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The Essentials and the Ultimate Triple Choice: A Creative Approach for Enhancing Employer Affordability of Group Health Coverage. Healthcare Innovation Announcement.
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The Essentials and the Ultimate Triple Choice: A Creative Approach for Enhancing Employer Affordability of Group Health Coverage
Healthcare Innovation Announcement Sekure Healthcare, Symetra Life Insurance Company and Contractor’s Choice have teamed up to enhance employer affordability with: • The Essentials1– an affordable health coverage product; and • The Ultimate Triple Choice– A coordinated offering of coverage products with a wide spectrum of affordability (benefits for all budgets) Notes: 1. It is important to understand that the Essentials is not a replacement for major medical/comprehensive health coverage
What is The Essentials? It’s an innovative health coverage that uses a Limited Benefit Medical Insurance (MiniMed Plan) with provider networks, 24/7 patient advocacy & other health resources inside an ERISA Trust managed by Contractor’s Choice. • Consumer Driven – Members have freedom of choice with no managed care utilization controls. • Guaranteed Issue -Nopre-existing conditions limitations or health questionnaires. • No Deductibles - First dollar fixed benefits coverage the day Member is effective. • Participation -Minimum of 5 enrollees. • Applicability - Ideal for employers who: • Offer no health benefits • Have low participation on major medical plans • Have a large Hispanic workforce, part-time and/or seasonal workers
What is The Essentials Product Structure? The Essentialsconsists of two separate product components coupled with a unique sales distribution/administration platform: Select Benefits - A Limited Benefit Medical Insurance Plan underwritten by Symetra Life Insurance (“Symetra”); and, Sekure Healthcare Program - PPO provider networks in US & Mexico, patient advocacy & other health resource services When used together, these two product components work in tandem for a more effective benefit plan Contractor’s Choice uses an ERISA Trust coupled with unique distribution & administration that increases market reach, accessibility & visibility
Insurance Benefits • The Symetra Select Benefits Insurance Policy is a fixed indemnity/limited benefit medical plan. • The Plan pays a predetermined cash benefit with a maximum limit to the covered person - this is different from an HMO Copay Plan. • The benefit is paid without regard to the selected provider or amount of charges. • Benefit categories include doctor office visits, preventive care, hospital care, lab/X-ray and more. • Symetra (www.Symetra.com) is “A” rated by A.M. Best, has nearly $19B in assets & over 2 million customers. Select Benefits is not a replacement for a major medical policy or other comprehensive policy. It is designed to cover benefits at preselected fixed dollar amount used on a routine basis. Coverage may be subject to exclusions, limitations, reductions and termination of benefits provisions.
Sekure Healthcare Program • The Sekure Healthcare Program helps to reduce medical expenses. • Sekure integrates access to healthcare services (medical, hospital, dental, pharmacy, vision, chiropractic, acupuncture & more) in the US & in Mexico. • National PPO networks offer Members savings with 20% to 35% discount before benefits are paid. • Health Advocate Unit available toll-free to assist Members in finding network providers. • 24/7 toll-free nurse line provides helpful medical information & assistance. www.MySekure.com
Insurance Benefit Plan Designs The Essentials has 3 Standard Plans & 1 Core Buy-Up Plan • The Standard Plans are 100% paid for by employer, available on super composite or 4 tier levels. Pricing on super composite tier from $99/month to $312/month. • The Core Buy-Up Plan is an innovative plan design - employer pays 100% of core level benefits. Each employee has option to buy up to higher levels of benefit coverage. Employer contribution is as low as $50 for the core level benefits on super composite tier. To Skip Viewing The Essentials Plan Designs and Proceed to Next Slide in the Presentation Click Here Note: Super composite pricing is one tier for employee and includes all eligible dependents
Essentials Core Buy-Up Plan Employer Pays as low as $50 for Core Plan and Employee has option to Buy Up for higher benefits
Sekure Healthcare Program Networks For healthcare not covered by insurance or for when insurance coverage limits are reached, the Sekure Healthcare Program offers substantial discounts.
Integrating Cultural Considerations Several important cultural considerations have been designed into The Essentials. • Coverage becomes more relevant to Latinos who make up 57% of California’s 6.6 million uninsured. • Sekure Healthcare is expanding its network of community clinics throughout CA. • Some Latinos prefer to have option to access community clinics. • Clinics offer low cost visits and some accept assignment of benefits. • 24x7 bi-lingual patient advocacy and nurse-line • Cross-border health coverage – healthcare access in Mexico is a feature requested by many Latino workers throughout CA.
Innovation - Health Access in Mexico • Members may use insurance benefits and other services in Mexico - • Call center in Mexico City performs 24/7 toll-free patient advocacy, appointment facilitation and unlimited “tele-consults” with trained physicians • Providers available in 300+ cities throughout Mexico in the Sekure Network • Healthcare costs in Mexico are lower than in US - contracted rates for Doctor’s Office Visits: $250 pesos for GP; $350 pesos for Specialist (about $25 US dollars) (about $35 US dollars) • Greater geographical reach - as an example, a worker in Fresno can enroll his dependents who live in Guadalajara
What is the Ultimate Triple Choice? • Contractor’s Choice provides an industry first with a PPO/HMO/Mini-Med Plan Offering to an employer - it’sthe “Ultimate” Triple Choice. • The Ultimate Triple Choice is an innovative coordinated product offering. • It addresses issues of high cost and minimum participation by providing employer with a much wider spectrum of affordability. • It is available to employers in certain industries - construction, landscaping, contract manufacturing, agriculture – that meet requirements of the Trust.
Affordability within the Healthcare ContinuumFor Group Coverage The Ultimate Triple Choice has a much wider spectrum of health coverage affordability! Limited Benefits Major Medical/Comprehensive Insurance Limited Benefits Medical Insurance/ MiniMed Plans Hi Deductibles Low Deductible PPOs Hi Copays Low Co Pays HMOs Traditional Indemnity Coverage LOW COST OF HEALTHCARE COVERAGE HIGH For Family <$100/mo $200/mo $500/mo $600/mo $800/mo $1,000/mo >$1,200/mo Example of Super Composite Monthly Rates* Mini-Med Plan Options HMO Plan Options PPO Plan Options Start at $99 $392 to $687 $949 to $1,125 * In Southern California
The Ultimate Triple Choice • A unique offering for employers needing more affordable choices due to price sensitivity of HMO/PPO Plans. • The affordability of the Essentialsallows employers to provide something to all classes of employees. • Contractor’s Choice provides enrollment support for all products. • Contractor’s Choice administers consolidated billing of all 3 products to employer on one monthly bill. • Minimum number of enrollees: 1 on PPO Plan, 2 on HMO Plan, and 5 on the Essentials. • A new approach in addressing some of the affordability challenges.
Thank YouFor Your Interest For more information or a quote, please contact: Nidia Sandoval Executive Account Manager CONTRACTOR'S CHOICE Telephone: (866) 358-9456 Fax: (714) 542-9309 Email: nsandoval@contractorschoice.net