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Limited Benefit Medical Plans “A Marketplace Perspective”

Limited Benefit Medical Plans “A Marketplace Perspective”. Presented by InnoBenefits Mitchell Besvinick May 30, 2007. Ask yourself this question…. …what value do I bring to my customers?. Are you a Rep?. Don’t be a rep, be a solution A rep is column 5 on a spreadsheet

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Limited Benefit Medical Plans “A Marketplace Perspective”

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  1. Limited Benefit Medical Plans“A Marketplace Perspective” Presented by InnoBenefits Mitchell Besvinick May 30, 2007

  2. Ask yourself this question… …what value do I bring to my customers?

  3. Areyou a Rep? • Don’t be a rep, be a solution • A rep is column 5 on a spreadsheet • Reps are expendable

  4. Becoming an Expert Facilitator • Know your limitations • Sell the process, not the product • Access to accurate information and solutions

  5. Limited Benefit Medical Sales Success • Know your competition and how you are different • Understand the process of Group Supplemental HI • Rollover, Rollover, Rollover

  6. Competition • SRC/Aetna • Starbridge/Cigna • Foundation One/American Fidelity • TransChoice/Transamerica • HM Benefits • Optimed • Nationwide • PanAmerican • American Worker Plan • Etc., etc., etc.

  7. Which Program Sells Best? • Scheduled Benefit Plan • National PPO • Easy to do business with • National PBM • Depth of products available

  8. What Exactly is Group Supplemental Hospital Indemnity? • Mini-Medical • HIP • Middle Medical • Limited Medical A reduced benefit, reduced cost health insurance program

  9. Two Types of Plans • Scheduled benefit plans • Built from hospital indemnity plans • Pre-determined benefit amounts • Schedule benefits • Reimbursement/Direct Pay of benefits

  10. Two Types of Plans • Usual and customary (UCR) plans • Usually include deductibles and co-payments • Built on major medical platform • Reduced benefits to fit pricing and risk constraints • In-network and out-of network benefits • Balanced billing

  11. Who Offers Group HI Plans • Retail Stores • Convenience / Grocery Stores • Health Services industries • Restaurants • Hotels / Motels • Janitorial Services • Landscaping / Lawn Services • Staffing Companies • Associations (1099 employees) Actually…any group is a prospect!

  12. The Changing Applications of Group HI Plans • Voluntary plans • Employer funded plans • Layering policies • Extending major medical eligibility • New state benefit requirements • Etc., Etc., Etc.

  13. Carrier Responsibility Underwrite Promote Administer Fulfill Limited Indemnity Plans and other voluntary products

  14. Broker Responsibility Consult Design Implement Administer Limited indemnity plans and other voluntary products via inbound/outbound call center and other enrollment solutions

  15. Market Requirements This combination ensures a successful result Administer Consult Design Implement

  16. Consult • Evaluate carrier/market plan designs • Research and detail demographic data • Evaluate company logistics • Geo-access medical providers for PPO • Geographic medical cost evaluations Design Implement Administer

  17. Benefits Offered* • Dual option limited medical plans • Dental Plans • Vision • STD • Life Insurance • Critical Illness • Traditional voluntary products • Most benefits Guaranteed Issue • No participation requirements • Most plans Section 125 eligible Consult Design Implement Administer *Benefits vary by carrier

  18. Medical Plan Benefits* • Daily Hospital Room and Board • Doctor’s Office Visits • Inpatient and Outpatient Surgery • Anesthesia • X-ray and lab benefits • Critical Illness Benefit • Prescription Drug Benefit • Supplemental Accident Benefit • Wellness Benefit • PPO Consult Design Implement Administer *Benefits vary by carrier

  19. Simple to understand • No deductibles • No annual dollar maximum • No pre-existing conditions (except maternity) • Provides “First Dollar Coverage” • Comprehensive list of covered services • Can be offered as Hi/Lo employee option • Freedom to go to any doctor or hospital (PPOs available) • Rate stable Consult Design Implement Administer

  20. Consult • Preparation for Enrollments • Detailed timeline development • Develop technology and business infrastructure • Develop comprehensive enrollment strategy • Place experienced, trained and licensed enrollers at call center • Develop, design and print research-based communication materials Design Implement Administer

  21. Consult Design • Conduct initial and annual open enrollment • Educate employees on benefit options (what it is and what it is not) • On-going/new hire enrollment support Implement Administer

  22. Consult Design • Orchestrate administrative flow with carrier and client • Eligibility tracking • Test and double check Implement Administer

  23. Client Responsibilities • Share information with employees • Make a payroll deduction • Forward file and monies to carrier We/You do all the rest

  24. Broker Responsibilities • Request proposals • Recommend carrier of choice • Participate in conference calls • Observe the process • Sell more cases Collect Commissions!

  25. Why InnoBenefits? • Experts in Limited Medical Plans • Large/brand recognized references • Nationally recognized consulting group • Access to custom administrative solutions • No competition to brokers

  26. Questions

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