america’s firstchoice in supplemental health insurance benefits
TRANSCRIPT
FirstChoice Supplement Series
America’s FirstChoice In Supplemental Health
Insurance Benefits
FirstChoice Supplement Series
FirstChoice is the name given by Manhattan Insurance Group (MIG) to a series of supplemental health plans underwritten by Central United Life (CUL, in most states) and Family Life Insurance Co. (FL, MI, and DE) and marketed through independent licensed representatives through affiliation with Stephens-Matthews Marketing, Inc. ( The plan name is Premier Options in FL)
FirstChoice plans are primarily intended to provide top quality supplemental health insurance benefits to those individuals and families who have some form of qualified ACA health insurance, but who recognize that the high out-of-pocket exposure in these plans ( 2016 $6,850 individual, $13,700 family ) could be financially devastating to them.
Remember the Harvard study!
The Harvard University Study of Bankruptcy
Back in 2007, Harvard University concluded what is believed to be the most in-depth study of bankruptcy ever conducted. Many incredible facts were revealed in the process.
For example, in 2004, the most recent year for which data was available, of the families filing for bankruptcy protection, over 565,000 cited Unpaid Medical Bills as the primary reason for the bankruptcy. Harvard was literally flabbergasted to discover that of these 565,000 families becoming bankrupt from unpaid medical bills,
75.7% of them actually had Health Insurance at the time!
The Harvard University Study of Bankruptcy
75.7% of families who declared bankruptcy in 2004 had major medical insurance at the time that the bills that ultimately led to their financial ruin were created!
Today, in 2015, the Out-Of-Pocket exposure is much greater than it was back in 2004; at the same time it has become significantly more difficult to qualify for bankruptcy! Our valuable protection is more necessary than ever before!
FirstChoice Supplement Series
The Harvard University Study of Bankruptcy
These 565,000 families did not plan to fail, they had sacrificed to own major medical insurance. They either failed to plan, or were unaware that simple and affordable coverage was available to help them. This is exactly why we developed the FirstChoice Supplement Series!
One last startling statistic before we leave the Harvard Study; of these 565,000 now bankrupt families,
87% could have avoided the filing with as little as $10,000 additional
dollars!
The power of FirstChoice
When used in conjunction with any qualified ACA plan design, for an average period of hospital confinement, even the smallest FCPS Supplement Plan will give your client the reasonable expectation that they can leave the hospital owing little of nothing in the way of Out-Of-Pocket costs!
Now Available to ANYONE!
There are individuals who, for many reasons, find qualified ACA plans unavailable, unaffordable, or otherwise unattractive to their needs.
Due to a recent court ruling, FirstChoice plans are available as supplements to other non-qualified plans or even as stand alone plans.
CUL Provides Multiple Alternatives to Qualified “Metallic” Plans
In addition to the FirstChoice Supplement Series, which features the Complete Plan design as an alternative to traditional ‘metallic’ plans, we also market the Affordable Choice plan designs in many states.
Affordable Choice plans are liberally underwritten and feature additional benefits not found in any FirstChoice plan designs ( RX Drugs, Dr. Visits, Labs and Imaging, etc.)
A Consideration For Healthy Clients
For those clients in good health looking for an alternative to a qualified ‘metal’ plan, a marriage of Affordable Choice and FCSS Supplement Plan could represent the best combination of solid protection and affordable premium in the marketplace today!
Common sense…
While FirstChoice plan designs are cost effective and desirable, no fixed benefit, defined benefit or otherwise limited benefit plan design can be expected to pay all of an individuals potential medical claims.
Benefits to the Client!
Three Plan Designs ( To suit a variety of needs) Guaranteed Renewable (Policy, not a certificate)Guaranteed Issue (Primary Insured must work an average of 27 hrs/wk)First Dollar Benefits (No Deductibles, Copays or Coinsurance to satisfy)All Provider ( Any Doctor, Hospital of your choice )No Coordination of Benefits ( Pays in addition to other insurance )No Utilization Review or PreauthorizationPreexisting Conditions Covered After 12 MonthsNo Ineligible Occupations
Benefits to YOU, the AGENT!
Very Competitive PremiumsElectronic Enrollment ( Mother’s maiden name)High Commissions Advances ( to qualifying agents)A Year Round Sales Opportunity (Not limited to AEP)Incredible Incentive Trips (for modest, obtainable production)An Excellent Portfolio of Additional Products( including Scheduled Benefit Cancer, Lump Sup Cancer, Dental Vision & Hearing, Accident, Health chassis Critical Illness, Life chassis Critical Illness, Simplified Life, Disability Income and many more!)
FirstChoice Supplement SeriesBenefits Vary in Plan Designs!
Daily Room Benefit ( Up to $500/day for 365 days per year*)First Hospital Confinement ( Up to $10,000 for first annual admission*)Intensive Care (Up to $1,000 per day for 20 days per period of confinement*)Private Duty Nursing ($250 per day up to 30 days per period of confinement*)Surgery (Up to $3,000 per day, up to 5 days per hospital confinement!*)Anesthesia ( $600 per day, up to 5 days per hospital confinement!*)Emergency Accident ( Up to $250 per accident, 4 per year *)Specified Injury Rider $25-2,000 Depending upon the injury**
* Refer to the benefit specific slides, to follow, for details! ** Not available in NC or GA
FirstChoice Supplementt SeriesBenefits Vary in Plan Designs!
*Refer to the benefit specific slides, to follow, for details!
Unlike the competition, FirstChoice Supplement Series (FCSS) feature two separate “Room related” riders that each provide benefits for hospital confinement. While these make the FCPS both strong as well as unique, it can cause some initial confusion to those unfamiliar with them.
In this primer we will look at both of the ‘room related’ benefits individually, as well as how they perform when combined.
FirstChoice Supplement Series
Daily Room Benefit
The “Daily Room Benefit” (DRB) is the ‘base policy’ in all FirstChoice plan designs! All other benefits are ‘riders’ added to the DRB. The plan designs are fixed and not subject to modification.
In all plan designs the DRB will pay its benefit for up to 365 days of continuous confinement during any benefit period. Discharge and subsequent readmission begins another 365 day benefit period. There is No Lifetime Max on the number of confinements or the number of days for which the FCPS DRB can be paid!
FirstChoice Supplement Series First Hospital Confinement
The “First Hospital Confinement” (FHC) is afeature in most FirstChoice plan designs! The FHC is available once per year per insured, and is paid for the first period of hospital confinement of the year.
The FHC is paid out over the first SIX days of confinement each year.
There is No Lifetime Max on the number of times that FCPS FHC can be paid per individual insured or per family!
FirstChoice Supplement Series First Hospital Confinement
The “First Hospital Confinement” (FHC) is a$5,000 max benefit with The Supplement design, ($10,000 with Complete and Standard plans ) and pays out over SIX days as follows:
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
Daily Benefit $500 $500 $1,000 $1,000 $1,000 $1,000
Cumulative Benefit $500 $1,000 $2,000 $3,000 $4,000 $5,000
FirstChoice Supplement Series First Hospital Confinement
The “First Hospital Confinement” (FHC) is a$10,000 max benefit with The Complete and Standard Plan designs, (exactly twice as much as The Supplement Plan,) and pays out over SIX days as follows:
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
Daily Benefit $1,000 $1,000 $2,000 $2,000 $2,000 $2,000
Cumulative Benefit $1,000 $2,000 $4,000 $6,000 $8,000 $10,000
FirstChoice Supplement Series When you Combine the three “Room Related” Benefits
This example features the “room related” benefits of the FCPS
Complete PlanComplete
PlanDay 1 Day 2 Day 3 Day 4 Day 5 Day 6
Daily RoomBenefit
$500 $500 $500 $500 $500 $500
First Hospital ConfinementBenefit
$1,000 $1,000 $2,000 $2,000 $2,000 $2,000
Cumulative Benefit
$1,500 $3,000 $5,500 $8,000 $10,500 $13,000
These two “Room Related” benefits pay in addition to all other plan benefits!
FirstChoice Supplement Series
Intensive Care Unit Benefit
The “Intensive Care Unit Benefit” (ICU) is featured in the Complete FirstChoice plan design! The ICU is payable per day, up to 20 consecutive days per period of confinement, if the insured is assigned to an Intensive Care room. This is paid in addition to the three “Room Related” benefits discussed earlier
There is No Lifetime Max on the number of times that FCSS ICU can be paid per individual insured, per year or per family!
FirstChoice Supplement Series Private Duty Nursing Benefit
The “Private Duty Nursing Benefit” (PDN) is afeatured in all FirstChoice plan designs! The PDN is payable at $250 per day, up to 30 consecutive days per period of confinement, if the insured is ordered by a doctor to require the services of a Private Duty Nurse while hospital confined. This is paid in addition to all of the benefits discussed earlier
There is No Lifetime Max on the number of times that FCPS PDN can be paid per individual insured, per year or per family!
FirstChoice Supplement Series Surgical Plus with Daily Surgical Benefit
Today, in most states, including AL, AZ, AR, CA, DC, IL, KY, LA, MO, GA,IA, IL, IN, KY, LA, MD, MO, MS, NC, NE, NV, PA, OK, SC, SD, TN, TX, VA , WY & WV, FCSS features a revolutionary Daily Surgical Benefit.
(We issue FCPS in MI and DE through our sister company, FLIC, and also a similar plan in FL, called Premier Options )
The name, Daily Surgical Benefit, is very indicative of how the benefit works!
FirstChoice Supplement Series Surgical Plus with Daily Surgical Benefit
In Daily Surgical Benefit states, the benefit is paid for surgery that is received while hospital confined (we will explain the outpatient surgical benefit later in this training)
During a period of hospital confinement during which one or more surgical procedures are performed, the Daily Surgical Benefit will be paid for each day of the continuous confinement, up to a maximum of 5 days.
EXAMPLE: A Complete Plan client is confined for 7 days, Monday through Sunday. A surgical procedure is performed on Wednesday. ( or any other day of the confinement ) The Daily Surgical benefit ($3,000) will be paid for 5 days of confinement. ( $15,000 )
FirstChoice Supplement Series Surgical Plus with Daily Surgical Benefit
EXAMPLE: Client is confined for 4 days. A surgical procedureis performed on one of these days. The Daily Surgical Benefit will be paid for 4 days of confinement. ( $12,000 )
EXAMPLE: Client is confined for 10 days. A heart bypass procedure is performed on one of these days. The Daily Surgical benefit will be paid for 5 days of confinement . ( 15,000 )
The Daily Surgical benefit amount is determined by the plan design selected.
FirstChoice Supplement Series Surgical Plus with Daily Surgical Benefit
The Daily Surgical Benefit amount is determined by the plan design selected; while it is always $3,000 per day, the number of days varies by plan..
Plan Design
Daily Surgical Benefit
Complete $3,000 per day
Standard $2,000per day
Supplement $2,000per day
There is no limit on the number of periods of hospital confinement, the total number of days per insured, or any lifetime max on the amount that can be paid under the Daily Surgical Benefit!
When outpatient surgery is received at an Ambulatory Surgical Center, the surgical benefit is 50% of the benefit that would have been paid for one day of surgery while hospital confined.
FirstChoice Supplement Series Anesthesia Benefit
The Anesthesia amount is determined by the plan design selected..
Plan Design
Daily Anesthesia Benefit
Complete $600per day
Standard $400 per day
Supplement $400per day
When Anesthesia is administered as a part of any covered surgical treatment for which a Daily Surgical Benefit is paid, the plan will may an additional amount equal to 20% of the DSB for anesthesia !
FirstChoice Supplement Series Emergency Accident Benefit
A benefit for four separate Emergency Accident treatments is available on all FCSS plan designs. The benefit is $250 regardless of the plan design selected.
This emergency accident benefit is paid in addition to any and all other benefits available within the policy, including the Specified Injury Rider, or from any other source.
There is no Lifetime Max on this benefit.
FirstChoice Supplement Series Specified Injury Rider
The Specified Injury Rider* lists numerous specific accidents and injuries for which specific amounts will be payable. These range from a low of $25 to a high of $2,ooo.
A copy of the actual rider schedule is available in the Agents Guide and is available at www.stephens-matthews.com
There is no annual or Lifetime Max on this benefit.
* Not available in NC or GA
Claims Examples
Client buys a FC Supplement to accompany their ACA qualified metallic plan. Claim is for an outpatient treatment for a broken femur.
DRB = $0FHC = $0ICU = $0Surgery, ASC $1,000 = $1,000Specified Injury Rider = $1,850 = $1,850 Emergency Accident Rider = $250 TOTAL =
$3,100
Claims Examples
Client buys a FC Supplement to accompany their ACA qualified metallic plan. Claim is for a 3 day hospital confinement with surgery, Benefits received as follows:
DRB 3 days X $50/day = $150FHC =
$2,000ICU = 0Surgery, $2,000/day X 3 days = $6,000Anesthesia, $400/day X 3 days = $1,200 TOTAL =
$9,350
Claims Examples
Client buys a FC Supplement to accompany their ACA qualified metallic plan. Claim is for a 7 day hospital confinement with surgery, two days in ICU. Benefits received as follows:
DRB 7 days X $50/day = $350FHC =
$5,000ICU = $0Surgery, $2,000/day X 5 days = $10,000Anesthesia, $400/day X 5 days = $2,000 TOTAL =
$17,350
Claims Examples
Client buys a FC Complete to accompany another limited benefit plan. Claim is for a 4 day hospital confinement with surgery, 1 day in ICU. Benefits received as follows:
DRB 4 days X $500/day = $2,000FHC = $6,000ICU 2,500 X 2 = 2,500Surgery, $3,000/day X 4 days = $12,000Anesthesia, $600/day X 4 days = $2,400 TOTAL =
$24,900
Claims Examples
Client buys a FC Complete as the only coverage that they feel they can afford. Claim is for a 7 day hospital confinement with surgery, two days in ICU. Benefits received as follows:
DRB 7 days X $500/day = $3,500FHC =
$10,000ICU 2,500 X 2 = 5,000Surgery, $3,000/day X 5 days = $15,000Anesthesia, $600/day X 5 days = $3,000 TOTAL =
$36,500
While we are talking about claims…
Let’s don’t forget that according to the American Cancer Society, Facts and Figures, 2014:
About 1 MALE in 2 will develop cancer in their lifetime!
So will a little over 1 FEMALE in 3! 3 out of 4 families will have an immediate
family member stricken with cancer! 65% of the cost of treating cancer is NOT
COVERED by major medical plans! (deductibles, coinsurance, copays, lost wages, travel, accommodations, and much more!)
Due to early detection and improved treatment techniques, cancer is no longer a
‘death sentence.’
Bad NewsMany of these new and improved treatment
techniques are extremely expensive!
More Great News!Manhattan Life and CUL have what many
people believe to be the finest cancer plans in our industry!
Great News!
Manhattan & CUL Bring a LOT to the Table!
* Affordable Choice, FirstChoice Supplement Series and FirstChoice GapGuard are absolutely the finest defined benefit plans on the market today!
* CUL Dental, Vision & Hearing is an industry leader
* CUL Cancer Care Plus & Cancer First Occurrence are considered by many to be the best policies of their kind.
* Compensation is excellent on all MIG and CUL plans!
* Annual incentive trips are amazing!
2016 incentive trips …
Rome
Venice
Thank You!We appreciate your time and attention to the training for our incredible hospital indemnity plans, FirstChoice Supplement Series!
If you have questions or need new agent contracting, contact Kerri at
1-800-544-8250 ext. 120
www.stephens-matthews.com