OptiMed Single Sourced Administration Services

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1 NEWS! GAP Available in California for small group! GAP is now available in California for small groups of 5+. Please ask your OptiMed Group Representative for more information on our Group Supplemental Medical Expense Insurance program now available in California. (GAP) Health Care Reform Information OptiMed Limited Medical plans fall outside the scope of the new Health Care Reform as excepted benefits as defined under HIPAA and the Public Health Service Act (PHS Act). Speak to our Group Representatives to learn more about our plans and services. OptiMed Group Product Lines GAP (Guaranteed Issue) Limited Medical (Guaranteed Issue) Stand Alone Out-Patient Prescription Drug (Guaranteed Issue) Dental (Guaranteed Issue) Vision (Guaranteed Issue) Major Medical Section 125 Flexible Spending Accounts COBRA and HIPAA Full Service Administration (Single Sourced) Ask your group representative for details on state availability and additional information. OptiMed Single Sourced Administration Services

2 Administrative Services Only COBRA Administration Section 125 Cafeteria Human Resource Out-Sourcing Coordinated Billing OptiMed Product Lines - In Detail The current economic crisis has created an environment whereby employers are being squeezed financially and are being forced to cut costs. Many employers turn to benefits as an area to make significant cuts. This in turn may create high turnover and may result in lost profits and productivity. OptiMed is a pioneer in the recognition that this crisis may be creatively addressed through the implementation of some of our signature group product lines such as: GAP Plans, Limited Medical Indemnity Plans (Minimed) and our Comprehensive Major Medical Partner Program (CMMP). Many of our product lines may be offered on a Voluntary Basis. The offering of a creative and affordable benefits package can be an effective means of retaining employees, reducing turnover and increasing productivity through improved morale while simultaneously helping your clients in controlling cost. OptiMed GAP Guaranteed Issue No Pre-existing Condition Limitations No Health Questions Asked Electronic Enrollment Options Composite Rates for Groups of 50 or more. Employers may be able to keep Renewals to 6% or below using OptiMed GAP. Employers who get hammered with 20-40%+ increases may be able to virtually duplicate current benefit levels with the OptiMed GAP plan while reducing increases significantly if not eliminating them altogether. OptiMed Gap is specifically designed to help save direct health insurance premium costs by allowing employers greater freedom in selecting lower cost high deductible plans or plans with higher out of pocket maximums. OptiMed GAP is designed to fill that hole. Simply put, by plugging in OptiMed GAP, employers may be able to raise deductibles

3 and out of pocket maximums to obtain lower cost coverage. OptiMed Gap may be written down to 5 lives. OptiMed GAP may be offered on a Voluntary Basis. OptiMed MiniMed: Limited Medical Plans Currently Quoting and Writing New Business Guaranteed Issue No-Pre-existing Condition Limitations for Group of 10 or more Assignment of Benefits Fully Insured Prescription Drug Program. Mini-medical plans fill a rapidly growing niche in the group health insurance marketplace by assisting employers to provide their non-covered employees real benefits that can help with employee retention without causing serious financial pain. OptiMed Mini-medical plans are limited benefit plans, meaning they pay only a limited benefit for a covered service at an affordable premium for both employers and employees alike. Mini-medical plans are not to be confused with major medical insurance and they are not meant to replace major medical plans. What is the Mini-Medical Niche? There are two target markets for mini-medical plans. 1. Employer groups who currently have a major medical plan in place but have part time and hourly employees who do not qualify to participate. 2. Employer groups who can no longer afford the escalating costs of a traditional plan or who have never considered offering benefits. OptiMed Mini-Medical Plans may be offered on a Voluntary Basis. OptiMed Comprehensive Major Medical Partner Program: Retrospective Refund for Favorable Claim Experience The OptiMed CMMP program is based upon a partially self-funded platform with reinsurance protection that eliminates excessive uncertain claim liability. The CMMP

4 program allows the employer to remit one monthly premium like a conventionally insured program. The CMMP program premium will be constant and guaranteed for a 12 month contract period. Should claims exceed the amount of premium paid, the reinsurer makes up the difference so that the employer has no additional claim liability. The CMMP program will have no additional claim liability than with a regular conventionally insured program. The Refund The most exciting feature of the OptiMed Comprehensive Major Medical Partner Program is the refund. An accounting is performed of claims versus premium allocated to the claim reserve fund. This accounting is completed at the end of the 15th month when the initial contract period and reinsurance coverage end. The refund is for the 12 month contract period, but paid at the end of the 15th month. All claim reserves not paid as a claim through the 15th month of the 12 month contract period are refunded in full to the employer. Each successive year is administered in the same fashion. OptiMed Dental and Vision: Guaranteed Issue with No-Pre-existing Condition Limitations Electronic Eligibility Accepted. OptiMed is pleased to offer dental and vision coverage for groups of 10 or more enrolled. Dental and Vision plans may be sold separately or alongside the MiniMed or major medical plans. New Business Enrollment Support Options Electronic File Transfer: OptiMed is able to easily accept electronic eligibility files. We can provide both brokers and HR with a simple and easy excel format for submitting eligibility. Enrollment Kits/Material: OptiMed is able to quickly and easily provide customizable Enrollment and Informational Kit templates in both English & Spanish, including posters, payroll stuffers and flyers customized to your specific client. We can even use your client s and agency logo. Client Website: OptiMed is able to provide a fully customizable website for your client at no additional cost, which will feature plan design information, rates, a bilingual informational video, provider search links, and a secure web portal with HR and member tools. HR tools include Online HR administration. Also available at no additional cost is an online enrollment link should you wish to consider our online

5 enrollment features. Online Enrollment: OptiMed can develop online enrollment tools for qualifying groups at no additional cost. Call Center Enrollment Support: OptiMed can provide an in-bound and out-bound enrollment support call center. Fulfillment/New Group Setup: We guarantee upon receiving complete New Group Submittal all ID Cards, Welcome kits and Summary Plan Descriptions will be shipped within 5 business days. Please check with your Brown & Brown account manager to confirm that OptiMed is available in the state or states in which you may have an interest in offering OptiMed. OptiMed is not available in Alaska, New York, Montana and the state of Washington.