contact your independent Select Benefits representative. 2 Dependents are not eligible for disability income coverage.

6 Select Benefits Plan Summary for Sample GAP This offer is subject to a minimum of the greater of 10% participation or 5 enrolled employees Proposal: GI /4/2012 Fixed-Payment Indemnity Policy Sample $1500 GAP Sample $2500 GAP Sample $5000 GAP Doctor's Office Visit, Urgent Care & Outpatient Hospital Benefit Outpatient Diagnostic X-Ray & Lab Benefit Outpatient Major Diagnostic Testing Benefit Hospital Inpatient Admission Benefit Coverage per confinement Admittances Surgical Benefit Surgical Anesthesia Benefit $30 per visit $150 pp/pcy 1 max. $30 per visit $150 pp/pcy max. $200 per test 2 tests pp/pcy max. $1,500 1 pp/pcy max. $500 pp/pcy max. Schedule D $350 per surgery 1 surg. pp/pcy max $200 per test 2 tests pp/pcy 1 max. $2,500 1 pp/pcy max. $2,000 pp/pcy max. Schedule D $500 per test 2 tests pp/pcy 1 max. $3,000 1 pp/pcy max. $4,000 pp/pcy max. Schedule D Patient Advocacy Services Included Included Included Survivor Benefit Included Included Included LG _OH(10.0) 1 / 2 03/09

7 Proposal: GI /4/2012 Monthly Premium Sample $1500 GAP Sample $2500 GAP Sample $5000 GAP Employee Employee + Spouse Employee + Children Family $43.43 $92.55 $71.19 $ $48.46 $ $79.45 $ $65.67 $ $ $ pp/pcy=per person, per calendar year These rates are guaranteed for 12 months following the effective date. Patient advocacy services are included at no additional cost. These services are provided by Health Advocate, Inc., 3043 Walton Road Suite 150, Plymouth Meeting, PA This is not an insured benefit. Policyholder's Approval of Plan Selection: Insurance benefits are provided under the Select Benefits Fixed-Payment Indemnity Policy, form number SBC /12, and/or Critical Illness Policy, form number LGC /07, and/or Outpatient Prescription Drug Indemnity Policy, form number LGC /11, and/or Group Accident Policy, form number LGC /11. It is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA The coverage is not a substitute for major medical or other comprehensive coverage. Benefits are paid based on a preselected fixed amount. It may be subject to exclusions, limitations, reductions and terminations of benefits provisions. Please review the description of benefits for additional details. For more information contact your agent. LG _OH(10.0) 2 / 2 03/09

8 Select Benefits Description of Benefits for Sample GAP : Sample $1500 GAP Proposal: GI /4/2012 Doctor's Office Visit, Urgent Care and Outpatient Hospital Benefit Benefits are paid at a preselected fixed dollar amount per visit, up to a calendar year maximum. Doctor s office visits include treatment received in a Doctor s office, Outpatient clinic, Urgent Care facility (not a Hospital Emergency Room). This benefit excludes preventive care, vaccinations, inpatient or outpatient surgical procedures. Outpatient Diagnostic X-Ray and Lab Benefit This benefit pays a preselected fixed dollar amount for one or more diagnostic X-ray or lab tests performed by a doctor during a single visit to a provider. A visit means one sitting for one or multiple diagnostic X-ray procedures or one sitting for one or multiple diagnostic laboratory procedures. Benefits are subject to a calendar year maximum and will be paid when hospital confinement is not required. Outpatient Major Diagnostic Testing Benefit Benefits will be paid at a preselected fixed dollar amount up to a calendar year maximum number of tests for the following: magnetic resonance imaging (MRI), computed tomography (CT, CAT scan), mammography, stress test, electrocardiogram, (ECG, EKG), ultrasound, bone density, amniocentesis and chromosome analysis. Hospital Inpatient Admission Benefit This benefit pays for admission to a healthcare facility for a minimum of 24 hours when confinement is medically necessary and is the result of a nonoccupational illness or injury. This benefit will be paid regardless of any other inpatient hospital benefits available to the insured. Surgical Benefit This benefit pays a preselected fixed dollar for surgeries performed by a doctor. Benefits are paid according to the surgical schedule. Surgical Anesthesia Benefit This provides benefits for anesthesia administered by an anesthesiologist or anesthetist in connection with a covered surgical procedure. The benefit pays a preselected fixed dollar amount up to a calendar year maximum number of surgeries. Patient Advocacy Services Healthcare advocacy and assistance services provided by Health Advocate, Inc. Health Advocate's Core Advocacy program provides personalized help to resolve healthcare and insurance-related issues. A NurseLine program is integrated with the Core Advocacy program. Additional service available is a Medical Bill Saver program that offers assistance with negotiating payment on uncovered medical bills. Survivor Benefit If an employee dies while insured, any covered dependents will be extended benefits (except Dependent Life) without premium payments for up to two years after the employee's death. This is as long as the plan remains in force and the covered dependent meets the coverage requirements in the policy. Select Benefits is not a replacement for major medical or any other comprehensive policy. It is designed to cover benefits at a preselected, fixed dollar amount. Coverage may be subject to exclusions, limitations, reductions and termination of benefits provisions which may vary by state. Any spousal benefits/rights may be restricted by Internal Revenue Code and the federal Defense of Marriage Act. Please see the policy certificate for details. Select Benefits is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA Symetra is a registered service mark of Symetra Life Insurance Company. LG / 1 03/09

9 Select Benefits Description of Benefits for Sample GAP : Sample $2500 GAP Proposal: GI /4/2012 Outpatient Major Diagnostic Testing Benefit Benefits will be paid at a preselected fixed dollar amount up to a calendar year maximum number of tests for the following: magnetic resonance imaging (MRI), computed tomography (CT, CAT scan), mammography, stress test, electrocardiogram, (ECG, EKG), ultrasound, bone density, amniocentesis and chromosome analysis. Hospital Inpatient Admission Benefit This benefit pays for admission to a healthcare facility for a minimum of 24 hours when confinement is medically necessary and is the result of a nonoccupational illness or injury. This benefit will be paid regardless of any other inpatient hospital benefits available to the insured. Surgical Benefit This benefit pays a preselected fixed dollar for surgeries performed by a doctor. Benefits are paid according to the surgical schedule. Patient Advocacy Services Healthcare advocacy and assistance services provided by Health Advocate, Inc. Health Advocate's Core Advocacy program provides personalized help to resolve healthcare and insurance-related issues. A NurseLine program is integrated with the Core Advocacy program. Additional service available is a Medical Bill Saver program that offers assistance with negotiating payment on uncovered medical bills. Survivor Benefit If an employee dies while insured, any covered dependents will be extended benefits (except Dependent Life) without premium payments for up to two years after the employee's death. This is as long as the plan remains in force and the covered dependent meets the coverage requirements in the policy. Select Benefits is not a replacement for major medical or any other comprehensive policy. It is designed to cover benefits at a preselected, fixed dollar amount. Coverage may be subject to exclusions, limitations, reductions and termination of benefits provisions which may vary by state. Any spousal benefits/rights may be restricted by Internal Revenue Code and the federal Defense of Marriage Act. Please see the policy certificate for details. Select Benefits is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA Symetra is a registered service mark of Symetra Life Insurance Company. LG / 1 03/09

10 Select Benefits Description of Benefits for Sample GAP : Sample $5000 GAP Proposal: GI /4/2012 Outpatient Major Diagnostic Testing Benefit Benefits will be paid at a preselected fixed dollar amount up to a calendar year maximum number of tests for the following: magnetic resonance imaging (MRI), computed tomography (CT, CAT scan), mammography, stress test, electrocardiogram, (ECG, EKG), ultrasound, bone density, amniocentesis and chromosome analysis. Hospital Inpatient Admission Benefit This benefit pays for admission to a healthcare facility for a minimum of 24 hours when confinement is medically necessary and is the result of a nonoccupational illness or injury. This benefit will be paid regardless of any other inpatient hospital benefits available to the insured. Surgical Benefit This benefit pays a preselected fixed dollar for surgeries performed by a doctor. Benefits are paid according to the surgical schedule. Patient Advocacy Services Healthcare advocacy and assistance services provided by Health Advocate, Inc. Health Advocate's Core Advocacy program provides personalized help to resolve healthcare and insurance-related issues. A NurseLine program is integrated with the Core Advocacy program. Additional service available is a Medical Bill Saver program that offers assistance with negotiating payment on uncovered medical bills. Survivor Benefit If an employee dies while insured, any covered dependents will be extended benefits (except Dependent Life) without premium payments for up to two years after the employee's death. This is as long as the plan remains in force and the covered dependent meets the coverage requirements in the policy. Select Benefits is not a replacement for major medical or any other comprehensive policy. It is designed to cover benefits at a preselected, fixed dollar amount. Coverage may be subject to exclusions, limitations, reductions and termination of benefits provisions which may vary by state. Any spousal benefits/rights may be restricted by Internal Revenue Code and the federal Defense of Marriage Act. Please see the policy certificate for details. Select Benefits is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA Symetra is a registered service mark of Symetra Life Insurance Company. LG / 1 03/09

11 Select Benefits Plan Design Rates for Sample GAP Proposal: GI /4/2012 The pricing below lists the cost to purchase each separate group insurance policy component of your company's Select Benefits plan. Sample $1500 GAP Employee Employee Employee Employee + Spouse + Child(ren) + Family Fixed-Payment Indemnity Policy $43.43 $92.55 $71.19 $ Total Monthly Premium $43.43 $92.55 $71.19 $ Sample $2500 GAP Employee Employee Employee Employee + Spouse + Child(ren) + Family Fixed-Payment Indemnity Policy $48.46 $ $79.45 $ Total Monthly Premium $48.46 $ $79.45 $ Sample $5000 GAP Employee Employee Employee Employee + Spouse + Child(ren) + Family Fixed-Payment Indemnity Policy $65.67 $ $ $ Total Monthly Premium $65.67 $ $ $ Insurance benefits are provided under the Select Benefits Fixed-Payment Indemnity Policy, form number SBC /12, and/or Critical Illness Policy, form number LGC /07, and/or Outpatient Prescription Drug Indemnity Policy, form number LGC /11, and/or Group Accident Policy, form number LGC /11. It is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA The coverage is not a substitute for major medical or other comprehensive coverage. Benefits are paid based on a preselected fixed amount. It may be subject to exclusions, limitations, reductions and terminations of benefits provisions. Please review the description of benefits for additional details. For more information contact your agent. LG /09

12 Exclusively for Health Advocate Members Healthcare Help Get Started Welcome to Your Health Advocate Benefit Your Healthcare Help, NurseLine and Medical Bill Saver benefit, provided free by your employer or plan sponsor, helps you and your family with healthcare-related problems. We re also here to provide around-the-clock support and to help lower your medical bills. Healthcare Help What is Healthcare Help? The Healthcare Help feature provides personalized assistance to help you and your family navigate the complexities of the healthcare system. When is it available? You can access the program 24/7. Normal business hours are Monday-Friday, between 8 am and 9 pm Eastern Time. After hours and during weekends, staff is available for assistance. What does it do? A Personal Health Advocate can help you with a full range of healthcare and insurance-related issues to save you time, money and worry. Reasons to call Find the right doctors, hospitals Schedule tests, appointments Locate eldercare services Secure second opinions Untangle claims, billing errors Navigate your insurance plan Explain conditions, treatments Help you make informed decisions Just call: HealthAdvocate.com/members How does it work? If you have a healthcare or insurance-related issue, call our toll-free number. You ll be assigned a Personal Health Advocate, who works with you one-on-one to find solutions to time-consuming issues, such as sorting out billing concerns, finding qualified doctors, transferring medical records, finding eldercare and more. Our Health Cost Estimator service shows you the costs of common medical procedures. Call us and we can give you the cost information you need, so you can make an informed decision. Who can use it? All three features are available to all eligible employees, their spouse, dependent children, parents and parents-in-law. If you have a question about who is covered for services, simply call us.

13 Exclusively for Health Advocate Members Healthcare Help Getting Started: Your Health Advocate Benefit NurseLine What is NurseLine? NurseLine is part of your Health Advocate benefit, provided free by your employer or plan sponsor, that offers registered nurses available 24/7 to help answer your questions. Now, you and your family have a place to turn to after hours for trusted advice and information, when you need it most. How can it help? Call any time, day or night Nurses answer questions about symptoms, medications; explain health conditions Offers simple, self-care tips for non-urgent conditions Refers you to the appropriate care (e.g., urgent care center or ER), as needed Just call: HealthAdvocate.com/members Remember Call 911 or go to the ER in an Emergency. Feature 3 Medical Bill Saver What is Medical Bill Saver? As part of your Health Advocate benefit, provided free by your employer or plan sponsor, the Medical Bill Saver program can lower your out-of-pocket costs on your medical bills not covered by your insurance. We will work with your providers to lower the balance on any uncovered medical or dental bill over $400. We can even attempt to negotiate deductibles and coinsurance in states where permitted. How can it help? Negotiation can result in 25-50% savings You pay nothing for this service Easy-to-read, personal Savings Result Statement, summarizing outcome and payment terms Provider sign-off on payment terms and conditions Just call: HealthAdvocate.com/members Independent. Confidential. Convenient. Health Advocate is not affiliated with any insurance or third party provider. Health Advocate does not replace health insurance coverage, provide medical care or recommend treatment Health Advocate, Inc. HA-M FLY

14 SYMETRA SELECT BENEFITS NEW CASE SUBMISSION CHECKLIST To ensure your Select Benefits case is processed as quickly as possible, follow this checklist. All required paperwork must be received by Select Benefit Administrators (SBA) at least 10 business days prior to the requested effective date. Coverage is effective the first day of the following month Incomplete materials will be returned to the broker/agent Application or Participation Agreement Complete with all fields filled in and appropriate boxes checked Signed and dated by the policyholder Signed and dated by the broker/agent Note: the broker/agent must be licensed in the state where the policy is solicited and appointed by Symetra. To get appointed, call Send all required documents to: Select Benefit Administrators P.O. Box 440 or 118 Third St. East for overnight deliveries Ashland, WI Toll-free phone: Fax: (715) Plan Summary Matrix Include a copy of the Proposal Plan Summary pages Note the sold plans and rates Select Benefits Enrollment Forms Each employee must fill out completely Premium Payment Made payable to Select Benefit Administrators For questions about case submission or administration, contact SBA at or SYMSBA@Symetra.com, Monday through Friday, 6:30am to 5pm CT. For sales support, contact your Select Benefits representative. All required paperwork must be received by SBA 10 business days before the requested effective date. Symetra Life Insurance Company th Avenue NE, Suite 1200 Bellevue, WA Symetra and the Symetra Financial logo are registered service marks of Symetra Life Insurance Company. Select Benefits is insured by Symetra Life Insurance Company located at th Avenue NE, Suite 1200, Bellevue, WA 98004, and is not available in all U.S. states or any U.S. territory. Select Benefit Administrators, located in Ashland, Wisconsin, is a division of Symetra Life Insurance Company. FOR INSURANCE PRODUCER USE ONLY LGS /11

15 Symetra Select Benefits Steps to Enrollment Success Education and communication are key components in helping employees make informed decisions about their benefits. Whether you re enrolling a small group or hosting a meeting for several hundred, these simple steps can help deliver the results you want. 1 2 Finalize Plan Design Establish the effective date of coverage Execute and submit policyholder application Complete and submit agent certification Identify Enrollment Logistics Number of locations Number of employees at each location Open enrollment dates - for each location Payroll dates End date for open enrollment Date payroll stuffers to be inserted with paychecks Placement/timing for enrollment posters 4 Order and Distribute Enrollment Materials Enrollment kits Kit orders must be received at least 10 business days prior to the enrollment date. Send requests to your Select Benefits representative. Stuffers Posters Employee and manager letters These items can be ordered from our Web site, by calling , sending to invest@symetra.com or by working with your Select Benefits Representative. 3 Determine Enrollment Methods Paper Call Center Online / electronic 5 Enrollment Communications Group meetings Managers and key persons meetings announcements First payroll deduction Webinar For more information about enrollment support, please contact your Select Benefits representative. Symetra Life Insurance Company th Avenue NE, Suite 1200 Bellevue, WA Symetra and the Symetra Financial logo are registered service marks of Symetra Life Insurance Company. Select Benefits is insured by Symetra Life Insurance Company, th Ave. NE, Suite 1200, Bellevue, WA Not available in all U.S. states or any U.S. territory. Broker or Agent Use Only LGS /11