Short Term Medical Plans Product Training. February 13, 2013

Transcription

1 Short Term Medical Plans Product Training February 13, 2013

2 Short term medical Insurance What is it? Short term policies are individual and family or child Only PPOs that will be issued in 1 through 11 calendar month durations. Any day of the month effective date except the last 3 calendar days of the month Billing will be prorated on the front and back end of the policy duration. Credit Card and Bank Draft payment only (no coupon) More limitations means lower premium like annual benefit and lifetime maximums It is not ACA compliant Stop gap coverage: catastrophic with some co-pays 2

3 Short term medical Insurance Who is buying and how? Existing Market Segments Looking for coverage between jobs Affordable COBRA alternative In a wait period for employer coverage Recent college graduate In underwriting for 12 month policy Early retirees waiting for Medicare eligibility Typical product distribution Carrier websites Carrier direct / mail / banner ads Online aggregators like ehealth.com Local IFP agents (some group) 3

4 Short term medical Insurance Main product attributes Affordable - typically 20-40% lower than reform ready plans Flexible - effective and term dates: buy just what you need Fast - Real time approval or next day, policy and ID Financial Safety Net Provides peace of mind they have coverage from unexpected, catastrophic loss 4

5 Short Term medical insurance Value Proposition Organizational Value Go after 30% of the IFP market Forecasting new members in CY 13 Diversification of revenue streams outside of reform 2013 and reform strategy for IFP Worksite market for groups with wait periods 5

6 Short term medical Insurance Important note Our Short Term Medical plans ARE NOT Mini-Med plans; which have a very low maximum benefit (e.g. $500-$2,000) for covered major medical services. Fixed Indemnity plans; which pay a fixed cash benefit for covered expenses like our cancer, hospital, accident, and fixed cash Income Protection Plans. 6

7 Short Term Medical Plans Health Plus Survey found that our IFP members 10% were looking for coverage while in a waiting period for group coverage 12% were looking for coverage while in between jobs 4% were looking for a more affordable alternative to COBRA 3% were students who recently graduated and became ineligible under parents plan 7

8 Short Term Product Portfolio: Short Term 80 Premier Plan Coverage Options Benefit period Deductible Options (Individual / Family) Short Term 80 Premier In network $500/$1,000 $1,000/$2,000 $1,500/$3,000 Out of network $1,000/$2,000 $2,000/$4,000 $3,000/$6,000 Lower deductibles ($500, $1,000, $1,500) to compete with BCBS. Benefit period coinsurance Coinsurance Maximum (Individual / Family) 20% $2,000 / $4,000 50% $4,000 / $8,000 $2,000 coinsurance max Benefit period Maximum Out-of- Pocket Office Visits The benefit period deductible and coinsurance maximum make up the benefit period Out-of-Pocket Maximum. It does not include Rx out of pocket and copayments for Non-Preferred Specialty Pharmacy drugs. $30 primary $50 specialist 50% after deductible $1 million policy duration max Urgent Care Emergency Room $75 co-pay $250 copay, then 20% after in-network deductible Standard Lab & X-ray 20% after deductible 50% after deductible $30 primary, $50 specialist co-pay, no limit. Inpatient & Outpatient Hospitalization Prescription Coverage Benefit period drug deductible Preferred generic Preferred brand Non-preferred brand Drug Benefit period maximum 20% after deductible 50% after deductible $200 per person $10, no deductible $30 after deductible $50 after deductible $1,000 per person 50% after major medical deductible $200 per person Rx deductible with $1,000 policy duration max. 8

9 Short Term Product Portfolio: Short Term 80 Plan Coverage Options Short Term 80 Benefit period Deductible Options (Individual / Family) Benefit period coinsurance Coinsurance Maximum (Individual / Family) Benefit period Maximum Out-of- Pocket In network $2,500/$5,000 $5,000/$10,000 $10,000/$20,000 20% $5,000 / $10,000 Out of network $5,000/$10,000 $10,000/$20,000 $20,000/$40,000 50% $10,000 / $20,000 The benefit period deductible and coinsurance maximum make up the benefit period Out-of-Pocket Maximum. It does not include Rx out of pocket and copayments for Non-Preferred Specialty Pharmacy drugs. Office Visits Visits 1-3: $30 Visits 4+: 20% after deductible Urgent Care Emergency Room 20% after in-network deductible 20% after in-network deductible 50% after deductible Standard Lab & X-ray 20% after deductible 50% after deductible Inpatient & Outpatient Hospitalization Prescription Coverage Benefit period drug deductible Preferred generic Preferred brand Non-preferred brand Drug Benefit period maximum 20% after deductible 50% after deductible Not covered. Higher deductibles ($2,500, $5,000, $10,000) compete with UHC, Assurant, etc. $5,000 coinsurance max $1 million policy duration max Visits 1-3: $30, visits 4+ are covered at deductible and coinsurance No Rx coverage to keep price point low 9

10 Short Term Medical Plan Competitors Price / Benefit Points (Male 25) $120 Male 25 $100 $98 Top 5 Best Sellers $80 $82 $76 $71 $67 $60 $57 $56 $40 $44 $36 $38 $39 $20 $- $500 $30ov $200 10/30/50 $1k max $1,000 $30ov $200 10/35/50 $1k max $1,500 $30ov $200 10/35/50 $1k max Admin Fee: $0 $2,500 $30 (3) $5,000 $30 (3) Admin Fee: $0 $10,000 $30 (3) $1,000 d/c ov $200 10/35/50 $750 max BCBS $2,500 $50(3)ov App fee: $30 HII 50% $5,000 $50ov App fee: $20 IHC $1,000 $50ov App fee: $20 IHC $2,500 d/c ov App fee: $20 Admin fee: $4/mo UHC SWHP

11 Short Term Medical Plan Competitors Price / Benefit Points (Male 35) Male 35 $140 $130 Top 5 Best Sellers $120 $100 $80 $118 $109 $101 $81 $89 $88 $63 $60 $51 $47 $43 $40 $20 $- $500 $30ov $200 10/30/50 $1k max $1,000 $30ov $200 10/35/50 $1k max $1,500 $30ov $200 10/35/50 $1k max Admin Fee: $0 $2,500 $30 (3) $5,000 $30 (3) Admin Fee: $0 $10,000 $30 (3) $1,000 d/c ov $200 10/35/50 $750 max BCBS $2,500 $50(3)ov App fee: $30 HII 50% $5,000 $50ov App fee: $20 IHC $1,000 $50ov App fee: $20 IHC $2,500 d/c ov App fee: $20 Admin fee: $4/mo UHC 11

12 Short Term Medical Plan Competitors Price / Benefit Points (Female 25) 12

13 Short Term Medical Plan Competitors Price / Benefit Points (Female 35) 13

14 Short Term Medical Plan Eligibility Requirements 90 days through 64 years of age Work or reside in Health Plan service area Must be a U.S. citizen or a permanent resident living in the United States for at least 1 year Can not have been declined by ICSW for ST PPO in the last 3 months Members can be added to established plans (Guarantee issue for newborn, court ordered & adoptee, does not apply to these plans) 14

15 Short Term Medical Plan Application Process Telephonic: Telephonic enrollment done by Underwriting Paper: mail, fax, walk-in Online: ETA on swhp.org 3/1/13 15

16 Short Term Medical Plan Underwriting Simplified underwriting: 7 questions Rates: Accept / Reject, no rate-ups Preexisting condition limitations apply regardless of prior coverage Are creditable coverage plans Will have additional criteria for Rx plans under Premier vs There are no reinstatements (member will have new member number with each new effective date) There are no renewals There are no appeals Review Application 16

17 Short Term Medical Plan Underwriting /Telephonic Enrollment Marketing will transfer calls to Underwriting Hunt Group x Information needed by Underwriting before call is transferred Applicants Name Rep code for sale Plan applying for Applicants telephone number incase call is dropped Is applicant a current or former applicant or member Underwriting will let applicant know during the interview if they are accepted or rejected and collect premium 17

18 Short Term Medical Plan Underwriting / Processing Applications Underwriting will enter all applications into MApps Underwriting will send acceptance letter quoting 1 st, monthly and last month s premium Underwriting will include the policy effective & term date Underwriting will not send a reject letter, if notified applicant by phone of denial Underwriting will send to membership the same day unless interview is after 3:30 PM, then it will be the next business day 18

19 Short Term Medical Plan Billing /Effective Date 1 st available effective date for ST PPO is March 1 st, 2013 Going forward any Effective date except last 3 calendar days of month Effective date is the later of: 12:01 a.m. of the requested effective date, must be a future date & less than 15 days from signature date Day after CSW receives application and payment Day after phone interview completed 19

20 Short Term Medical Plan Billing / Effective Date If applying 3/28/13 the 1 st available effective 4/1/13 Includes Saturday, Sunday & holidays If applying on a Friday, they will not be in the system until Monday, but will have coverage and any claims incurred will be paid Blackout dates Bill runs Draft March 29 th -31st 29 th 1 st April 29 th -31st 31 st 1 st May 29 th -31st 31 st 1 st June 28 th -30 th 28 th 1 st July 29 th -31st 31 st 1 st August 29 th -31st 30 th 1 st September 28 th -30 th 30 th 1 st October 29 th -31st 31 st 1 st November 28 th -30 th 29 th 1 st December 29 th -31st 31 st 1 st January 29 th -31st 31th 1 st February 26 th -28 th 28 th 1 st 20

21 Short Term Medical Plan Billing /Terminations Term date: Any day after 1 calendar month 30, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330, up to 364 calendar days Normal span 1 calendar month example 2 nd through 1 st / 14 th through 13 th / 31 st through 30 th Contract span 1/15/13-2/18/13 allowed Contract span 1/15/13-2/13/13 not allowed If initial Payment is declined electronically, the policy will be voided and reapplication is required if valid payment info is not received within 2 business days. If Ongoing Payment is declined electronically, the policy will be termed and reapplication is required. 21

22 Short Term Medical Plan Billing /Terminations ICSW must be notified before the last business day of the month to stop ongoing payment draft, will not refund. Can term at any stage of policy as long as 1 st months premium is satisfied and notice given before the last business day of the month e.g. Contract span 1/15/13-3/15/13 They contact ICSW on 2/27/13 wanting to term 3/7/13 it is allowed Contract span 1/15/13-3/15/13 They contact ICSW on 3/1/13 wanting to term 3/7/13 it is not allowed 22

23 Short Term Medical Plan Billing /Terminations If a member is on a ST PPO plan and is approved for Major Medical before the ST PPO plan terms; ICSW will term ST PPO when the Major Medical is effective and apply premium accordingly If a member calls ICSW to term a ST PPO contract, the call needs to be transferred to Enrollment (Marketing will not be responsible for disenrollment for these plans) 23

24 Short Term Medical Plan Billing / Premiums Payment; monthly or lump sum payment Initial Payment Credit Card only Card will be charged within 5 business days of effective date Ongoing Payment - ACH Bank Draft only Draft will occur 1st business day of month Only applies to 2 months or greater contract terms Ongoing premiums cannot be paid by check, mailed or received at front desk 24

25 Short Term Medical Plan Billing / Premiums Premiums will be calculated based on the member s age on the 1 st of the month they are receiving coverage in 1 st effective date 3/15/2013 Member is 49 years of age Birthday is 3/12/2013 The member will be 50 years of age on 1 st effective date; however premium will be calculated at 49 year old rate Premiums will be prorated for 1 st and last month for all policies that do not the 1 st of the month as contract date Prorated premium = Premium / # days in month X number days of coverage within month 25

26 Short Term Medical Plan Retention Notice of termination Instructions to re-apply; another ST or 12 month policy 26