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FIRST Choice “ Guaranteed Issue ” Health Insurance Plans. Underwritten by: Central United Life Insurance Company Marketed by: BMC Agency, Inc.
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FIRSTChoice“Guaranteed Issue”Health Insurance Plans Underwritten by: Central United Life Insurance Company Marketed by: BMC Agency, Inc.
This PowerPoint presentation is intended strictly as a training tool for licensedFIRSTChoiceagents, as well as an information source for prospective agents to evaluate the product. It is expressly forbidden to be used in any sales situation or public venue, in whole or in part.
BMC Agency, Inc. has a “ZERO TOLERANCE” policy in which any violation of this “Agent Eyes Only” rule by any FIRSTChoicerepresentative may result in their immediate termination WITH CAUSE!
FIRSTChoiceGuaranteed Issue Health Plans Central United Life is a member of the Manhattan Insurance Group, whose Worksite strategy is to offer sound, affordable products that meet the demands of even the most sophisticated of Policyholders. CUL has focused on the acquisition of life, accident and health insurance for more than 20 years.
FIRSTChoiceGuaranteed Issue Health Plans Since the introduction of the first “Guaranteed Issue” Health Insurance supplement for individuals in 2003, BMC Agency, Inc. has remained committed to refining and revolutionizing the individual health insurance marketplace. This is why CUL chose BMC to assist in the development and promotion of their incredible FIRSTChoiceseries.
FIRSTChoiceGuaranteed Issue Health Plans Who qualifies for “Guaranteed Issue” Consideration? Individuals age 18-64 who work an average of 30+ hours per week, their spouse ( if 18-64 ) and their children.
FIRSTChoiceGuaranteed Issue Health Plans Once issued, the plans are GUARANTEED RENEWABLE to age 65, so long as premiums are paid when due. It is not necessary to maintain ‘full time’ employment status once a FIRSTChoice plan is issued!
FIRSTChoiceGuaranteed Issue Health Plans How are Pre Existing Conditions treated? Conditions for which an insured sought or received medical treatment in the 12 months prior to application date, or which manifest symptoms that would have caused an ordinarily prudent person (a person of average intelligence)to have done so will not be covered for 12 months after the effective date, whether or not they are disclosed on the application.
FIRSTChoiceGuaranteed Issue Health Plans Are there any Ineligible Conditions or Ineligible Occupations withFIRSTChoice? NO! Individuals 18-64 working an average of 30+ hours per week may apply regardless of their Occupation or Pre-Existing conditions!
FIRSTChoiceGuaranteed Issue Health Plans Most FIRSTChoiceplan designs include a unique combination of features that provide significant “front loaded” benefits when they are needed the most. There are three separate benefits designed to provide cash for the expense of the hospital room when confined. The Daily Room Benefit The Indemnity Benefit The First Hospital Confinement Benefit
FIRSTChoiceGuaranteed Issue Health Plans The Daily Room Benefit is paid for up to 365 days per period of confinement, currently much longer than any competitor. ( Others are usually 30 or 31 days maximum )
FIRSTChoiceGuaranteed Issue Health Plans TheIndemnity Benefit is paid on the first day of hospital confinement in any calendar year.
FIRSTChoiceGuaranteed Issue Health Plans The First Hospital Confinement Benefit is paid during the first period of hospital confinement of any calendar year. Depending on the plan selected, it can be as much as $10,000 over the first 6 days, in addition to any and all other benefits!
FIRSTChoiceGuaranteed Issue Health Plans The First Hospital Confinement Benefit in both the GOLD and PLATINUM plan designs pays as follows: Day 1:$1,000 Day 2:$1,000 Day 3:$2,000 Day 4:$2,000 Day 5:$2,000 Day 6:$2,000 TOTAL: $10,000 If a period of confinement lasts less than 6 days, the balance of the benefit is available for a subsequent confinement for the same condition, provided it occurs within 6 months.
FIRSTChoiceGuaranteed Issue Health Plans There are THREE important areas that must be considered when selecting which Guaranteed Issue plans to market. We feel that the FIRSTChoicePlan Series is superior to the competition in all three! PLAN DE$IGN PREMIUM$ COMPEN$ATION
FIRSTChoicePlan Design The FIRSTChoicePLATINUM Plan has 9 separate benefits, including the 4 most significant, that are equal to or superior to ANY OTHER GUARANTEED ISSUE plan currently available!
FIRSTChoicePlan Design Remember that all FIRSTChoiceplans are GUARANTEED RENEWABLE POLICIES, not certificates of some Group Master policy or Association Plan. This provides much greater protection for the insureds!
FIRSTChoicePlan Design FIRST ChoicePlans are true “Defined Benefit” plans. As such, the stipulated benefit is always paid in full, regardless of the billed amount. There is no “pays UP TO $$$” language in FIRST Choice policies!
FIRSTChoicePlan Design Unlike the competition, many of which have no benefit for Intensive Care, or pay it “in lieu” ( instead of! ) the DRB, FIRSTChoicepolicies pay all Intensive Care benefits IN ADDITION TOany and all other benefits of the policy, including the DRB. This is a HUGE advantage to the policyholder!
FIRSTChoicePlan Design Virtually ALL Guaranteed Issue Plans address SURGERY in one of two ways. Many pay a percentage, often 100%, of the Medicare reimbursement rate ( RBRVS, or Resource Based Relative Value Scale ). What many agents and most clients do not realize is that this amount IS NOT based upon the total cost of the procedure, but simply on the amount charged by the PRIMARY SURGEON ONLY! This does not include the Operating Room, Suture Kits, dressings, etc.!
FIRSTChoicePlan Design Another problem is this; at a time when an estimated 46% of doctors are threatening to boycott Medicare over what they feel is inadequate compensation, how will a client under age 65, and not covered by Medicare, compel their doctor to accept this discounted amount?
FIRSTChoicePlan Design The rest address Surgery with an established Surgical Schedule, usually with a maximum benefit of $10,000. Often, the benefit from a $10,000 Surgical Schedule will be more than for the identical procedure under a 100% RBRVS Medicare Reimbursement rate!
FIRSTChoicePlan Design One drawback to most plans with Surgical Schedules is that they tend to limit coverage to one or two surgical procedures per year, maximum!
FIRSTChoicePlan Design FIRSTChoiceincorporates the best of both, with a $10,000 Surgical Schedule that can be accessed an UNLIMITED number of times each year, for either inpatient or outpatient procedures!
FIRSTChoicePlan Design The FIRSTChoice benefit for Anesthesia is the highest percentage paid, 25%of the amount paid for Surgery. Since our Surgical Schedule will deliver more benefits and do it more often than other plans, the Anesthesia Benefit is correspondingly higher as well!
FIRSTChoicePlan Design Unlike the vast majority of competitors, FIRSTChoiceplansprovide benefits for MATERNITY, both Natural Delivery as well as Caesarian Section, effective 10 months after the policy effective date!!
FIRSTChoicePlan Design FIRSTChoiceplans are the only “Guaranteed Issue” plans currently known to include Private Duty Nursing benefits. The Platinum Planalso has the highest levels of AD&D protection, $30,000!
FIRSTChoicePlan Design The total paid for an Accident will come from several different plan benefits. They are: Accident Rider Specific Injury Rider Surgery Schedule, with Anesthesia
FIRSTChoicePlan Design Accident Rider: Pays a (first dollar) benefit for each accident. Specific Injury Rider: Pays as much as $1,800 per accident from a (first dollar) schedule of procedures. Surgery Schedule: Pays a (first dollar) percentage of the Surgery Schedule, plus 25%+ for anesthesia!
FIRSTChoicePlan Design There are benefits absent from FIRSTChoicethat appear with other Guaranteed Issue plans. They include Prescription Drugs, Outpatient Labs & X-Rays, Critical Illness, and “Association Junk”
FIRSTChoicePlan Design Prescription Drugs tend to fall into one of two categories, Maintenance Drugs and Occasional Drugs. Let’s consider each!
FIRSTChoicePlan Design Maintenance Drugs are taken regularly, and are often available in generic or generic equivalents. Literally hundreds are available at discount chains, often for $4.00 each, or less! These are less expensive than when using a discount drug card!
FIRSTChoicePlan Design Maintenance Drugs can also be very expensive. For that reason, ALL BMC Agents are provided access to a quality PPO repricing and Discount Medical benefits card. This optional benefit can reduce the cost of procedures by 30% and more!
FIRSTChoicePlan Design Occasional Drugs are most commonlyAntibiotics, used infrequently, andPain Medication, usually very inexpensive. We believe it is less costly over time for the client to ‘pay as you need’ these, as opposed to building in costs that drive up plan premiums.
FIRSTChoicePlan Design X-Rays and Lab tests are legitimate medical procedures, but have become abused as doctors increasingly practice ‘defensive medicine.’ We have chosen to avoid coverage for these elements in favor of additional coverage for expensive confinements/procedures.
FIRSTChoiceGuaranteed Issue Health Plans Critical Illness plans normally require even more scrutiny in underwriting than Major Medical. To include CI benefits within a Guaranteed Issue program adds a disproportionately high premium cost that we feel is an ineffective use of our clients premium dollars.
FIRSTChoicePlan Design Prior to 2003, the only option for “Uninsurable” clients was an expensive ‘state pool’ or an “Association Package” that featured “discounts” on some medical services, but mostly benefits unrelated to Health Insurance.
FIRSTChoicePlan Design Today, even though numerous “Guaranteed Issue” plans exist that feature solid Health Insurance benefits, most plans are still littered with movie tickets, rental cars, Disney discounts, and vitamins. With FIRSTChoice, you get quality INSURANCE BENEFITS, period.
FIRSTChoicePlan Design By limiting eligibility to employees who work an average of 30+ hours/week,and avoiding marginal benefits subject to abuse, we are able to provide what we believe to be the strongest package of “Guaranteed Issue” benefits available in our industry today!
FIRSTChoicePremiums Ranging from the HSA Supplement for less than a dollar a day, to the PLATINUM plan design with the richest benefits available in any Guaranteed Issue chassis, FIRSTChoiceplan designs are available in a variety of configurations, all of which are lower in price than competitor plans with fewer and smaller benefits!
FIRSTChoiceCOMPEN$ATION Almost all “Guaranteed Issue” plans today pay a ‘levelized’ commission, and very few offer annualization. FIRSTChoiceplans provide ‘heaped’ first year commission with 6 months advanced commissionsavailable to agents that qualify!
FIRSTChoiceCOMPEN$ATION The highest commission levels available from competitors for top IMO/FMO contracts is 30% First Year Commission. ********************************************************************************************************************* This same 30%, (with 8% renewals), is what we pay AGENTSwith FIRSTChoice!
FIRSTChoiceCOMPEN$ATION Higher Contracts can be earned by General Agencies and Managers with active production teams. Details are available from the BMC Marketing Partner that provided you with this PowerPoint presentation!
BMC Agency, Inc. and CULFIRSTChoice • STRONG BENEFITS! • ************************************************************************************************************ • Low Premiums! • *********************************************************************************************************** • High Compensation! • ************************************************************************************************************** • “The FIRSTChoicein • Guaranteed Issue Health Plans!”