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


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


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


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.


Horrible AccidentWife in hospital 10 daysNeeds surgery on legShe cannot work for 2 months

$2500/$5000 80/20 PlanHSA $10,000 Plan plus




Prescriptions

Rx deductible $500

RX out-of-pocket $3,000




Let’s Compare – Accident Scenario

Deductible $10,000

Co-insurance $0

Office visits $0

Labs $0

Prescriptions

Rx deductible $0

out-of-pocket $0







Hospital Confinement Assoc.

$300 $3,000

E.R. Fracture $750 $750

Accident Direct $15,000 $15,000

Alliance Life Flight Reimbursement

$4000 $4000



CancerDaughter in hospital 10 daysNeeds chemo and radiationWork time compromised





Prescriptions

Rx deductible $500

RX out-of-pocket max $5,000




Let’s Compare – Cancer Scenario

Deductible $10,000

Co-insurance $0

Office visits $0

Labs $0

Prescriptions

Rx deductible $0

out-of-pocket $0







Critical Illness Direct $10,000 $10,000



Normal YearSon needs stitchesOther son breaks arm6 visits to doctor for various things



Co-insurance Max $0 Office visits – assuming 10 visits $450


Prescriptions

Rx deductible $100

RX out-of-pocket $0

Out-of-Pocket $550 Plus annual premium ($549/mo) $6,588



Let’s Compare – Normal year

Deductible $1,500

Co-insurance $0

Office visits $0

Labs $0

Prescriptions

Rx deductible $0

out-of-pocket $0


Net Medical Expenses $6,804

supplements paid to you $750

Net Expense ($6,054)



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!

health insurance 101 what to buy web preso

Economy & Finance

family deductible

deductible clarification

familyonce deductible

single deductible

wellness visits

extra cost7030 copay100

highcost drugs

covered drug expenses