2015 Lone Star Script Care LLC ALL AGENTS ARE REQUIRED TO READ AND UNDERSTAND ALL OPERATING POLICIES AND PROCEDURES.

Transcription

1 2015 Lone Star Script Care LLC ALL AGENTS ARE REQUIRED TO READ AND UNDERSTAND ALL OPERATING POLICIES AND PROCEDURES.

2 The History of Benefit Plans The aim of discount benefit plans at first was to fill gaps in health insurance plans. Today, more people turn to high-deductible plans to save on costs. Helping fill those gaps is once more an urgent issue. Why? The decoupling of major medical insurance. Double-digit premium increases. New rules and taxes with Obamacare. In the discount benefits world, there are no annual or lifetime maximums, no minimum time needed in the program before it becomes effective and one card covers the entire family.

3 Why Benefit Plans? With the Patient Protection and Affordable Care Act (PPACA or ACA), there are services that are not necessarily covered in the 10 Essential Health Benefits (EHB). Vision and Adult Dental benefits along with other benefits are not included in the new Affordable Care Act plans. 8 out of 10 clients who enroll in major medical healthcare plans ask if Dental and Vision coverage is included. Dental insurance averages $30-35/mo. for each individual. Vision insurance averages $20-25/mo. for each individual. Primary Care Physician visit co-pays range from $ per visit depending on plan co-pay costs. The Lone Star Benefit Plan with multiple benefits only costs $ $24.95 per month for the ENTIRE FAMILY!

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5 we can help. Discount Benefits Select Select Plus Dental: Aetna Dental Access Vision: Coast to Coast Vision Hearing: Connect Hearing Pharmacy Savings Diabetic Management & Supplies Durable Medical Equipment Health Wealth Connection Lab Discounts & Services Medical Bill Negotiator MRI-CT Scans Retail Health Clinics Vitamin Discounts 24 Hour Physician By Phone: Tele-Health One Time Processing Fee $20.00 $20.00 Monthly Family Price Includes spouse and dependents $8.95 $14.95

6 This plan is NOT insurance. Disclosures The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR This plan provides discounts at certain healthcare providers for medical services. This plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. This discount card program contains a 30 day cancellation period. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. Member shall receive a full refund of membership fees, excluding registration fee, if membership is cancelled within the first 30 days after the effective date. AR and TN residents: A refund of all fees will be issued if membership is cancelled within the first 30 days. Discount Medical Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box , Dallas, TX , Website to obtain participating providers: MyMemberPortal.com.

7 Dental Members simply show their card with the Aetna Dental Access logo and pay the discounted price at the time of service. In most instances, members save approximately 50% per visit on services from general dentistry and cleanings to root canals and crowns. Over 132,000 available dental practice locations in the Aetna Dental Access national network. Save on routine dental services such as X-rays and fillings. Save on specialty dental care such as orthodontics and periodontics where available.

8 Dental Comparative Analysis * The select regional average cost represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City as displayed in the Estimate Cost of Care Tool as of September **Actual costs and savings may vary by provider, service and geographic location. The average cost with Aetna Dental Access is the average of the negotiated fees for the cities referenced above. Procedure Average Cost* Average Cost with Aetna Dental Access** Member Savings Periodic Oral Exam $56 $30 $26 Comprehensive Oral Exam $87 $43 $44 X-Ray, Intraoral Complete Series Including Bitewing $141 $76 $65 X-Ray, Bitewings Four Films $68 $36 $32 X-Ray Panoramic Film $121 $63 $57 Cleaning (Prophylaxis) Adult $107 $59 $48 Cleaning (Prophylaxis) Child $77 $42 $35 Sealant Per Tooth $62 $31 $31 Filling 1 Surface Resin(White) Filling, Front (Anterior) Tooth $170 $90 $80 Crown Porcelain Fused to High Noble Metal (i.e. gold) $1,167 $757 $410 Restorative Crown Porcelain Fused to Noble Metal $1,111 $715 $396 Root Canal Front Tooth (Anterior) Excluding Final Restoration $764 $455 $309 Root Canal Premolar Tooth (Bicuspid) Excluding Final Restoration $869 $555 $314 Root Canal Molar Excluding Final Restoration $1,085 $746 $339 Scaling/Root Planing Four or More Contiguous Teeth $236 $144 $92 Complete Upper Denture (Maxillary) $1,190 $901 $289 Extraction of Erupted Tooth or Exposed Root Includes Local Anesthesia and Suturing If Needed $184 $83 $101 Comprehensive Orthodontic Treatment Child $5,546 $3,508 $2,038

9 Dental Comparative Analysis Average Costs for Dental Insurance $30/mo per person ($360/yr) premium (can be over $1000/yr for a family plan). Pays 100% for preventative, 80% for basic procedures and 50% for major procedures. Does NOT cover orthodontics or cosmetic care. Caps out at $1500/yr day waiting period. Average Costs for Dental Benefits $19.95/mo per family ($239.40/yr) premium (covers entire family). Up to 50% discount on all procedures with NO caps. Includes orthodontics and cosmetic care. No waiting period.

10 Vision Clients have access to over 12,000 eye care locations nationwide. Save 20% to 60% on prescription eyewear. Save 10% to 20% on contact lenses (excluding disposables) at participating retail locations. Save 10% to 40% on soft contact lenses, including disposables, through America s Eyewear mail order service. Savings of 10% to 30% on eye exams at participating locations. Save 40% to 50% off the national average on LASIK surgery (other laser surgeries available at select locations). No limit to the number of times you can use your card.

11 Example 1 - New York, NY Regular Exam (Ophthalmologist) $ CTC Member pays: $ Savings $30.00 Conventional Lasik: $5, CTC Member Pays: $3, Savings $1, TOTAL SAVINGS $1, Example 2 - Dallas, TX Regular Exam (Ophthalmologist) $ CTC Member pays: $ Savings $57.00 Frames (Regular) $89.95 CTC Member Pays: $54.47 Savings: $31.48 Progressive / Polycarbonate $ CTC Member pays: $ Savings $52.25 TOTAL SAVINGS $ Example 3 - Tampa, FL Extended Exam (Ophthalmologist) $ CTC Member pays: $ Savings $67.50 Frames (Designer) $ CTC Member Pays: $72.72 Savings $ Single Vision Lens (Plastic) $ CTC Member pays: $ Savings $59.50 TOTAL SAVINGS $254.28

12 Tele-Health (Doctors by Phone) Doctors by Phone or Tele-Health services are available at home, work, or wherever the client may be. They can connect via telephone or online video, free of charge, with a network of physicians for informational or diagnostic consultation. This service is a convenient and inexpensive alternative to Emergency Room, Urgent Care or Physician office visits. Doctors by Phone provides the inexpensive and most convenient care. Physicians discuss symptoms, recommend treatment options, diagnose many common conditions, and prescribe medication when appropriate. Doctors by Phone is not insurance. Doctors by Phone does not replace your primary care physician.

13 Durable Medical Equipment Save 20% to 50% on health and wellness products such as: Walking aids Bathroom safety Wheelchairs and scooters Hospital beds and accessories Cushioning and pressure relief Pads, cushions, lumbar supports Orthopedic products

14 Diabetic Management Average savings of 48% on supplies and the convenience of right-to-the-door service. Monitor levels with name brand glucose meters and diabetic supplies. Healthcare information and resources for those newly diagnosed, living with, or caring for others with diabetes.

15 Hearing Aids A network of more than 3,000 full service centers. 35% discount off hearing aid prices. Free initial hearing screening. Unlimited follow-up visits during the useful life of the hearing aid for cleaning and checkups. A free hearing screening every two years.

16 MRI and CT Scans Save 50% to 75% on typical costs for the following imaging services: MRI CT Scans Ultrasounds Large nationwide panel of radiologists and imaging specialists with over 2,900 radiology centers throughout the United States.

17 Lab Services Save 10% to 80% on typical costs for blood tests. The network will help find the location of the nearest major clinical laboratory and provide the necessary order. Confidential results available in as little as hours for most tests. Health-Wealth Connections Simple online tools and solutions are offered to help your members manage their health and personal finances.

18 Medical Bill Payment Negotiator Negotiators can often save you 25% to 50% on medical bills over $1000, which have not been submitted to insurance or previously discounted.

19 Retail Health Clinics Over 400 Healthcare Clinic at select Walgreens nationwide. Walk-ins or appointments available. Medical professionals include board-certified family nurse practitioners and physician assistants. Prescriptions may be written, if necessary. $49 youth sports, camp or back-to-school physicals.

20 Pricing - Consumer Plans Select - Dental & Vision, etc. $8.95/mo per family* Select Plus - Dental, Vision & Tele-Health, etc. $14.95/mo per family* *There is a one time, non-refundable application fee of $20.00 added to the first monthly premium only.

21 Application FAQ s. Does a client have to qualify? No. There are not qualification requirements. Does the client receive anything in the mail? Yes. The client will receive membership cards and a membership booklet in the mail within days after their initial enrollment. How does a client find out if their provider(s) are part of the network? Their membership booklet will list all of the providers within a geographical location (based on their zip code). The client may also find providers at by creating an account and by entering their ID number and information.

22 FAQ s Continued.. How do I submit an application? Simply complete the 1 page application located on the training site and fax to Within 24 hours, you will be able to review your enrollment and their status in your back office. Does the client have to select a draft date? No. Members will be drafted on the same date every month.