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Annette Dahlke National Key Broker Account Executive 920-661-2312 adahlke@goldenrule.com. Health Plans for Individuals and Families Underwritten by Golden Rule Insurance Company. Key Differentiators. Strength in Numbers.
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Annette Dahlke National Key Broker Account Executive 920-661-2312 adahlke@goldenrule.com Health Plans for Individuals and FamiliesUnderwritten by Golden Rule Insurance Company
Strength in Numbers Voted one of Fortune Magazines Top 3 Most Admired Health Care Companies in America
Alabama • Arizona • Arkansas • DC • Delaware • Florida • Illinois • Indiana • Iowa • Louisiana • Maryland • Michigan • Mississippi • Missouri • Nebraska • North Carolina • Ohio • Oklahoma • Pennsylvania • South Carolina • Tennessee • Texas • Virginia • West Virginia • Wisconsin CT DC Gen 25 Product States WA MT ND MN OR NY WI ID SD MI WY PA IA NE DE MD OH NV IN IL WV UT VA CO KS CA MO KY NC TN OK AZ AR SC NM GA AL MS TX LA FL Gen 24-25 State Non Gen State PacifiCare State No Product Available
Commitment to Quality * Actual 2008 health underwriting results ** Actual health claims results 2008
Product Portfolio
Lower New Business Rates Up to 5% less 2.5% less 5-15% less
Copay plans* CopaySelectSM – benefit-rich with unlimited doctor office copays CopaySaverSM - our most affordable copay plan Health Savings Account (HSA) plans - Qualified HSA100® - our comprehensive HSA HSA70SM - our most affordable HSA plan High Deductible plans - Non-Qualified Plan 100®- our simplest plan to understand, 100% coinsurance Plan80SM – similar to the Plan 100, premium savings of 80/20 coinsurance Saver80SM - our most affordable plan Dental- Vision- Short Term MedicalSM www.goldenrule.com/estore *Not available in AK
Copay SelectSM $500, $1,000, $1,500, $2,500, $3,500, $5,000, $7,500, $10,000 Deductible Choices Coinsurance Choices 80% 100% 70% $5,000 $0 $3,000 Preventive Care (No Deductible, No Annual Max) *
Copay SelectSM Tier 1 - $15 copay, no deductible Tier 2 – 4 combined $200 deduct Tier 2 - $35 copay, Tier 3 - $65, Tier 4 – 25% Prescription Drugs Tier 1 = More than half of covered Rx Hydrocodone Tramadol Lisinopril Metformin Prednisone Atenolol Tier 4 = Less than 1% of covered Rx In 2008 less than 2% of Golden Rule Policy Holders with an annual Rx maximum exceeded $3,000 in Rx expenses.
Copay SaverSM • Premiums for Copay SaverSM are significantly less because coverage is not provided for some outpatient services, such as: • Outpatient doctor visits beyond office copays • Brand name prescriptions - $15 generic RX card is included • Diagnostic testing, x-ray & lab (must be performed within 14 days of surgery or confinement) unless otherwise noted. 20% - 40% Less $1,500, $2,500, $5,000, $7,500, $10,000 Deductible Choices Doctor Office Visit (2 per person, per year) (Upgradable to 4 visits) Preventive $35 Copay (3 month wait)
HSA 100® $1,250, $2,500, $3,000, $3,500, $5,000 Single Deductible Choices $2,500, $5,000, $6,000, $7,000, $10,000 Family Deductible Choices (3 month wait) $35 office copay 100% lab, x-ray, immunizations (no wait)100% Mam, Pap, PSA Preventive Care (No Deductible, No Annual Max) $3000 annual maximum* Preferred price card included Prescription Drugs
HSA 70SM Up to 20% Less Than HSA 100 Cost Savings (3 month wait) $35 office copay 70% lab, x-ray, immunizations (no wait)70% Mam, Pap, PSA Preventive Care (No Deductible, No Annual Max) $3000 annual maximum* Preferred price card included Prescription Drugs 30% Coinsurance Coinsurance Out-of-Pocket Varies By Deductible Deductible Choices Same As HSA 100
OptumHealthBankSM Convenience… • Health plan and savings account administered together • 2% interest • Prepaid debit card, checkbook or online bill payment options • Online banking makes lump sum deposits easier…
High Deductible Plans – Plan 100® • Plan deductibles* • $1,500, $2,500, $5,000, $7,500, $10,000 • Two calendar-year deductibles per family • 100% Coinsurance after deductible** • Doctor office visits • Prescriptions • Preventive care*** • Inpatient/Outpatient services *Not all deductibles available in all states. ** of covered expenses ***Limited benefit. See product brochure for detailed plan description
High Deductible Plans – Plan 80/Saver 80 • Plan 80 • 15-25% less than Plan 100® • 80/20 to $15,000 coinsurance • Saver 80 • 30-40% less premium than Plan 100® • 80/20 to $15,000 coinsurance • Limited coverage • Coverage for major expenses
Dental and Vision *Available as health insurance rider or stand-alone policy, depending on state; product availability varies by state.
UnitedHealthcare Dental • Dental PremierSM • Available statewide • Richer out of network benefit • Higher premium than Value • Dental ValueSM • Lower premium than Premier • Available only in strongest network areas • Lower out of network benefit
No deductible, no wait Preventive Routine exams, routine x-rays, cleaning, fluoride treatment (under age 16), sealants, space maintainers (under age 13) Deductible, then 80% (6 month wait) Basic Routine extractions, simple fillings Deductible, then 50% (12 month wait) Major Root canals, crowns, veneers, dentures $50 per person, per calendar year (Max 3) Deductible $1,000 per person, per calendar year Max Benefit
UnitedHealthOne Vision Option Individual Vision Insurance that will Open Your Eyes Administered by Spectera, Inc. Golden Rule Insurance Company, a UnitedHealthcare company, is the underwriter of the vision plans marketed under the UnitedHealthOne brand.
Focus on the Value • 24,000 Network Providers* • Private practice and retail chain providers * As of publication date
Plan Enhancements * Not available in all states. See product brochure for detailed benefit options descriptions.
Preventive Care Benefits Package* No Deductible No Coinsurance No Waiting Period No Annual Maximum *Available with Plan 100, Plan 80, Saver 80, and Copay Saver
Maternity Option* Available with all plans except HSAs. • Per pregnancy benefit • No deductible • Insured pays 20% • Pays graduated benefit • Years 1&2 = $2,500 covered ($2,000 paid) • Years 3&4 = $5,000 covered ($4,000 paid) • Years 5+ = $7,500 covered ($6,000 paid) *Not available in all states. See product brochure for detailed benefit options.
Term Life & ADD Brochure Insert Term Life • $50,000 • $100,000 • $150,000 • Accidental Death • $50,000 Eligibility • Primary Insured/Covered Spouse • Ages 18-64 • Coverage per person • Terminates at age 65
Preferred Price Card Discounts provided at thousands of participating pharmacies • Included with all health plan (except Copay plans) • Offers drug discounts* • Average savings of 20%** Walgreen’s Kroger Meijer Eckerd Target CVS *Discount program, not insurance. ** Data provided by Golden Rule’s Managed Care and Product Mgt. Dept. 2008
Enhanced Supplemental Accident – New! Helps reduce out-of-pocket! Applies to: • Deductible • Co-insurance • Copays • Saver Plan outpatient
Enhanced Supplemental Accident Benefit Brochure Insert Benefit Amounts • $500 • $1,000 • $2,500 • $5,000 • $10,000 Eligibility • 90 days of an injury • Credited towards deductible/coinsurance • Optional Benefit – just a check mark
Enhanced Supplemental Accident About $1.15 per day!
Deductible Credit Help boost client retention with deductible credit! Deductible not met Up to 50% = 20% Deductible Reduction Deductible Calendar Year 1 $5,000 Calendar Year 2 $4,000 Calendar Year 3 $3,000 Calendar Year 4 $2,500
Deductible Credits • Deductible is reduced by 20% per year if it not satisfied in the prior calendar year. • Maximum deductible credit / reduction is 50% • Plan must be in force / active at least 6 months in a calendar year to be eligible for credit in the following year. • Credit given on a per person basis (except on family HSA plans) • If deductible is met it is reset to the original level the following year, and deductible credit can be earned again. * For covered expenses, not including copays. See product brochure for detailed description
Broad Expansive Network UnitedHealthcare Choice Plus (available in most states) Choice of Network Providers Provider discounts up to 45%* www.goldenrule.com
Preferred Network UnitedHealthcare Choice Plus(available in most states) Broad, expansive national network 4,900 Hospitals 580,000 Physicians Choice of network providers, even while traveling Often offers significant provider discounts** Network discounts up to 45% for claims repricing Access to preferred network directory: www.goldenrule.com...(click on)Networks **Discounts vary by provider, geographic location, and service provided
Provider Network Discounts* Amount billed $294.00 Discount: 224.27 76% Amount billed $162.00 Discount: 43.15 27% *Discounts vary by provider, geographic location, and service provided
Who’s Eligible? • Individuals to age 64.5 • Dependents to age 25 • Residents of the United States
Why Rider Instead of Rate Up? Why Rider? • Accommodate Pre-Ex. • Premium Doesn’t Change. What’s involved? • No more than 4 on an individual. • No more than 6 per family. • What’s new? Rate up of 10%
Adult Rating Classes Preferred I – 7% less than Preferred II Meets preferred underwriting guidelines and had previous health insurance coverage in last 63 days* Preferred II – 10% less than Standard I Meets preferred underwriting guidelines and did not have previous health insurance coverage in last 63 days* Standard I – 25% less than Standard II Meets standard I build guidelines with minor health concerns Standard II Meets Standard II build guidelines with more complex health history.*
Preexisting Conditions • Preexisting conditions will not be covered during the first 12 months* after an individual becomes a covered person. • Note: This exclusion does not apply to conditions which are both: • Fully disclosed to Golden Rule on the application • Not excluded or limited by our underwriters • Unacceptable conditions** • Hypertension/high cholesterol/tobacco use • Individuals contemplating hospitalization or surgery • Undiagnosed ailments or symptoms *Varies by state. **This is only a summary. Check Broker Guide for further details.
Common Declines* • Congestive Heart Failure • Diabetes • Emphysema • Heart Attack • Rheumatoid arthritis • Stroke • Coronary artery disease/ bypass/ angioplasty This is only a summary. Check the Broker Guide for further details.
Clearance Periods* • Atrial fibrillation – 2 years • Cancer – depends on type • Colon cancer – 5 years • Prostate cancer – 2 years • Epilepsy – 1 year since last seizure • Hyperthyroid – 6 months • Gastric Bypass – 5 years and stable weight for at least 12 months This is only a summary. Check the Broker Guide for further details.
On-line Tools 48 www.goldenrule.com It’s convenient! Fast and efficient Your own Golden Rule store
Ease of E-Store • Online quoting • Application submission • Online tracking • Marketing material • Training access • More www.goldenrulehealth.com/broker
Preliminary Evaluations* Two Easy Ways • Call • 800-474-4467 • E-store • Age and gender • Diagnosis and Date • Prescribed treatment • HBP readings • Height and weight Information needed: *Preliminary Evaluations are not a guarantee of coverage. Final decision is up to underwriting at time of application submission.