Transcript - Bay Insurance Marketing

Table of Contents
Section 1 – AIM Preface
1-1 Overview
1-2 Other Markets
1-3 Highlights
1-4 Eligibility
Section 2 – MultiPlan PPO Network
Section 3 – Medical Plans
3-1 Doctor & Lab Visits
3-2 Hospital & Surgical
3-3 Critical Illness & Accident
3-4 Prescription
Section 4 – Riders
4-1 Catalyst Rx Card
4-2 Family Accident
4-3 Hospital $500 Daily
4-4 Critical Illness Only
Section 5- Stand Alone Plans
5-1 AIM Rx Card
5-2 Family Accident
5-3 Xtra Hospital &Critical Illness
5-4 Critical Illness $10,000
5-5 Hospital $500 Daily
5-6 HSA Bridge
AIM Overview
AIM is a consumer driven association that strives to meet the needs and
challenges for those who have difficulty acquiring quality health insurance at an
affordable rate due to medical conditions. AIM Health Plans are comprised of the
most comprehensive Limited Medical Benefits in the country, are fully insured and
are written on a guaranteed issue basis. AIM stands for Guaranteed Issue to
provide Americans with excellent coverage and affordable rates. AIM provides
coverage for:
• Individuals
• Families
• Small & Large Employer Groups
• Large Associations
• Employer Groups
Section 1-1
Other AIM Markets
Although AIM specializes in the Guaranteed Issue market for those with
medical conditions, AIM also provides a solution for other situations such
as:
People that are looking to “Bridge” before Medicare
(usually ages 60-64).
People who cannot afford High premiums and still
need medical coverage.
College students or young adults just coming off their parents Health Plans.
People with HSA’s or High Deductible Plans that need to offset or “Bridge”
their high deductibles.
Employers who may need to split Limited Medical
plans and Major Medical for particular employees or
employers that can not afford to offer Major Medical Plans
Section 1-2
AIM Highlights
• Guaranteed Issue – No Declines
• Guaranteed Renewable
• HIPAA Compliant
• Assignable Benefits
• Unlimited Surgical Benefits
• Stable Rates
• A.M. Best Rated Carriers
• “True” Health Insurance…Not a discount plan
Section 1-3
Eligibility
18-64 years of age
Individuals can not be receiving Disability Benefits
Individuals can not be Medicare Eligible
Individuals can not be receiving Workman’s Comp
Maternity is not eligible prior to a 12 month waiting period
There is a 12 month waiting period for pre-existing conditions except
where there is evidence of 12 months of continuous credible coverage
Section 1-4
Multiplan PPO Network
AIM utilizes the MultiPlan Network to maximize client savings and reduce potential outof-pocket expenses. The AIM medical plans pay benefits at the same dollar amounts
whether or not a client uses a network Doctor, Hospital or Facility. There is no reduction
in benefits if a client utilizes services outside of the network.
MultiPlan offers:
 Re-pricing when network providers are used.
 The largest, seamless national network.
 Over 500,000 providers in 50 states.
 Provider website www.multiplan.com to instantly locate network providers.
 Electronic claims submission.
If a client uses a Doctor, Hospital or Facility outside the network a
manual claims form would need to be submitted for re-imbursement,
Unless the benefits were assigned to the Doctor, Hospital or Facility.
Section 2
Medical Plans
AIM offers 4 Medical Plans to suit the coverage and budget needs of your clients.
Silver
Gold
Diamond
We will break down the 4 Medical Plans into 4 Sections
1.) Doctor & Lab Visits
2.) Hospital & Surgical
3.) Critical Illness & Accident
4.) Prescription
Section 3
Silver
Gold
Diamond
$50 Per Visit
$75 Per Visit
$75 Per Visit
$100 Per Visit
5
5
5
7
$50 Per visit
3 per year
$100 Per visit
3 per year
$150 Per visit
3 per year
$400 Per visit 5 per year
$100 Per Visit
1 per year
$100 Per Visit
1 per year
$150 Per Visit
1 per year
$150 Per Visit 1 per year
Doctor’s Office Visits:
For treatment of injury or sickness per covered
person per calendar year. This benefit can also be
used as an emergency room benefit.
Number of Office Visits:
Per person Per year (no limit to a family)
Diagnostic Testing or X-ray:
Medically necessary diagnostic tests and x-rays
performed in a doctor’s office or outpatient facility.
E.g. MRI, CAT Scan, EKG, Mammography
Preventative Care Benefit:
Includes 1 physical exam or Well-child Care per year
1.) Doctor & Lab Visits
Visits are all per person per 12 months.
Section 3-1
Silver
Regular Inpatient Stay:
A maximum of 100 days per policy year
Gold
Diamond
$750
Per Day
$1,000
Per Day
$1,000
Per Day
$1,000 Per Day
None
None
$1,000 / 5 days
$1,000 / 15 days
None
None
None
$2,000 per stay
50%
80%
100%
100%
Unlimited
Unlimited
Unlimited
Unlimited
None
20%
20%
25%
ICU/CCU:
An Extra Daily Benefit
Hospital Admission:
An Extra BENEFIT for the first day admitted in the
hospital
Surgery: Inpatient/Outpatient
Plan pays as a % of Medicare Reimbursement
Schedule
Surgery Maximum:
Maximum annual benefit for surgery
Anesthesia Benefit:
As % of surgery benefit
2.) Hospital & Surgical
The Hospital and Surgical portion of the coverage is where you will really see the differences
Between the plans as you will discover in the next several slides.
Section 3-2
Silver
Regular Inpatient Stay:
A maximum of 100 days per policy year
Gold
Diamond
$750
Per Day
$1,000
Per Day
$1,000
Per Day
$1,000 Per Day
None
None
$1,000 / 5 days
$1,000 / 15 days
None
None
None
$2,000 per stay
50%
80%
100%
100%
Unlimited
Unlimited
Unlimited
Unlimited
None
20%
20%
25%
ICU/CCU:
An Extra Daily Benefit
Hospital Admission:
An Extra BENEFIT for the first day admitted in the
hospital
Surgery: Inpatient/Outpatient
Plan pays as a % of Medicare Reimbursement
Schedule
Surgery Maximum:
Maximum annual benefit for surgery
Anesthesia Benefit:
As % of surgery benefit
Regular Inpatient Stay is 100 days annual maximum per person. Re-entry is unlimited, only the total
number of days an individual can use in a 12 month period is limited to 100 days total. Plan pays
according to the daily schedule i.e. $750 per day up to $1000 per day on the Gold, Diamond and
HealthMax Plus Plans.
Section 3-2
Silver
Regular Inpatient Stay:
A maximum of 100 days per policy year
Gold
Diamond
$750
Per Day
$1,000
Per Day
$1,000
Per Day
$1,000 Per Day
None
None
$1,000 / 5 days
$1,000 / 15 days
None
None
None
$2,000 per stay
50%
80%
100%
100%
Unlimited
Unlimited
Unlimited
Unlimited
None
20%
20%
25%
ICU/CCU:
An Extra Daily Benefit
Hospital Admission:
An Extra BENEFIT for the first day admitted in the
hospital
Surgery: Inpatient/Outpatient
Plan pays as a % of Medicare Reimbursement
Schedule
Surgery Maximum:
Maximum annual benefit for surgery
Anesthesia Benefit:
As % of surgery benefit
ICU/CCU Benefit is available on the Diamond Plan at 5 days total per year per
person and the HealthMax Plus Plan at 15 days Total per person per year. This
Benefit pays in addition to the Regular Inpatient Stay. For example: If a patient went
into ICU on the Diamond, the plan would pay a total of $2000 per day while in
ICU/CCU for up tp 5 days .
Section 3-2
$1000 Regular Inpatient
+$1000 ICU/CCU Benefit
$2000 Per Day
Silver
Regular Inpatient Stay:
A maximum of 100 days per policy year
Gold
Diamond
$750
Per Day
$1,000
Per Day
$1,000
Per Day
$1,000 Per Day
None
None
$1,000 / 5 days
$1,000 / 15 days
None
None
None
$2,000 per stay
50%
80%
100%
100%
Unlimited
Unlimited
Unlimited
Unlimited
None
20%
20%
25%
ICU/CCU:
An Extra Daily Benefit
Hospital Admission:
An Extra BENEFIT for the first day admitted in the
hospital
Surgery: Inpatient/Outpatient
Plan pays as a % of Medicare Reimbursement
Schedule
Surgery Maximum:
Maximum annual benefit for surgery
Anesthesia Benefit:
As % of surgery benefit
The Hospital Admission Benefit gives extra money on the first day admission. It
is only available on the HealthMax Plus Plan. There is no limit on how many
times the benefit can be used. Also, the Admission Benefit pays in addition to the
ICU/CCU daily benefit.
Section 3-2
$2000 Hospital Admission
+$1000 ICU/CCU Benefit
$3000 First Day
Silver
Regular Inpatient Stay:
A maximum of 100 days per policy year
Gold
Diamond
$750
Per Day
$1,000
Per Day
$1,000
Per Day
$1,000 Per Day
None
None
$1,000 / 5 days
$1,000 / 15 days
None
None
None
$2,000 per stay
50%
80%
100%
100%
Unlimited
Unlimited
Unlimited
Unlimited
None
20%
20%
25%
ICU/CCU:
An Extra Daily Benefit
Hospital Admission:
An Extra BENEFIT for the first day admitted in the
hospital
Surgery: Inpatient/Outpatient
Plan pays as a % of Medicare Reimbursement
Schedule
Surgery Maximum:
Maximum annual benefit for surgery
Anesthesia Benefit:
As % of surgery benefit
Surgery: Inpatient/Outpatient benefit pays as a percentage of the Medicare Re-imbursement Schedule for Inpatient or
Outpatient Surgeries. For example, the Gold Plan pays 80% of the Medicare Re-imbursement schedule, therefore a
surgical procedure that Medicare listed at $10,000 X 80% Gold Plan = $8,000 Payout.
The Surgery Maximum Lifetime Benefit is UNLIMITED.
Another noteworthy point about the Medicare Schedule is that it pays according to zip code. In other words a surgical
procedure done in New York City would probably cost more than the same surgical procedure in Cleveland. Therefore
Medicare offers a higher Re-imbursement for more expensive zip codes.
Section 3-2
Silver
Regular Inpatient Stay:
A maximum of 100 days per policy year
Gold
Diamond
$750
Per Day
$1,000
Per Day
$1,000
Per Day
$1,000 Per Day
None
None
$1,000 / 5 days
$1,000 / 15 days
None
None
None
$2,000 per stay
50%
80%
100%
100%
Unlimited
Unlimited
Unlimited
Unlimited
None
20%
20%
25%
ICU/CCU:
An Extra Daily Benefit
Hospital Admission:
An Extra BENEFIT for the first day admitted in the
hospital
Surgery: Inpatient/Outpatient
Plan pays as a % of Medicare Reimbursement
Schedule
Surgery Maximum:
Maximum annual benefit for surgery
Anesthesia Benefit:
As % of surgery benefit
Anesthesia Benefit is included on the Gold and Diamond Plan at 20% and the HealthMax Plus at 25%. It pays as a
percentage of the Surgeon’s benefit. For example, if the Surgeon received $10,000 X 20% Gold or Diamond = $2,000.
On the HealthMax Plus the same procedure would have paid $2,500 to the Anesthesiologist.
Section 3-2
3.) Critical Illness Benefit: The carrier will pay the benefit amount shown for a
covered person that has been diagnosed with a critical illness. Please note the
differences of benefit limits and coverage availability. The Silver Plan does not
offer Critical Illness Benefit.
Gold
$2,500 one time benefit
Primary Applicant Only
Diamond
$2,500 one time benefit
Primary Applicant Only
HealthMax Plus
$5,000 one time benefit
Primary Applicant and Spouse Only
Section 3-3
The Ten Critical Illness Triggers
1) Terminal Cancer
2) Heart Attack
3) Kidney (renal) Failure
4) Stroke
5) Coma
6) Coronary Artery Bypass Graft
7) Loss of Sight, Speech or Hearing
8) Major Organ transplant
9) Paralysis
10) Severe Burns
Section 3-3
Accident Benefit: The carrier will pay up to the benefit amount as
shown per covered accident. There is only one accident allowed per
covered person per year. This benefit pays a portion of the medical
costs resulting from injury. The costs must be incurred within 90 days
of the injury.
Silver
$2,500 per accident
$100 deductible
80% coinsurance
1 accident per covered
person year
Gold
$5,000 per accident
$100 deductible
80% coinsurance
1 accident per covered
person year
Diamond
$5,000 per accident
$100 deductible
80% coinsurance
1 accident per covered
person year
The HealthMax Plus Plans offers Accident Coverage as a Rider Only.
Section 3-3
4.) AIM Rx Card: All 4 plans include this prescription plan.
Walk-In Pharmacy Discount - Plan Members will also receive the AIM Rx Discount
Card, which allows you to shop locally and receive discounts on your immediate need
medications. The AIM Rx Discount Card is accepted by over 53,000 pharmacies.
$5 Mail Order Generic Plan - As part of our commitment to lowering healthcare costs,
AIM Rx offers over 400 prescription drugs at $15 for a 90 day supply.
Brand Name Mail Order – Plan Members can save even more with the AIM Rx
Maintenance Mail-order Service. Conveniently order a 90 supply delivered right to your
home. Our average client savings is over 48% on most Name Brand Medications.
This benefit has no waiting period and no annual maximum on usage
As an enhanced service all new clients are called to help them with their prescription
medications and determine the most cost effective way to utilize their prescription benefit.
Note: Although we call all new clients we are not always successful at contacting them. It is
important that clients call to activate their card prior to using the benefit or the card will not
work.
Section 3-4
AIM Rx Card: continued.
Sales Tip: If you are speaking with a prospect who is taking expensive medications we
offer a Prescription Hotline that will provide a Drug Cost Analysis to determine a strategy
that will save the client the most amount of money. This can be a great closing tool, we
call it the “Prescription Drug Close.” If you are saving a potential client $2-$3-$400 a
month on their medications chances are you will have a “Slam Dunk” on the Medical
Plan you want to offer. The point of this story is don’t overlook the importance of solving
a potential clients prescription problem.
www.aimrxcard.com
Prescription Hotline: 1-800-758-1751
Section 3-4
Riders
1.) Catalyst Rx (All Plans)
2.) Family Accident (HealthMax Plus Only)
3.) Hospital $500 Daily
(All Plans)
4.) Critical Illness Only (All Plans)
Section 4
1.) Catalyst Rx Card Rider
The plan pays medically necessary prescription drug charges in excess of the co-pay
amount. Benefits are obtained through the use of an identification card that will be
issued upon enrollment. To fill a prescription, present the card and the Physician’s
prescription to a participating pharmacy and pay the applicable co-payment for covered
medications.
Benefit Highlights:
•
•
•
•
$10.00 co-pay for generic medications (Formulary)
No deductibles, No waiting periods, No restrictions due to pre-existing conditions
No claim forms to complete – savings are provided immediately
Acceptance at over 53,000 pharmacies nationwide including Walgreens, CVS,
Wal-Mart and Rite Aid stores
• Savings on medications not covered on the formulary Brand-Name Drugs:
discounted price as adjudicated at the time of purchase
• Supply of generic drug subject to the maximum annual benefit of $1,500 per
Insured Person
Available on Silver, Gold, Diamond and HealthMax Plus
Section 4-1
2.) Family Accident Rider $5,000
The plan covers single and/or entire family for medical expenses due to an
injury.
After a $100 deductible, the plan pays 100% up to $5,000.
Benefit includes a $10,000 Accidental Death & Dismemberment Insurance
(for primary applicant only).
Ambulatory service is covered in full.
Air- Ambulance pays up to $4,000.
No limit on how many times an insured can use the policy.
Available on HealthMax Plus Only
Section 4-2
3.) Hospital $500 Daily
• Hospital Confinement pays on an Indemnity basis $500 per day in the
hospital for 31 days per calendar year.
• Plan also pays an additional $500 per day if the insured is in ICU or CCU
for an additional 31 days per calendar year.
• Family coverage (Applicant plus 2 or more dependents) includes coverage
for applicant, spouse and children.
• These benefits and amounts are in addition to any other benefits received
by the policy.
HIPAA Compliance does not apply to this rider
Available on HealthMax Plus Only
Section 4-3
4.) Critical Illness
•
•
•
•
Increases 1 time Critical Illness Benefit to $20,000
Family coverage will cover both the primary insured and their spouse.
Pre-existing conditions are covered after 12 consecutive months of coverage.
The policy has 10 Critical Illnesses that are covered. (See Triggers on page 17)
HIPAA Compliance does not apply to this rider
Available on All Plans
Section 4-4
Stand Alone Plans
• AIM RX
• $5K & $10K Family Accident
• Xtra $500Hospital & $25K Critical Illness
• Critical $10K
• Hospital $500
• HSA Bridge $5K & $10K
Section 5
AIM Rx Card
Walk-In Pharmacy Discount - Plan Members will also receive the AIM Rx Discount
Card, which allows you to shop locally and receive discounts on your immediate need
medications. The AIM Rx Discount Card is accepted by over 53,000 pharmacies.
$5 Mail Order Generic Plan - As part of our commitment to lowering healthcare costs,
AIM Rx offers over 400 prescription drugs at $15 for a 90 day supply.
Brand Name Mail Order – Plan Members can save even more with the AIM Rx
Maintenance Mail-order Service. Conveniently order a 90 supply delivered right to your
home. Our average client savings is over 48% on most Name Brand Medications.
This benefit has no waiting period and no annual maximum on usage
As an enhanced service all new clients are called to help them with their prescription
medications and determine the most cost effective way to utilize their prescription benefit.
Note: Although we call all new clients we are not always successful at contacting them. It is
important that clients call to activate their card prior to using the benefit or the card will not
work.
Section 5-1
Family Accident
Family Accident is available in $5000 & $10000.
• $5,000 Accident Medical Insurance –
covers you and your family
• $10,000 Accident Medical Insurance –
covers you and your family
•Up to $5,000 for medical expenses due
to an accident with a $100 deductible;
then pays 100% of reasonable and
customary charges.
•Up to $10,000 for medical expenses due
to an accident with a $100 deductible;
then pays 100% of reasonable and
customary charges.
• No Limit on how many times an
insured’s family uses the policy.
• No Limit on how many times an
insured’s family uses the policy.
• Also includes $10,000 of Accidental
Death & Dismemberment for the Primary
Insured only.
• Also includes $50,000 of Accidental
Death & Dismemberment for the Primary
Insured only.
• Ambulance ride is covered in full and Air
Ambulance up to $4,000
• Ambulance ride is covered in full and Air
Ambulance up to $4,000
• Includes the AIM Rx Card
• Includes the AIM Rx Card
Section 5-2
Xtra Hospital & Critical Illness
• Hospital Confinement pays on an Indemnity basis $500 per day in the
hospital for 31 days per calendar year.
• Plan also pays an additional $500 per day if the insured is in ICU or CCU
for an additional 31 days per calendar year.
• Family coverage (Applicant plus 2 or more dependents) includes coverage
for applicant, spouse and children.
• These benefits and amounts are in addition to any other benefits received
by the policy.
• $25,000 One-time Critical Illness Benefit.
• The insurance carrier (A.I.G.) will pay one time benefit of $25,000 for the
diagnosis of a critical illness.
• Family coverage will cover both the primary insured and their spouse.
• Pre-existing conditions are covered after 12 consecutive months of coverage.
• The policy has 10 Critical Illnesses that are covered. (See Triggers on page 19)
Section 5-3
Critical $10,000
•
•
•
•
•
$10,000 One-time Critical Illness Benefit.
Family coverage will cover both the primary insured and their spouse.
Pre-existing conditions are covered after 12 consecutive months of coverage.
The policy has 10 Critical Illnesses that are covered. (See Triggers on page 19)
Includes the AIM Rx Card
Section 5-4
Hospital $500 Daily
• Hospital Confinement pays on an Indemnity basis $500 per day in the
hospital for 31 days per calendar year.
• Plan also pays an additional $500 per day if the insured is in ICU or CCU
for an additional 31 days per calendar year.
• Family coverage (Applicant plus 2 or more dependents) includes coverage
for applicant, spouse and children.
• These benefits and amounts are in addition to any other benefits received
by the policy.
• Includes the AIM Rx Card
Section 5-5
HSA Bridge
AIM offers 2 HSA Bridge Plans
$5,000 Accident
$10,000 Accident
•Up to $5,000 for medical expenses due
to an accident with a $100 deductible;
then pays 100% of reasonable and
customary charges.
•Up to $10,000 for medical expenses due
to an accident with a $100 deductible;
then pays 100% of reasonable and
customary charges.
• No Limit on how many times an
insured’s family uses the policy.
• No Limit on how many times an
insured’s family uses the policy.
• Ambulance ride is covered in full and Air
Ambulance up to $4,000
• Ambulance ride is covered in full and Air
Ambulance up to $4,000
$5,000 Critical Illness
$10,000 Critical Illness
• $5,000 One-time Critical Illness Benefit
for diagnosis of a critical illness.
• $10,000 One-time Critical Illness Benefit
for diagnosis of a critical illness.
•The policy has 10 Critical Illnesses that
are covered. (See Triggers on page 19)
•The policy has 10 Critical Illnesses that
are covered. (See Triggers on page 19)
•Includes the AIM Rx Card
•Includes the AIM Rx Card
Pre-existing conditions are covered after 12 consecutive months of coverage.
Section 5-6
We don’t stop here in supporting You!
Whenever you need answers, support or
on the spot Prescription quotes….
Our Live Support Staff Is Only A Phone Call Away!
1-800-416-9907
www.aimhealthplans.com
Hours are Monday thru Friday 9:00 a.m.- 5:00 p.m. EST