Explore New Roads Gap Medical. May Insurance Broker Meeting September 2015

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1 Explore New Roads Gap Medical May Insurance Broker Meeting September

2 Why Explore New Roads? The New Road Marketplace changes Broker opportunities Customer needs Timely solutions ACA unfolding Shrinking commissions Migration to high-deductible plans Diversify book of business Expand portfolio Reduce health cost Require simplicity, flexibility, affordability Fill gaps Consumer driven health plans Wellness coaching and incentives Health Savings Account with Hospital Indemnity plan Gap Medical plan 2

3 Introducing Gap Medical SIMPLE Reimburses eligible out-of-pocket expenses for inpatient and outpatient services Insured product that protects gaps when needed First dollar coverage Simple to enroll Easy claims process Offered guarantee issue (no medical questions) Requires underlying Major Medical plan FLEXIBLE Plan design align with Major Medical Flexible benefit options and benefit amounts Employer-funded or employee-paid, but employers tend to fund AFFORDABLE Closely tied to core medical plan Revenue source for producers 3

4 Gap Medical What is it? Guards against financial risk associated with paying out-of-pocket medical expenses Helps to fill gaps and protect income and assets Provides direct payment to providers for eligible medical expenses Works well for groups with a high deductible plans Requires underlying major medical plan DOES NOT REPLACE HEALTH INSURANCE 4

5 Gap Medical Why is it needed? To respond to a changing marketplace: Thirty percent of employers said a high-deductible plan would be the only option offered to their employees in 2015, double the rate in More than a third of employees say voluntary supplemental health benefits are a reason to stay with or join an employer. 2 To minimize financial risk: Bankruptcies resulting from unpaid medical bills affected nearly 2 million people, making health care the No. 1 cause of such filings (outpacing bankruptcies due to credit-card bills or unpaid mortgages). 3 Even outside of bankruptcy, 56 million adults still struggle with healthcare bills. And nearly 10 million with health-insurance still accumulate medical bills they can t pay. To compensate, 15 million will deplete savings and 25 million will cut back on meds. 3 Less than half of households above poverty level have enough assets to cover an outof-pocket maximum of $3000-$6000 (considered moderate). 4 1 Towers Watson, National Business Group on Health employer health care survey 2015; 2 Met Life Study of Employee Benefit Trends, American Journal of Medicine, 2013NerdWallet Health, NerdWallet Health, Kaiser Family Foundation, Issue Brief, March

6 Gap Medical How does it work? Gap Medical plan offered to Employees On or off open enrollment Employer-paid or voluntary Employee enrolls in plan (guarantee issue) and receives ID card Employee seeks inpatient or outpatient services from provider Gap Medical plan sends payment to provider (or reimbursement to employee) Employee presents ID card to provider Employee (or provider) sends EOB to Beazley Major Medical carrier sends an EOB to employee Provider sends itemized bill to Major Medical plan and Gap Medical plan 6

7 Gap Medical What is the potential impact for Employers? 7

8 Gap Medical What is the potential impact for Employees? INPATIENT CASE EXAMPLE Normal Delivery of Healthy Baby Scenario: Julie has a healthy baby and stays in hospital for three days. Baby Jesse is ready to go home after one day, so he is moved to routine nursery care. Gap Medical benefit level (PER INSURED): Inpatient: $5,000. Outpatient: $3,000. Major Medical MOM S CARE Amount of bill: $4,200 Amount applied to deductible: $4,200 BABY S CARE Amount of bill: $1,800 Amount applied to deductible: $1,800 Gap Medical MOM S CARE Amount Gap pays: $4,200 BABY S CARE Amount Gap pays: $1,800 Patient s out-of-pocket costs WITHOUT Gap: $6,000 Patient s out-of-pocket costs WITH Gap: $0 8

9 Gap Medical What is the potential impact for Employees? OUTPATIENT CASE EXAMPLE Knee Injury Scenario: Jack has several outpatient visits for diagnosis and treatment of a knee injury, incurred while playing basketball. Gap Medical benefit level (PER INSURED): Inpatient: $5,000. Outpatient: $3,000. Major Medical ER visit: $250 co-pay Specialist visit: $50 co-pay Amount billed for outpatient surgery, surgeon, anesthesia: $3,800 Patient s out-of-pocket costs WITHOUT Gap: $4,100 Gap Medical Amount Gap pays for ER visit: $250 Amount Gap pays for MD visit: $0 Amount Gap pays for outpatient surgery, surgeon, anesthesia: $2,750 Patient s out-of-pocket costs WITH Gap: $1,100 9

10 Beazley Gap Medical Why sell Gap Medical? Works well for groups with high deductible plans Pays certain out-of-pocket expenses (deductibles, co-pays and co-insurance) incurred during inpatient hospitalization and outpatient hospitalization in select settings: o Inpatient hospital benefit pays expenses for admissions that are due to: Accident or sickness Routine nursery care during an OB admission Mental/ nervous hospital admission o Outpatient hospital benefit reimburses out-of-pocket expenses in select settings May be offered as 40-70% of inpatient benefit amount Allows close mirroring of underlying Major Medical plan Uses EOB to pay claim, which helps streamline claim process 10

11 Beazley Gap Medical How to build a plan? Benefit Options Benefit Definitions Benefit Amounts Inpatient Hospital Benefit (REQUIRED) Aligns with Major Medical Outpatient Hospital Benefit (OPTIONAL) 40-70% of Inpatient Reimburses deductibles, co-pays and co-insurance incurred during inpatient hospitalization, such as hospital room and board and other inpatient hospital expenses. Reimburses eligible out-of-pocket expenses incurred in select outpatient facilities: Treatment in a hospital ER (not admitted). Surgery and other Surgical procedures in outpatient hospital or surgery center (in Physician s Office or Urgent Care facility - optional). Radiological diagnostic testing in an outpatient hospital or MRI facility (in Physician s Office or Urgent Care facility - optional). Chemotherapy/Radiation Therapy performed in a licensed facility (optional). Reimbursement levels: Per insured: $500-$7000 Per family: 2-3 times benefit year maximum per insured Reimbursement levels: Per insured: (10-50% of inpatient benefit) Per family: 2-3 times benefit year maximum per insured 11

12 Beazley Gap Medical Inpatient Hospital Benefit What is covered? Provides a benefit amount for both accident and sickness Reimburses certain out-of-pocket expenses (deductibles, co-pays, co-insurance) incurred while the insured is an Inpatient: o Hospital room & board o Inpatient surgery o Radiological Imaging (X-ray, CT, MRI) o Professional fees (Surgeon, Radiologist, Anesthesiologist, etc.) o Other Hospital ancillary charges o Newborn nursery care o Mental and Nervous Health hospital admission Benefit Levels from $500 - $7,000 What is not covered? Drug and Alcohol treatment in a rehabilitation center Nursing Home, Skilled Nursing facility or Hospice Care facility 12

13 Beazley Gap Medical Outpatient Hospital Benefit What is covered? Provides a benefit amount for both accident and sickness Reimburses certain out-of-pocket expenses (deductibles, co-pays, co-insurance) incurred in the following settings: o Treatment in a hospital emergency room (i.e., not admitted to inpatient) o Surgery or surgical procedures: In a hospital outpatient facility or freestanding outpatient surgery center In a physician s office or urgent care facility* (optional) o Radiological diagnostic testing: In a hospital outpatient facility or MRI facility In a physician s office or urgent care facility* (optional) o Chemotherapy or Radiation Therapy Rider in a licensed facility* (optional) *Not available in all states Benefit Levels: o Per Insured: $250 - $3,500 (10-50% of Inpatient Benefit) o Per Family: 2-3 times benefit year maximum per insured 13

14 Beazley Gap Medical Outpatient Hospital Benefit What is not covered? Physician office visits for routine care Lab work (unless part of ER or Surgical Outpatient services) Chiropractic services Ambulance transportation Preventive exams Prescription drugs Durable medical equipment Outpatient therapy (physical therapy, speech therapy, occupational therapy or rehabilitation) Outpatient immunotherapy (such as treatment for rheumatoid arthritis or Crohn s Disease) Catheterization (such as cardiac or urinary catheterization), unless performed as part of an emergency hospital visit (ER) or outpatient surgery Outpatient dialysis EKG, EEG or ECG o These procedures are not covered as radiological tests or standalone procedures. However, if they were part of an eligible outpatient ER visit or surgical procedure, then they would be covered. 14

15 Beazley Gap Medical Who is an ideal prospect? What is overall size of group? o Beazley will go as low as 10 eligible lives (8 insured participants) o Works for all-sized groups o Works for fully-insured and self-funded groups What is the optimal industry? o Beazley does not have any excluded industries What are the primary reasons for considering Gap Medical? o Save employer money o Help employees with first dollar benefits 15

16 Beazley Gap Medical How is our pricing structured? Rate for age, underlying Major Medical carrier, deductible and amount of Gap purchased Composite rates with employer funding, available down to 10 employee lives Offered guarantee issue (no medical questions) No Pre-Existing Condition clause May be offered employer-paid, employee-paid (voluntary), or a combination Participation requirements: o Groups with eligible employees require a minimum of 8 covered employees. o Groups with eligible employees require a minimum of 12 covered employees. o Groups with eligible employees require a minimum of 15 covered employees o Groups with 100+ eligible employees require a minimum of 15% participation 16

17 Beazley Gap Medical How do we support case implementation through claims? Producer appointment and registration: Timely appointment process with immediate access to registration and web tools Onboarding new business: Dedicated new case specialist involvement from proposal through case installation Producer portal: Easy access to information on pending quotes, proposals, active cases, employer billing, plus commissions and a resource center with marketing materials Enrollment: Variety of enrollment options and communication materials Claims: Timely claims service 17

18 Beazley Gap Medical Benefits to you and your customers FOR BROKERS Opportunity to diversify revenue and expand product portfolio Insured commissioned product Timely solution for existing customers and prospects FOR EMPLOYERS Opportunity to broaden benefit options without increasing costs Plan sponsor portal for ease of administration (billing, eligibility) Gap protection solution to directly address employee out-of-pocket cost concerns FOR EMPLOYEES Valuable protection against life s uncertainties Offsets expenses and fills gaps just when it is needed most Easy-to-understand product Simple claim process (submit EOB for reimbursement) 18

19 About Beazley Group Worldwide operation Beazley Insurance Company Inc. is rated A by A.M. Best Established in 1986 as a specialist insurer and reinsurer Headquartered in London, with operations in Europe, Asia, Australia and the U.S. Manages five Lloyd's of London syndicates, all rated A by A.M. Best Recognized market leader in Specialty Lines, Reinsurance, Property, Marine, Political Risks & Contingency, and Life, Accident & Health Generated $2 billion in gross premiums worldwide in 2014 Our vision is to become, and to be recognized as, the highest performing specialist insurer Received Insurance Insider Honours Awards in 2013: o Risk Carrier of the Year award o Cuthbert Health Award for event cancellation claim in the wake of Superstorm Sandy 19

20 Benefits and ranges of options vary and may not be available in every state. Coverage is subject to and governed by the terms and conditions of each policy issued. Premium will vary based on plan chosen. A waiting period for late entrants may apply. These policies are renewable at the option of the company. This material is intended for informational purposes for brokers and other related distribution entities only. It is not intended to be accessible in Arizona, Missouri, New Hampshire, Oregon, and Washington until any required approvals have been obtained. Beazley, which is rated A by A.M. Best, includes the issuing company of Beazley Insurance Company, Inc., 30 Batterson Park Road, Farmington, Connecticut, For the most current listing of our product offerings and availability, visit Administrative services on all accident and health products are provided by HealthPlan Services (HPS). 20

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