Health insurance 101 what to buy web preso
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Transcript of Health insurance 101 what to buy web preso
WHY DOESN’T ANYONE EXPLAIN THIS STUFF?
TRADIT IONAL 80 /20 HEALTH PLANSVS
CATASTROPHIC PLANS PLUS SUPPLEMENTS
HOW DO THEY COMPARE?
Health Insurance…what you need to know
HealthCare Reform
All wellness is now covered on any new plan Annual physicals for adults including mammograms,
pap smears etc Quarterly well checks for children immunizations
All children are guarantee issue
Co-Pay Catastrophic
Enhanced 80/20Regular 80/20Regular 70/30
Enhanced HSA 100Regular HSA 100Value 100
Type of Plans
Available Co-Pay Base Plans
Enhanced 80/20 Co-PayDeductibles –
Individual/Family $500/$1500 $1000/$3000 $1500/$4500 $2000/$6000 $2500/$7500 $3500/$10,500 $5000/$15,000
80/20 Co-PayDeductibles –
Individual/Family $3500/$10,500 $5000/$15,000
70/30 Co-PayDeductibles –
Individual/Family $1500/$4500 $2500/$7500 $5000/$15,000
Co-Insurance Maximum:$2500 Individual - $5000 FamilyOnce deductible is met, Insurance pays 80%. You pay 20% til maximum is met.
Co-Insurance Maximum:$5000 Individual - $10,000 Family
Co-Insurance Maximum:$3500 Individual - $7000 Family
Available Catastrophic Base Plans
Enhanced HSA 100Deductibles – Single/Family $1500/$3000 $2500/$5000 $3500/$7000 $5000/$10,000 $5950/$11,900
• Value 100
Deductibles – Individual• $5000• $7500
HSA 100Deductibles – Single/Family $1500/$3000 $2500/$5000 $3500/$7000 $5000/$10,000 $5950/$11,900
100 means 100% coverage after deductible is met.HSA deductible clarification:Single deductible is for 1 person on plan. If there is more than 1 person, the family deductible applies.
How Co-Pay Base Plans Work
Enhanced 80/20 Co-Pay 100% wellness Covered Unlimited Office Visits
$35 Office Visit $60 Specialist/Urgent Care
Prescription drugs ››You pay the copay for each prescription or refill for each supply of
medicine for 30 days ››If you use an out-of-network pharmacy, you’ll need to pay the full cost
up front and then ask Humana to pay you back by submitting a claim ››The prescription drug deductible is separate from other deductibles;
expenses applied to the prescription drug deductible won't apply to the other deductibles for your plan such as medical, mental health, or certain illnesses
››Prescription drug deductibles and copays do not apply to the medical out-of-pocket maximum
››Find details about Humana's preferred mail-order service at RightSourceRx.com
1. Your covered drug expenses are first applied to your drug deductible (unless a level 1 drug – with these drugs you only have to pay your copay, no deductible)
❏$500 deductible (included in plan) ❏$150 deductible (this lower deductible is available for an extra cost) 2. Once you've met your deductible, then you pay a copay: •• $15 / level 1: low-cost generic and brand-name drugs
(These drugs are covered before meeting your deductible) •• $35 / level 2: higher cost generic and brand-name drugs •• $60 / level 3: high-cost, mostly brand-name drugs •• 35% / level 4: some drugs you inject and other high-cost drugs
($5,000 out-of-pocket maximum per person per calendar year on level 4 drugs)
3. Then, your plan pays any remaining costs for in-network drugs
Then, you pay 30% of out-of-network drug costs
80/20 Co-Pay 100% Wellness Covered 6 office/Urgent care visits per year per family
$35 Office Visit $60 Specialist/Urgent Care
Prescription drugsSame as enhanced 80/20 except:
❏$700 deductible (included in plan) ❏$300 deductible (this lower deductible is available for
an extra cost)
70/30 Co-Pay 100% Wellness Covered 3 office/Urgent care visits per year per family
$35 Office Visit $60 Specialist/Urgent Care
Prescription drugsSame as enhanced 80/20 except:
❏$1000 deductible (included in plan) ❏$500 deductible (this lower deductible is available for
an extra cost) •• $40 / level 2: higher cost generic and brand-name
drugsI think the “co” stands for complex
How Catastrophic Base Plans Work
Enhanced HSA 100 100% wellness Covered
• Value 100• 100% wellness Covered• Prescription same as 70/30
Co-Pay plan
HSA 100 100% wellness CoveredOnce deductible is met, plan covers 100%. RX does NOT go toward deductible.
Once deductible is met, plan covers 100%. RX has separate deductible.
Once deductible is met, plan covers 100%. RX goes toward deductible.
What we are used to….
Traditional plans 80/20 Co-pays Co-insurance Prescription coverage
Separate deductibles Separate Co-insurance
E.R./Urgent Care Co-pays Deductibles Applies toward deductible
ExampleDeductible
$2500/$5000Co-pays
$35/$60Co-Insurance
20% after deductible Out-of-Pocket Max
$2500/$5000E.R.
Applies toward deductibleUrgent Care - $60 Co-pay
Individual Family
What we are used to….
Attributes of Traditional Plans•Higher Premiums•Higher Rate Increases•Appearance of lower deductibles•Co-pays and Co-insurance = Complex Insurance•People Get Used to employer plans•You focus on “how you pay” vs “how much you pay”•No indemnity…meaning…”nobody pays you”•Encourages office visits and wellness visits
A Better Way
Catastrophic Plans plus…supplements
AttributesSimplified Insurance
Lower Premiums Easy to Understand….Easy to Use Minor rate Increases (supplements never increase!) Easy to understand bottom line….or you focus on “how much
you pay”
Insurance Company pays you $ when you need it most Due to healthcare reform…all plans now cover wellness 100% Makes these plans even more attractive!
A Better Plan
Supplements
Association
Base Plan
Pays you for catastrophic events
Pays you for catastrophic events
Reduces day-to-day costs
Covers wellness 100%Eliminates ongoing
expensesMost cost effective
Let’s Assume a Family
39 year old Father38 year old Mother16 Year old son14 year old daughter12 year old son
Let’s Compare
Traditional 80/20 Plan
DeductiblePremium monthly
Premium annually
$500/$1000 $1,095 $13,140
$1500/$3000 $703 $8,436
$2500/$5000 $549 $6,588
Enhanced H S A 100 Plan + Supp
DeductiblePremium monthly
Premium annually
$7000 $612 $7,344$10,000 $442 $5,304$11,900 $425 $5,100
Catastrophic plans + Supplements have additional benefits such as:
What can a large group of people negotiate?
Association Benefits
TelaDoc (a Utah Favorite) 24/7 access to Board Certified
Physician via Telephone– call as often as you would like … will send rx to local pharmacy
$0 Co-Pay $5,000 heart attack benefit* 80% off of labs Global Emergency Services Up to 60% off of imaging
services…MRI, CT Scan etc. $750 for E.R. visit w/
fracture/dislocation HRA – (for Self-employed)
Approx. $4,000 tax savings each year
Free legal consultation Free Identity theft resolution Accidental death Life
Insurance Motor Plan – roadside
assistance $200 reimbursement for
ground ambulance $4000 reimbursement for air
ambulance due to accident Hospital Confinement daily
benefit ($400, $300, $200) And even more….
Included in bundled cost
What can a large group of people negotiate?
Association Benefits
Personal ExperienceClient this last year slipped in a parking lot & hit his
head.Within a week – he needed brain surgery and was in
a coma for six months.Collected $72,000 in cash just from association
Hospital Confinement benefit
Additional Supplements…thru Chesapeake
Hospital Confinement $500/ day
Accident Direct Pay-out up to $25,000 per person
Up to 50% more if more than one family member in accident
Critical Illness Direct $30,000 per adult
(Can get up to $60,000) $10,000 per child
Vision Free eye exam each year Free lenses for glasses each year 40% off of frames
Included in bundled cost
Lets Compare with scenarios
How does the enhanced 80/20 plan with $2500 deductible compare to the enhanced HSA 100 plan with $10,000 family deductible + supplements in the following scenarios?:
Heart Attack Scenario (Father)Accident Scenario (Mother)Cancer Scenario (child)Average Year (nothing big..a few small things)
This will happen more than 95% of the time
Real Life Scenarios – Compare Plans
Heart AttackFather in hospital 10 daysNeeds open heart surgeryHe cannot work for 1 month
Disappointing isn’t it? And remember, you are not finished if anyone else in the family has an event. This is just with the individual deductible.
$2500/$5000 80/20 PlanH S A $10,000 Plan plus
SupplementsDeductible $2500
Co-insurance Max $2,500 Office visits – assuming 10 visits $600
Labs – ded. met $0
Prescriptions
Rx deductible $500
RX out-of-pocket max $5,000
Out-of-Pocket $11,100 Plus annual premium ($549/mo) $6,588
Net Medical Expenses ($17,688) Cost of travel & lost work ?
Money Paid to You $0
Let’s Compare – Heart Attack Scenario
Deductible $10,000
Co-insurance $0
Office visits $0
Labs $0
Prescriptions
Rx deductible $0
RX out-of-pocket max $0
Out-of-Pocket $10,000 Plus annual premium ($442/mo) $5,304
Net Medical Expenses ($15,304)
supplements paid to you $43,000
How the Supplements Paid
Benefit Pay-out per day/Event Totals
Hospital Confinement $500 $4,000
Hospital Confinement – Association benefit
$400 $4000
Heart Attack Benefit (Alliance)
$5,000 $5,000
Critical Illness Direct $30,000 $30,000
$43,000 paid to family
Coverage that kicks in when you need it most…and simply costs less when you don’t need it.
Real Life Scenarios – Compare Plans
Horrible AccidentWife in hospital 10 daysNeeds surgery on legShe cannot work for 2 months
$2500/$5000 80/20 PlanHSA $10,000 Plan plus
SupplementsDeductible $2500
Co-insurance Max $2,500 Office visits – assuming 10 visits $600
Labs – ded. met $0
Prescriptions
Rx deductible $500
RX out-of-pocket $3,000
Out-of-Pocket $9,100 Plus annual premium ($549/mo) $6,588
Net Medical Expenses ($15,688) Cost of travel & lost work ?
Money Paid to You $0
Let’s Compare – Accident Scenario
Deductible $10,000
Co-insurance $0
Office visits $0
Labs $0
Prescriptions
Rx deductible $0
out-of-pocket $0
Out-of-Pocket $10,000 Plus annual premium ($442/mo) $5,304
Net Medical Expenses ($15,304)
supplements paid to you $26,750
How the Supplements Paid
Benefit Pay-out per day/Event Totals
Hospital Confinement $500 $4,000
Hospital Confinement Assoc.
$300 $3,000
E.R. Fracture $750 $750
Accident Direct $15,000 $15,000
Alliance Life Flight Reimbursement
$4000 $4000
$26,750 paid to family
Real Life Scenarios – Compare Plans
CancerDaughter in hospital 10 daysNeeds chemo and radiationWork time compromised
$2500/$5000 80/20 PlanHSA $10,000 Plan plus
SupplementsDeductible $2500
Co-insurance Max $2,500 Office visits – assuming 10 visits $600
Labs – ded. met $0
Prescriptions
Rx deductible $500
RX out-of-pocket max $5,000
Out-of-Pocket $11,100 Plus annual premium ($549/mo) $6,588
Net Medical Expenses ($17,688) Cost of travel & lost work ?
Money Paid to You $0
Let’s Compare – Cancer Scenario
Deductible $10,000
Co-insurance $0
Office visits $0
Labs $0
Prescriptions
Rx deductible $0
out-of-pocket $0
Out-of-Pocket $10,000 Plus annual premium ($442/mo) $5,304
Net Medical Expenses ($15,304)
supplements paid to you $15,000
How the Supplements Paid
Benefit Pay-out per day/Event Totals
Hospital Confinement $500 $5,000
Critical Illness Direct $10,000 $10,000
$15,000 paid to family
Real Life Scenarios – Compare Plans
Normal YearSon needs stitchesOther son breaks arm6 visits to doctor for various things
$2500/$5000 80/20 PlanHSA $10,000 Plan plus
SupplementsDeductible $0
Co-insurance Max $0 Office visits – assuming 10 visits $450
Labs – ded. met $0
Prescriptions
Rx deductible $100
RX out-of-pocket $0
Out-of-Pocket $550 Plus annual premium ($549/mo) $6,588
Net Medical Expenses ($7,138) Cost of travel & lost work ?
Money Paid to You $0
Let’s Compare – Normal year
Deductible $1,500
Co-insurance $0
Office visits $0
Labs $0
Prescriptions
Rx deductible $0
out-of-pocket $0
Out-of-Pocket $1,500 Plus annual premium ($442/mo) $5,304
Net Medical Expenses $6,804
supplements paid to you $750
Net Expense ($6,054)
How the Supplements Paid
Benefit Pay-out per day/Event Totals
E.R. Fracture $750 $750
$750 paid to family
Conclusion…catastrophic plans + Supplements give you:
Lower CostBetter CoverageYou can now afford dental, life Insurance and
additional options.Call me and I will compare your plan with others to
see what the best plan is for you & your family.
Dave KollerInsphere Insurance Solutions, Inc.(801) [email protected]
No matter your scenario…the catastrophic plan plus supplements serves you the best…lower cost …better coverage!
Over time, you really win. Supplements never increase over time…and Catastrophic plans increase the least!