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Changes in what they buy

Changes in what they buy. Assurant Health – now and into 2014 The fast track to sales!. What we’ll cover today. Q4 – your biggest quarter ever? Acronymania! The portfolio at-large Metallic Plans – designs – thoughts - insights

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Changes in what they buy

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  1. Changes in what they buy Assurant Health – now and into 2014 The fast track to sales!

  2. What we’ll cover today • Q4 – your biggest quarter ever? • Acronymania! • The portfolio at-large • Metallic Plans – designs – thoughts - insights • Alternatives to ACA – besides IM plans, what else can you offer?

  3. The elephant in the room You’re unsure of the future You’ve seen rates going up You’re concerned about the new complexities You need to survive—and thrive 3

  4. Factors leading to price increases Richer benefits Essential health benefits Guaranteed issue Narrow age bands New taxes and fees 4

  5. Shift in thinking Reform brings BIG opportunity New customers and new markets Assurant Health fits in much broader space You’ll have a solution for nearly EVERY client Assurant Health has a strategy to help! 5

  6. With Assurant Health, you can Preserve book of business Gain market share Increase your revenue Bundle products to enhance coverage and earn more 6

  7. Sales solutions—now and later 7

  8. Pair the right plan to the right customer • Sell Certainty*—steady benefits and rates through December ’14 • New 2014 ‘metallic’ plans – 41 state footprint • Assurant Health Access • Assurant Supplemental Coverage • Short Term Medical *As long as clients don’t make any plan changes. Available for individual major medical plans effective April 1 through December 28, 2013 in 32 states: AL, AK, AR, AZ, CA, CO, DC, DE, FL, GA, IA, ID, IN, LA, MI, MO, MT, NC, NE, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV and WY. 8

  9. Assurant Health—the value for you 9

  10. Assurant HealthCommitted to showing you a way forward for success • Part of Assurant, Inc., a Fortune 500 company • Rated A- (Excellent) by A.M. Best Company* • 120 years of experience** • Health insurance solutions for small businesses and individuals nationwide *Source A.M. Best Ratings and Analysis of Time Insurance and John Alden Life Insurance Company (December 2011) **Assurant Health is the brand name for products underwritten and issued by Time Insurance Company (est. 1892) and John Alden Life Insurance Company (est. 1961) Individual Medical Plans

  11. Assurant Health PortfolioBuilding blocks for affordable health insurance solutions Product offerings vary by state. Individual Medical Plans

  12. Assurant Health Access—who • Need affordable access to health care • Value health insurance but need plan that fits in budget • Currently ineligible for major medical • Want coverage for medical issues they’ll likely face • Are unwilling or unable to pay a high deductible

  13. Assurant Health Access—what • Excepted benefits under Affordable Care Act • Fixed-indemnity plans that pay a set amount for covered medical periods • Pay clients cash benefits to help cover medical or other expenses • Not minimum essential coverage 13

  14. Assurant Health Access—why • Affordable to buy and use • Discounts on medical expenses • Cash to help pay for expenses—in addition to what major medical pays • Access to health care with medical ID card • Tools to help plan and budget for medical expenses

  15. Assurant Supplemental Coverage (ASC) • Provides added protection—helps offset remaining out-of-pocket health care costs • Flexibility to use funds to pay non-medical expenses—especially relevant when many costs related to a critical illness are non-medical • Price flexibility through a variety of plan designs and options • Not considered minimum essential coverage 15

  16. Assurant Supplemental Coverage—who • Want to purchase more condition-specific, lower-premium products • Want to fill the gaps in their health care plan • Want help covering other expenses—rent, child care, transportation, lodging

  17. Short Term Medical (STM)—what Assurant Health is not engaged in rendering tax or legal advice. Please consult a qualified tax or legal professional. Protection from gaps in health insurance Variety of deductible and coinsurance options for 2014 6-month option—and new 12-month coming soon! Key considerations Plans are not minimum essential coverage Clients with STM plan ending outside enrollment and not eligible for a new plan could have gap in coverage Underwriting and pre-existing condition limitation applies 17

  18. Short Term Medical—who • Protection for those in transition • Between jobs … security when job hunting • Waiting for employer benefits … fills the gap • Healthy individuals … bridging gaps during enrollment • Seasonal employees … flexible options • Clients with limited need for care and/or willing to pay out of pocket for preventive and other routine care • Generally healthy 18

  19. Short Term Medical—why • Peace of mind and the coverage clients need at an affordable price • They want a lower-cost option—affordable coverage to get them through transition • They want protection from unexpected illnesses and injuries 19

  20. Short Term MedicalAvailability by state VT NH MA RI CT NJ DE DC MD WA ME MT MI ND MN OR NY ID SD WI WY PA IA NE OH NV IL IN UT WV CO VA MO CA KS KY NC TN AZ OK SC AR NM MS GA AL LA TX HI FL AK

  21. Changes in what they buy Q4, 2013 – Your Biggest Quarter Ever?!

  22. Who’s in Play? • Existing Customers • When will they ‘metallicize’? • Do you need to move them before 2013 is up? • Insurance renews every month • Have you done outreach to shore up your clients?

  23. Who’s in Play? • Prospective customers • There’s NOBODY you can’t sell - Say “no” no more! • ‘Do the Math’ – gone are the days of in-depth underwriting! • Media barrage will drive all your prospects to ACT! • Sell Certainty if can qualify - sell GI if not! (Or non-IM plans) • Medical market expected to DOUBLE – could you find a way to enjoy twice the money you make today, or more??? Individual Medical Plans

  24. Changes in what they buy Acronymania - expanding your healthcare vocabulary for 2014

  25. What you will hear and need to know! • (PP)ACA – (Patient Protection and) Affordable Care Act • QHPs - Qualified Health Plans - are plans that are certified to be sold on the Exchange • The rate on and off the Marketplace/Exchange for those plans must be the same • QHPs can be sold on or off the Exchange/Marketplace • Metallic (Bronze, Silver, Gold, Platinum) and Catastrophic • MEC – Minimum Essential Coverage – type of coverage needed to avoid tax penalty (some exceptions) • HMO – Health Maintenance Organization – last in vogue during the Clinton years – think narrow network and restricted access to providers • EPO – Exclusive Provider Organization – in-network care only (except for emergencies)

  26. and the list goes on… • HHS – Department of Health and Human Services – entity responsible for implementation of ACA • CMS - Centers for Medicare & Medicaid Services – the government entity managing the credentialing process for agents to sell through the Marketplace • (M)AGI/HHI – (Modified) Adjusted Gross Income (1040EZ - line 4, 1040A – line 21, 1040 - line 37)/Household Income – what drives subsidy eligibility – AGI plus foreign income, student loan, higher education costs • SEP – Special Enrollment Period aka life event Individual Medical Plans

  27. Changes in what they buy The ACA and how we built the Metallic Plans at Assurant Health

  28. Plans in all metal levels • Copays are back—office visits and drugs! • Catastrophic plans available • Same valuable features—like Patient Care • Option to add TelaDoc discount card • Pair metal plans with ASC to help offset high deductibles and out-of-pocket costs on certain plans Patient Care is an independent advocacy service and is not affiliated with Assurant Health. Patient Care does not provide clinical or legal advice.

  29. Plan classifications • Grandfathered • Policies issued before March 23, 2010, are considered grandfathered and are exempt from some of the main provisions of HCR • They are not required to cover preventive services without cost sharing • They do not have to cover essential health benefits • Plans remain grandfathered so long as they do not make significant changes in coverage • Non-grandfathered • Any policy issued post signing of PPACA • Policies issued before March 23, 2010, but the customer made changes to the plan post PPACA that changed the grandfathered status • Must conform to all applicable reform requirements

  30. Open Enrollment/SEP • Individuals can only purchase on the public Exchange during open enrollment • Initial open enrollment October 1, 2013 – March 31, 2014 • Subsequent open enrollment periods: October 1 – December 7 • A qualifying life event (birth, death, marriage, loss of coverage) can trigger a special enrollment period where individuals can purchase on the Exchange outside of open enrollment • The special enrollment period for the individual market is 60 days from the date of a triggering event

  31. Cost sharing • Identifies what out-of-pocket costs the individual is responsible for; not including premium • Cost sharing will vary by metallic levels • Total OOP max for 2014 is set at HSA federal OOP limits for high deductible health plans. The OOP max applies to individual major medical, small group and self funded • All copays go toward total OOP max • Office visit and prescription

  32. Maximum out-of-pocket amounts • Plan designs have changed • Total out-of-pocket maximums decrease for 2014 • Individual = $6,350 • Family = $12,700 • Out-of-pocket amounts include deductibles, coinsurance, copays and access fees 33

  33. Metallic levels • Plans that customers buy will be identified by one of four metallic levels: bronze, silver, gold or platinum • Actuarial value is the percentage of claims the plan pays for in-network essential health benefits • Levels are identified based on actuarial value • Bronze = 60%Silver = 70%Gold = 80%Platinum = 90% • Actuarial value is NOT the same as coinsurance

  34. Essential Health Benefits • Ambulatory (outpatient) • Emergency • Hospital • Maternity/newborn • Mental health/substance abuse • Prescriptions • Rehab/habilitative • Lab • Preventive • Pediatric, including dental and vision 35

  35. All the details for 2014 plans • Hand out your product reference 36

  36. Changes in what they buy Subsidies, Tax Penalties, Fines and ‘Doing the Math’

  37. Subsidy Example – Family of 4

  38. FPL by Household Size Assurant Health Access

  39. Maximum premium relative to FPL Individual Medical Plans

  40. Individual tax penalty If an individual chooses not to have major medical insurance, they may be subject to a tax penalty. Individuals may be exempt from the penalty if: The premium of the lowest priced bronze plan on the public Exchange in their state would be more than 8% of the individual’s household income (HHI). ‘8% affordability rule’. The individual’s household income is below the income threshold for filing taxes. The individual qualifies for any other exemption including religious reasons, lack of citizenship, incarceration status or membership in an Indian tribe.

  41. Tax penalty, continued The penalty amount is the greater of the specified percent of income or the flat dollar amount. The penalty amount required will increase by the cost of living after 2016. The flat dollar amount is the lesser of the maximum flat dollar amount per family (noted in the table above) or the sum of the flat dollar amounts applicable to each individual in the family.

  42. Helpful tool—subsidy calculator • Helps you pair right plan to right client • assuranthealthsales.com 43

  43. How will Assurant Health help make you money in 2014?

  44. Assurant Health Portfolio - 2014 • Individual Major Medical • Small Group Fully Insured • Small Group Self-Funded • Assurant Health Access • Assurant Supplemental products • Dental, Accident, Critical Illness, Cancer/Heart/Stroke • Short-Term Medical Insurance

  45. Who Gets What Plan? • Subsidy Eligible ($11k-$44k sgl/$40k-$93k family of 4) • Buy Metallic plan through Marketplace (Not an AH solution) • Buy AHA plan if 9.5% is too much of HHI for budget OR • Buy STM and ride out year 1 and see what shakes out

  46. What do I get paid? • Subsidy Eligible ($11k-$44k sgl/$40k-$93k family of 4) • Buy Metallic plan through Marketplace (Not an AH solution) • $800/mth x 12 x 6% = $576 • $48/month in compensation WHEN WILL YOU GET PAID???

  47. Who Gets What Plan? • Not Subsidy Eligible ($44k+ sgl/$93k+ family of 4) • Buy Metallic plan through Marketplace (Not an AH solution) – undergo financial colonoscopy and get no government financial support • Buy Metallic plan from AH – most expensive option • Buy Assurant Health Access – less cost – first dollar coverage • Buy Short-Term Medical – less cost, catastrophic coverage

  48. What do I get paid? • Not Subsidy Eligible ($44k+ sgl/$93k+ family of 4) • Buy Metallic plan (on Marketplace) • $800 x 12 x 6% = $576 ($48/mth) • Buy Metallic plan from AH (off Marketplace) • $800 x 12 x 10% = $960 ($80/mth) • Buy Assurant Health Access • $465 x 12 x 20% = $1,116 ($93/mth) • Buy Short-Term Medical • $425 x 12 x 20% = $85/mth so long as they keep it/continue to re-write

  49. The new solution sale? • Subsidy/Not Subsidy Eligible – sweet spot selling • Buy Assurant Health Access (First Dollar Coverage) AND • Buy Short-Term Medical (Stop-loss coverage) $286 + $250 = $536 – 12 month comp (blended) = $1,286.40/yr or $107.20/mth • Buy Supplemental (round out coverage and enhance package)

  50. Get the materials you need • Product references available for download and print • Find a Form on assuranthealthsales.com • State-specific versions 51

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