Filling the gap healthcare made simple

1. Filling the gaphealthcare made simple Dr chip backus

2. The Problem • Health insurance is not AFFORDABLE • And…becoming even less affordable for many • Plans have higher premiums and deductibles • Even affordable individual plans • Healthcare quality and coverage is uncertain • Routine medical care is not covered until high deductible has been met • Visits become much more expensive than they should be • Premiums + Copay (vary according to plan)

3. Quote from businessman.. • Larry Katz, president and CEO of Dots Diner restaurant group in Metairie, Louisiana, owns six diners. • "We currently employ 65 full time employees and thus, will not be able to benefit from most of the subsidies and tax credits offered to smaller companies under the ACA," Katz told the committee.  • Consequently, Katz will be discontinuing healthcare coverage currently offered to his employees, since "the penalty, while huge, is less than the costs of offering the required coverage to all of our employees." Katz could also sell or close two of his least profitable diners to meet the 50 full time employees limit.  • Inc magazine

4. Typical aca Silver Plan • 10 Employees • Deductible $2000/ individual • Deductible $4000/family • Out of pocket maximum $6350/yr- indiv/$12700/yr-family • Copays: • $105 for primary doctor visit • $105 for specialist • 45% coinsurance for ER visit after deductible met • Monthly premium $3866 ($386.60/employee)

5. Business owner options?? • Keep current rising premium, high deductible plan • Drop the benefit and provide no health insurance (<50 employees) • Each individual can sign for individual plan • If over 50 employees, choose to drop coverage and pay a fine • Keep the minimum required coverage (60%) and add Simply Healthcare • Provide minimum required and allow employee to pay for Simply Healthcare • Provide Simply Healthcare for your employee

6. The gap • High deductibles that are rarely met • Business owners still wanting to help employees stay healthy • Too pricey • Full responsibility for many employees for routine care • What does this mean? • Full payment and expensive costs for most sick or injury visits (routine care)!!!

7. Solution…Simply Healthcare • People want to see out of pocket healthcare costs lower RIGHT NOW…not after they pay $6350-12,700 deductible and high premiums • We provide the savings immediately! • Simply pay $30 /employee/month and they pay $35 for most visits • Facility: Piney Flats Urgent Care (expanding in the future to other urgent care facilities) • We are not insurance or a cheesy discount plan

8. How does it work? • -Obtain list of interested employees • -They are added to a list of those participating • -The list is sent to Simply Healthcare director • -Updated at clinic(s) monthly • -Employee presents card at reception window • -Pay copay$35 for most visits • -additional costs if procedure or labs necessary • -Costs are at a 35% discount or more

9. Older system vs Newer concept • - Full insurance to cover all -Major medical insurance • Lower premiums, low deductibles -Higher premium and deductible • No HSA/FSA -HSA and FSA plans to offload burden • Low Copay -High copay to full payment • Business responsible for insurance -Individual plan, and Simply Healthcare • Emergency visits -Urgent cares and primary docs

10. Who qualifies?? • -Any employee • -Full or part time • -Immediate Family members of each of the employees • -spouse: $20/month • -children: $15/month

11. Who benefits? • -Small Businesses • -Offer some benefit to maintain employees cost effectively • -Why don’t you have something now? • -Too expensive, until now • -Businesses with 50 or more • -High deductible plans are expensive for routine care even after deductible met • -Self Insured Business • -Limit claims filed and usage of their plan, keeping those costs down • -Keep it convenient

12. What do we handle? • Respiratory infections -Abdominal pain • Sinus infections -Routine kidney stones • UTI’s -Minor eye problems • Asthma-mild to moderate -Dental infections • Lacerations -Back pain/minor injury • Minor fractures/broken bones -Arthritis • Toe nail removal -Nausea/vomiting • Minor burns -Depression • Minor bites -Diarrhea • Rashes -Abscesses

13. Future for simply healthcare • -One copay for all visits • -Multi specialist copay visits • -Primary care • -Orthopedics • -Cardiology • -ENT • -Dental • -Multi locations

14. HAPPINESS AND HEALTH FOR YOUR EMPLOYEES • -How do you keep your employees loyal to you and your business? • -Offer something that others don’t or at least match it • -Show them you care by stretching even if a little • -How do you Increase your business productivity? • -Keep employees happy • -Keep employees healthy • -Get them back to work quickly • How do you save money and meet these desires? • -Simply Healthcare

15. Final thoughts • -With The Affordable Care Act many could lose opportunity to get care immediately • -Waiting days for their sick visit or expensive uncovered ER visit • -Many over the age limit may not get care • -Many will be paying high insurance premiums for less coverage • -Joining our private healthcare team will ensure: • - Consistent Quality healthcare • - Convenience (7 days/wk) • -Potential network and specialist growth • Thank you!!