This is a sample proposal only. Rates may vary. To order a customized proposal for your business, see MedSave.com/Corehealth.

Transcription

1 This is a sample proposal only. Rates may vary. To order a customized proposal for your business, see MedSave.com/Corehealth. OnlineAdviser at MedSave.com [email protected]

2 Core Health Insurance Limited Medical Plans - Outline 1. Why Limited Benefit Medical Plans? 2. How Core Health Works 3. Group Employer/Sponsor Information Case Submission 4. Rates (employer/employee) 5. Who We Are 6. Enrollment Process i. Employer ii. Employee

3 Why Limited Medical Benefit Plans? Healthcare is costly: It s in the news everyday Healthcare cost are rising, 46 million uninsured Americans, employers dropping group health coverage. Healthcare is a problem in America and one out of six U.S. residents, don t have health insurance. According to a 2005 report from the Kaiser Family Foundation, companies are spending an average of $7,289 per employee annually and $3,137 for single health insurance (nationally). Increased healthcare insurance cost is a problem for small and large business in the U.S. What Limited Medical Plans Offer: Limited medical plans offer coverage for everyday services, they provide an insurance solution for those employees with tight budgets where affordability and first dollar coverage is wanted. It s a concept that is catching on fast. Large companies like McDonalds, Wal-Mart, and Exxon Mobile have embraced limited medical plans as an affordable, smart alternative. It is estimated that there are already 1 million employees nationwide with some sort of limited medical program. Limited medical plans are designed for: Entry level and part-time employees Middle wage earning employees Companies looking to provide voluntary and non voluntary benefits To help with 1st dollar coverage when there are high deductibles to meet in current health plan Core Health Insurance is the right choice Backed by a highly rated insurance company, Core Health Insurance provides the right plans, technology, and affordability that employers and employees are demanding today. These plans offer significant flexibility; employers decide if they want to contribute towards the premium (which lowers the overall cost) or just wants to make the program available (completely voluntary) with out any or minimal contribution. Core Health Plans offer a wide range of benefits: Single or Family Coverage Wellness visits Doctor Office Visits (adult and child) Advanced Studies Benefits Hospitalization Benefits $1 Million Lifetime Maximum Emergency Room Benefits Accidental Medical Benefits Surgery Benefits And more... Why should you consider Core Health Plans? Our limited medical plans are designed to help our clients reduce turnover, improve recruiting, and provide a peace of mind to the workforce. All of your employees deserve coverage Core health insurance is simple, affordable, and smart. Core Health Plans will improve your company's image, increase morale, and help with retaining your workforce. We offer 4 different plans (Value, Silver, Gold, and Platinum) that will cover any employee income and comfort level.

4 How Core Health Plans Work Core Health Plans are Assignable Benefits not Direct Reimbursement: Assignable benefits are when your provider bills the insurance company directly for reimbursement of your claims. This is good; when you visit a provider (doctor, hospital, etc...) you want to be able to show them an insurance card. If you present them with an assignable benefits card (like Core Health) it will instruct them to bill the insurance company directly; where the insurance company will process the claim and send you an Explanation of Benefits (EOB). Many limited medical plans in the marketplace only offer direct reimbursement where they are paying you benefits only after you have paid the provider first. With Core Health Insurance plans you can walk into provider offices with confidence. You will receive a professional ID card that you can present and the provider will have instructions on who to bill for your services. How does a PPO work*? Preferred Provider Organizations (PPO) have negotiated discounts with providers (doctors, hospitals, etc...) nationwide. By utilizing providers in these networks you can save significant money on your healthcare. The PPO networks are an option for you and is not mandatory; although it is typically in your best interest to use a network. Based on your state of residence Core Health Plans will add a PPO network (if available) to your plan automatically*. 1. Member has sickness, illness, or wellness need. 2. Member finds a provider within the PPO that he/she has decided to visit. 3. Member does not find a provider in the network and chooses to go outside the network for coverage. 4. Member receives care and provider sends claims to Insurance company for payment. A. If a provider is "in the Network", the insurance company processes a provider pre-agreed discount to the provider fees billed to the member. Next the insurance company pays its portion of the bill based on the benefits set forth in the Plan Certificate. The member and provider receive an explanation of the benefits ("EOB") and the provider bills the member for any additional amounts due on the discounted services. B. If the provider is not in the Network, there are no preagreed provider discounts. The insurance company pays its portion of the fees (benefits set forth in the Plan Certificate). The member will then be billed by the provider for the balance of the provider fees, which are not discounted and usually result in a higher member payment." 5. Insurance Company notifies member what benefits were paid to provider. 6. Provider notifies client of remaining balance. Balance should be lower if member used a PPO provider. * Not all states have PPO access. Get a quote to see if a PPO has been assigned to your state. Example of PPO vs. Out of Network Savings: Bob has a wrist injury and needs out-patient surgery. He has accumulated 2 X-Rays, 3 Office Visits, and 1 Out Patient Surgery Procedure. The total procedure cost $3,050 and he has the Core Health Gold Plan. Here is an example of how the plan could work: Procedure Procedure cost PPO Out of Network Fee After PPO Discount (no PPO) Gold Plan Benefit Office Visit(s) $400 25% $300 $400 $300 (3 visits) X-ray(s) $550 30% $385 $550 $200 (2 x-rays) Surgery $2,100 50% $1,050 $2,100 $1,000 Total Cost $3,050 $1,735 $3,050 $1,500 Total Gold Plan Benefit:... $1,500 $1,500 Total Out of Pocket:... $235 $1,550

5 Group Enrollment: Core Health Insurance Thank you for considering us for your Limited Medical Insurance needs. Make sure you have completed and submitted everything necessary 15 days before requested effective dates. Missing information will lead to delays in processing. Properly completed cases will be given first priority. Employer master application fully completed and signed by an owner, officer or partner Individual applications (Waivers) Fully completed and signed Complete copy of most recent State Quarterly Unemployment Tax Report 1st month s premium Copy of final quote used for sale Company Name Company Tax ID Number Company Address Company Information City State Zip Contact Name Requested Effective Date Number of Full-Time EE s Contact Phone Contact Number of Part-Time (seasonal) Number of enrolling Employer Contribution % Current Carrier Current Monthly Premium Company/Organization Administrative Agreement The undersigned Company/Organization, by its authorized representative, hereby agrees to administer and facilitate the acquisition of Limited Medical Insurance policy or certificates (the Policy or Policies ) issued by UNITED STATES FIRE INSURANCE COMPANY for the benefit of employees of the Company/Organization by performing the following (select alternative 1 or 2): Contributory Plan. The Organization shall: 1. Contribute $ per employee per month towards the Policy premium (access to lower rates); 2. Contribute % 50% of premium per employee per month towards the Policy premium (access to lower rates). Voluntary Plan. Contribute none of the premium (check if applicable). The undersigned agrees to administer the eligibility list and the authorized payroll deductions, and timely remit the premiums for the Policies. Pay Premium by: List Bill (check) Credit Card (visa/mc) EFT (Electronic Funding Transfer) Executed By Title Printed Name Date Executed:, 20 Core Health Plans New Business: Fax P.O. Box 1086 Janesville, WI Agent Information: OnlineAdviser at MedSave.com [email protected]

6 Core Health Insurance Group Proposal: Representative: Proposed Effective Date: OnlineAdviser at MedSave.com Employer Contribution: Single / Individual Single & Dependents Married, No Dependents Family Employee Portion - Weekly Value Silver Gold Platinum $9.57 $12.28 $23.18 $27.80 $17.60 $22.87 $44.06 $53.04 $15.51 $20.11 $38.62 $46.46 $24.12 $31.48 $61.01 $73.53 Employer Portion - Weekly Single / Individual Single & Dependents Married, No Dependents Family $9.57 $17.60 $15.51 $24.12 Value Silver Gold Platinum $12.28 $23.18 $27.80 $22.87 $44.06 $53.04 $20.11 $38.62 $46.46 $31.48 $61.01 $73.53 Employee Portion - Monthly Single / Individual Single & Dependents Married, No Dependents Family $38.28 $70.41 $62.04 $96.49 Value Silver Gold Platinum $49.10 $92.70 $ $91.49 $ $ $80.45 $ $ $ $ $ Employer Portion - Monthly Single / Individual Single & Dependents Married, No Dependents Family $38.28 $70.41 $62.04 $96.49 Value Silver Gold Platinum $49.10 $92.70 $ $91.49 $ $ $80.45 $ $ $ $ $ Note: Rates are based on 75% employee participation. A 5% increase in rates will be applied if employee participation is between 50% - 74% Laurel Oaks Dr.

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8 Who we are: Insured by: United States Fire Insurance Company is the insurer of the Core Health Insurance Limited Medical Plans. It is a part of Fairmont Specialty Group, a Division of Crum & Forester. The Company is A- ( Excellent ) rated by A. M. Best. United States Fire Insurance Company, as a part of the Fairmont Specialty Group, underwrites specialty insurance products and programs throughout the United States, and is known for its experience, excellence in service, innovative products and dedication to service. Crum & Forester is part of the Fairfax Financial Holdings Limited international financial services holding company, with primary focus on insurance products and markets. Fairfax is a publicly traded company, and for the fiscal year 2006, it had in excess of $26 Billion in assets and in excess of $5.4 Billion of written premium. Focusing on the specialty health insurance area, the company uses its expertise to develop innovative health products to provide insurance plans to the currently insured as well as the uninsured or underinsured population of the United States. Marketed by: OnlineAdviser at MedSave.com [email protected]

9 Core Health Insurance Limited Medical Plans Marketing & Fulfillment Core Health Insurance Plans were developed with Fairmont Specialty by SASid, Inc. a 35 year old company that is a national program manager of specialty life and accident and health insurance products. SASid manages all marketing and the enrollment of policyholders and certificate holders, and provides policies and certificates to enrollees, and provides customer service and premium collection service up to the point of claims administration. SASid is a premier internet marketing and insurance program management company, using the latest technology and a most experienced staff to provide the most efficient service to its customers. To inquire about the Plans, the enrollment process, policy and health card issuance, changes to your enrollment or policy profile or questions about coverage, you may contact SASid by mail, phone, fax or , or log on to the Core Health Insurance website: By Mail: Core Health Plans P. O. Box1086 Janesville, WI By Phone: (800) By Fax: (608) By Website: [email protected] Log into: Core Health Plans Claims Administration Claims are administered on behalf of United States Fire Insurance Company by International Funding, Ltd., a Madison, Wisconsin based administrator with over 20 years of specialized accident and health administration experience. Claims can be submitted by mail or faxed to: Core Health Plans P. O. Box Dallas, TX Fax Number: (608) Claims can be submitted by Providers electronically through International Funding s Emdeon Payer ID # Claims Customer Service Inquiries: call (888)

10 Enrollment Process Enrolling Your Company Enrolling your company with Core Health Insurance plans is simple. Just follow the steps below and you re on your way. If you have any questions or need assistance with any of the following please contact your agent. Step 1- Complete Group Enrollment Form (included in this proposal) Group Enrollment Form Proposed Rates Group Participation Agreement or Application based on state (this can be downloaded or printed off at or contact your agent) Step 2 Enter in Employee Census Online Paper Step 3 Complete Employee Enrollment (see below for employee enrollment) Every employee must complete an enrollment form Step 4 Confirm Effective date and billing (each employee is set up correctly) Enrolling Your Employees Simple and Fast For the initial enrollment, each eligible employee must complete an Employee Enrollment Form. This can be done by one of the following methods (or combination): Phone enrollment call a 800# and give the representative the group number Internet go to and enter group number o Each employee will be given a group code which will show proposed plans and enrollment information Traditional paper enrollment download, print, complete and fax/send. State specific paper enrollment forms can be found at If an employee elects not to participate in the insurance plan, please make sure the Waiver of Insurance section at the bottom of the first page is completed and signed. This is for your protection so that the employee cannot subsequently contend that you never offered insurance coverage. Please submit all completed forms, whether the employee is accepting or declining the insurance. To enroll employees after the initial enrollment period, or make changes in an employee s coverage, you can use the same employee enrollment form. It can be found on the Core Health Insurance website in the Administration section. Send completed forms by fax, mail or to: Core Health Plans New Business: fax (608) P.O. Box 1086 Janesville, WI or scan and to [email protected] or apply online at