HEALTH CHOICE SELECT AN AFFORDABLE APPROACH TO HEALTHCARE FOR

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1 HEALTH CHOICE SELECT AN AFFORDABLE APPROACH TO HEALTHCARE FOR For agent training use only and not for general distribution

2 Health Choice Select Approved States WA ME MT ND AK OR CA NV ID UT WY CO SD NE KS MN WI IA IL MO MI OH IN KY NY PA WV VA NC HI AZ NM OK TX AR LA TN AL MS GA SC FL He Approved But Not Released He Final Review In Process All states listed except North Carolina has the Standalone 24HR Enhanced Accident Plan approved

3 Health Choice Select This is a Defined Benefit plan that provides fixed-indemnity benefits and not a major medical insurance plan. Fixed-indemnity benefits are provided for hospital confinement, specified medical, surgical and outpatient events. These benefits are paid in specific amounts and do not provide expense reimbursement for charges based on your health care provider s bill.

4 Health Choice Select is a Hospital Indemnity Plan. Since all the benefits are defined in the plan it allows the consumer to know exactly what the policy pays before accessing any health care services

5 Health Choice Select & Minimum Essential Coverage Defined Benefit insurance plans do not meet the Minimum Essential Coverage requirements under the Affordable Care Act and you may need to pay a tax penalty depending upon your income level and the cost of plans available

6 Health Choice Select $5,000,000 Lifetime Maximum per policy Three annual maximum benefit amounts to select from Three benefit options to pick from Use any Doctor or Hospital you choose without penalty For additional savings the PHCS network is available at no additional cost TelaDoc provides a convenient alternative to Urgent Care or ER visits at no cost to you ScriptSave card is provided at no cost to help you save money on prescriptions Optional Accident, Life, Critical Illness and Dental plans are available to enhance your protection

7 First Day Hospital Confinement Reduction Option First Day Hospital Confinement Benefit Percentage* To help manage healthcare costs you may decide to reduce the First Day benefit amount for Hospital Confinement and Intensive Care..(one reduction per calendar year per covered person may apply) 100% - Pays 100% of the Hospital Confinement and ICU Benefit 80% - Pays 80% of the First Day Hospital Confinement and ICU Benefit.. 2 nd day and thereafter pays the full benefit selected 50% - Pays 50% of the First Day Hospital Confinement and ICU Benefit.. 2 nd day and thereafter pays the full benefit selected 20% - Pays 20% of the First Day Hospital Confinement and ICU Benefit.. 2 nd day and thereafter pays the full benefit selected Reduction of benefit if applied for; only applies to the First Day of Hospital Confinement. All other benefits will be paid at the full unit benefit you selected

8 How First Day Hospital Confinement Reduction Works. 3 Day Hospital Stay for Injury. 2 units with a 50% First Day Confinement Benefit $6,000 a day 1 st day with 50% reduction of confinement benefit $ 3, nd and 3 rd day of hospital confinement benefit 12, Hospital Confinement Benefit (Sub total) $ 15, Surgery (2 X RBRVS Schedule) 4, Assistant Surgeon (20% of Surgery Benefit) Anesthesia (25% of Surgery Benefit) 1, Total Eligible Benefit $ 22,184.11

9 Elect an Annual Maximum Benefit. Think about the Annual Maximum Benefit as being a Bucket of Money your client purchased.

10 2 nd Choose an Annual Maximum Benefit. Eligible Expense Each time they have an eligible medical expense, money comes out of the bucket to help pay for those expenses based on the Benefit Plan they selected.

11 2 nd Choose an Annual Maximum Benefit. Every year Philadelphia American refills the bucket.

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16 Optional Riders & Policies CRITICAL ILLNESS INSURANCE RIDER / POLICY: You can select from $10,000 to $50,000 to help cover out-of-pocket medical expenses and other cost associated with a covered medical illness. Critical Illness insurance is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnosis of a covered illness. Maximum amount of Critical Illness Insurance available is $50,000 for any one person. FAMILY TERM LIFE INSURANCE RIDER: Protect your family with inexpensive term life insurance coverage that pays a death benefit depending on age of up to $50,000 for the principle insured, $10,000 for the spouse and $3,000 on each child 24 HOUR ACCIDENT EXPENSE INSURANCE POLICY: Accident Expense insurance provides you with up to $4,000 for accidental injury; up to $100,000 for an accidental death and up to $10,000 for ground or air ambulance. The accident plan also has an optional accident disability benefit and pays in addition to other insurance you may have and is guaranteed renewable to age 80.. DENTAL CHOICE: A unique hybrid dental insurance plan combining traditional dental insurance with network provider s discounts. Take advantage of network providers at over 169,000 access points across the United States Pays if you go out of network. Non-network providers are paid at the same rate and fee schedule as network providers No waiting periods on Diagnostic & Preventative Services Diagnostic & Preventative paid at 100% after co-pay when using a network provider

17 Sponsored Benefits Sponsored Benefits are value added healthcare programs from other providers designed to enhance your healthcare experience without additional cost to your clients. TelaDoc and ScriptSave are sponsored benefits that we are making available to your clients and are not part of the Health Choice Select policy.

18 Teladoc is a convenient alternative to urgent care or ER visits. U.S. board-certified physicians are available anytime, anywhere, and can resolve many non-emergency medical issues. They can resolve most non-emergency medical issues via phone or online video. Saving you time and money by getting no cost care in three easy steps:

19 Teladoc is a convenient alternative to urgent care or ER visits. U.S. board-certified physicians are available anytime, anywhere, and can resolve many non-emergency medical issues. They can resolve most non-emergency medical issues via phone or online video. Saving you time and money by getting no cost care in three easy steps: Step 1: Contact TelaDoc 24/7/365 Access Teladoc s network via phone, video or mobile app by going to

20 Teladoc is a convenient alternative to urgent care or ER visits. U.S. board-certified physicians are available anytime, anywhere, and can resolve many non-emergency medical issues. They can resolve most non-emergency medical issues via phone or online video. Saving you time and money by getting no cost care in three easy steps: Step 2: Talk with a Physician A physician will review your medical history and contact you with in minutes

21 Teladoc is a convenient alternative to urgent care or ER visits. U.S. board-certified physicians are available anytime, anywhere, and can resolve many non-emergency medical issues. They can resolve most non-emergency medical issues via phone or online video. Saving you time and money by getting no cost care in three easy steps: Step 3: Resolve the Issue A physician will diagnose and prescribe medication, and if medically necessary will send prescription to your pharmacy

22 Prescription Savings Card Save on Brand Name and Generic Prescriptions The ScriptSave Card is provided at NO COST to your clients as a value added feature. The card is a prescription savings card only and is NOT insurance. Easy-To Use o Simply present this card at any participation pharmacy when filling or refilling a prescription. Your card is ready to be used right away Call for help finding a pharmacy, to learn about available services and information about your medications Compare before you buy. Go to but in your group number #2242 and list your medication. It will give you prices for your medication at pharmacies near you.

23 Prescription Savings Card

24 While you are free to use any Doctor or Hospital you choose without Penalty. You have the option of accessing the MultiPlan / PHCS Limited Benefit Network to take advantage of great savings at no additional costs. You will have access to Doctors, Hospitals, Labs, Imaging Centers and Home Healthcare Centers. To find providers in your area go to and select the provider link located at the bottom of the left hand sidebar.

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27 You can do your search by several different criteria's or just put in the ZIP Code to get all listing in a particular area

28 PHCS Network Composition Summary By MSA

29 Actual Re-priced Claim

30 General Anesthesia

31 Metacarpal Fracture

32 Amputation of Finger

33 everification Explain to the applicant how everification works What is everification? everification will replace the TI (telephone interview) on qualified application that are submitted through the eapp system. A qualified application is an eapplication that has a social security number, address and cellphone number. (STM is not eligible We will send an or text message to the applicant with a link to their application. They will have the ability to review and verify the information on a qualified application at their convenience in their home or office. Applications with incomplete information or where there is a discrepancy between the eapplication and what the applicant verified will be forwarded to the TI unit for telephone follow-up.

34 Underwriting 3 Top Reasons For Counter Offers Discrepancy's Tobacco rate is the #1 reason for PALIC counter offers and yet it is the easiest for agents to correct. Remember the question asks the applicant if they used any form of tobacco in the last 24 months not just cigarettes in the last 12 months. Height and Weight is another reason that causes several counter offers. Many times we will receive different Height and Weight information from the applicant then what is on the application Missing health information. The eapp will rate-up as you go through the questions. Please read each question carefully to the applicant and do not paraphrase the question. The same three reasons that causes counter offers will be the same reasons everification won t work in many cases unless they are corrected.

35 Pre-existing Conditions Explain to the applicant how Pre-existing Conditions effects coverage What is a Pre-Existing Condition? A condition for which treatment was rendered or recommended by a Physician or for which drugs or medicine was prescribed within 12 months prior to a covered Person s Effective Date and will not be covered for the following12 month period It is important to note that pre-existing conditions applies to all benefit with the exception of the Preventive Care Benefit. Re-pricing is still available through the PPO network.

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37 Additional Slides For More Detail

38 Optional Health Choice Riders

39 Optional Health Choice Riders

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