Product Training
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 4-1Catalyst trx Card 4-2 Family Accident 4-3 Hospital $500 Daily 4-4 Critical Illness Only Section 5- Stand Alone Plans 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. 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 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
Plans from gary 1.) Doctor & Lab Visits Visits are all per person per 12 months. Section 3-1
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
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
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. $1000 Regular Inpatient +$1000 ICU/CCU Benefit $2000 Per Day Section 3-2
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. $2000 Hospital Admission +$1000 ICU/CCU Benefit $3000 First Day Section 3-2
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
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 Gold $5,000 per accident $100 deductible Diamond $5,000 per accident $100 deductible 80% coinsurance 1 accident per covered person year 80% coinsurance 1 accident per covered person year 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 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 h the use of an identification card that t 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 e 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 it 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 Up to $5,000 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. Also includes $10,000 of Accidental Death & Dismemberment for the Primary Insured only. Ambulance ride is covered in full and Air Ambulance up to $4,000 Includes the AIM Rx Card $10,000 Accident Medical Insurance covers you and your family 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. 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 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 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 Up to $5,000 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. Ambulance ride is covered in full and dair Ambulance up to $4,000 $5,000 Critical Illness $5,000 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) Includes the AIM Rx Card $10,000 Accident 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. Ambulance ride is covered in full and dair Ambulance up to $4,000 $10,000 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) 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