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FIRSTChoice “Guaranteed Issue”
Health Insurance Plans
Underwritten by:
Central United Life Insurance Company
Marketed by:
BMC Agency, Inc.
This PowerPoint presentation is intended strictly as a training tool for licensed FIRSTChoice agents, as well as an information source for
prospective agents to evaluate the product. It is expressly forbidden to
be used in any sales situation or public venue, in whole or in part.
BMC Agency, Inc. has a “ZERO TOLERANCE” policy in which any
violation of this “Agent Eyes Only” rule by any FIRSTChoice
representative may result in their
immediate termination
WITH CAUSE!
FIRSTChoice Guaranteed Issue Health Plans
Central United Life is a member of the Manhattan Insurance Group, whose Worksite strategy is to offer sound, affordable products that meet the
demands of even the most sophisticated of Policyholders. CUL has focused on the
acquisition of life, accident and health insurance for
more than 20 years.
Since the introduction of the first “Guaranteed Issue” Health Insurance
supplement for individuals in 2003, BMC Agency, Inc. has remained committed to
refining and revolutionizing the individual health insurance marketplace.
This is why CUL chose BMC to assist in the development and promotion of their
incredible FIRSTChoice series.
FIRSTChoice Guaranteed Issue Health Plans
FIRSTChoice Guaranteed Issue Health Plans
Who qualifies for “Guaranteed Issue” Consideration?
Individuals age 18-64 who work an average of 30+ hours
per week, their spouse ( if 18-64 ) and their children.
FIRSTChoice Guaranteed Issue Health Plans
Once issued, the plans are GUARANTEED RENEWABLE to age 65, so long as premiums are paid when due. It is not necessary to maintain ‘full time’ employment
status once a FIRSTChoice plan is issued!
FIRSTChoice Guaranteed Issue Health Plans
How are Pre Existing Conditions treated?Conditions for which an insured sought or
received medical treatment in the 12 months prior to application date, or which
manifest symptoms that would have caused an ordinarily prudent person (a
person of average intelligence) to have done so will not be covered for 12 months after the
effective date, whether or not they are disclosed on the application.
FIRSTChoice Guaranteed Issue Health Plans
Are there any Ineligible Conditions or Ineligible Occupations with FIRSTChoice?
NO!Individuals 18-64 working an average of 30+ hours per week may apply regardless of their
Occupation or Pre-Existing conditions!
FIRSTChoice Guaranteed Issue Health Plans
Most FIRSTChoice plan designs include a unique combination of features that provide significant “front loaded” benefits when they are needed the most. There are three separate benefits
designed to provide cash for the expense of the hospital room when confined.
1) The Daily Room Benefit2) The Indemnity Benefit3) The First Hospital Confinement Benefit
FIRSTChoice Guaranteed Issue Health Plans
The Daily Room Benefit is paid for up to 365 days per period
of confinement, currently much longer than any competitor.
( Others are usually 30 or 31 days maximum )
FIRSTChoice Guaranteed Issue Health Plans
The Indemnity Benefit is
paid on the first day of hospital confinement in any calendar year.
FIRSTChoice Guaranteed Issue Health Plans
The First Hospital Confinement Benefit is paid during the first
period of hospital confinement of any calendar year. Depending on
the plan selected, it can be as much as $10,000 over the first 6 days,
in addition to any and all other benefits!
The First Hospital Confinement Benefit in both the GOLD and PLATINUM plan designs pays as follows:
FIRSTChoice Guaranteed Issue Health Plans
Day 1: $1,000Day 2: $1,000Day 3: $2,000Day 4: $2,000Day 5: $2,000Day 6: $2,000TOTAL: $10,000
If a period of confinement lasts less than 6 days, the balance of the benefit is
available for a subsequent confinement for the same
condition, provided it occurs within 6 months.
FIRSTChoice Guaranteed Issue Health Plans
There are THREE important areas that must be considered when
selecting which Guaranteed Issue plans to market. We feel that the
FIRSTChoice Plan Series is superior to the competition in all three!
1) PLAN DE$IGN2) PREMIUM$3) COMPEN$ATION
FIRSTChoice Plan Design
The FIRSTChoice PLATINUM Plan has
9 separate benefits, including the 4 most significant, that
are equal to or superior to ANY OTHER GUARANTEED ISSUE plan currently available!
As of 7/27/10 FIRSTChoice PLATINUM PLAN
USA+ Secure Advantage 2000
Core Value 1000 MAX eHealthStarr GetMed 360 AIM Health Max Plus
Daily RoomBenefit
$2,500 days 1,3, 4, 5,& 6$1,500 day two
$500 days 7 - 365
$2,000/dayUp to 31 days/yr
$1,000/dayUp to 30 days/yr.
$1,000/dayUp to 30 days/yr. Then 3x
$500/day
$1,000/day x 31 $2,000 first day +$1,000/day for 100 days
per yearIntensive
Care$2,000/day
Up to 20 days/yr.IN ADDITION to DRB
$2,000 days 2-31IN LIEU of DRB
$1,000/day up to 5 days/yr., IN ADDITION to
DRB
X $2,000/dayUp to 15 days/yr.
$1,000/dayUp to 15 days/yr.
Surgery $10,000 ScheduleUnlimited Times
$100% of Medicare RBRVS
100% of RBRVS not to exceed charges
$100% of Medicare RBRVS $10,000 ScheduleMax of 2 Times/yr.
$100% of Medicare RBRVS
Anesthesia 25% of Surgical benefit 25% of Surgical benefit 20% of Surgery benefit 20% of Surgery benefit 25% of Surgical benefit 25% of Surgical benefitWellness $400 mammogram,
$200 PSA, $100 PAP $30 X 1 visit/yr or $20
Copay "in network"1 X $150/yr. $100 x one visit/yr. $20 Copay X 5 in network
$40 X 5 out of network$150 x 1 per year
X-Ray /Labs
X 1 X CWE at DirectLabs $75 X 5/yr. 3 visits/yr 100% coins. to $1,000 annual max, shared
with Dr. Office benefit
Up to $100 x 3/yr. $400 x 5/yr.
Maternity Covered as any illness10 month wait
X X X X Covered as any illness12 month wait
OP Sickness( Doctor's Office )
4 X $100 per insured category+
5 X $30 or $20 Copay "in network"
$75 X 5/yr. 5 X $30 Copay, 100% coins. to $1,000 annual max
$20 copay X 5 in network$40 X 5 out of network
$100 x 7 per year
Emergency Room Increases OP Sick. benefit to $150
1 per year up to $100 X $100 per visit,1 visit per year
Max of 2 visits to receive Max of $1,000.yr.
$100 ded. per visit
X
Prescription Medicine
X Companion Life RX benefit
4-Tiered RxDiscount Rx
Discount Program X Generic Copay + Brand Name discount card
CriticalIllness
X X X X $10,000 $5,000
Private Duty Nursing
$250/day for20 days/yr.
X X X X X
AD&D $30,000 $10,000 X X $15,000 XAccident % of $1,800 schedule +
4 X $200 per accident1 per year. $5000 -
$200 ded.$5,000 annual max$100 ded, then 80%
X $5,000 less $100 ded. All other benefits pay first.
X
Mental Health X X 60 x $500/day Inpatient10 x $25 Outpatient
60 x $500/day Inpatient40 x $50 -75% Coins.
Outpatient
X X
Substance AbuseX X 60X $500/day inpatient
20 x $25 outpatient( Combined with Mental Health benefit above )
X X
Ambulance $300/trip, one trip/yr. 1 x up to $100/yr. XPRICE $241.00/mo. $370/mo. $282.72/mo. $334/mo. $329.90 $349/mo.
As of 7/27/10 FIRSTChoice GOLD PLAN
USA+ Essential Health 1000
Core Value 1000 eHealthStarrStarr 500
GetMed 360Platinum 250
Value Health Plan Diamond Plan
Daily RoomBenefit
$2,100 days 1,3, 4, 5,& 6$1,400 day two
$400 days 7 - 365
$1,000/dayUp to 31 days/yr
$1,000/dayUp to 30 days/yr.
$500/dayUp to 30 days/yr.
$250/day x 31 $1,000/day Up to 30 days/yr.
IntensiveCare
$1,000/dayUp to 20 days/yr.
IN ADDITION to DRB
$2,000 days 2-31IN LIEU of DRB!
X X $1,000/dayUp to 15 days/yr.
$3,000/day Up to 14 days/yr. IN LEU of DRB!
Surgery $5,000 ScheduleUnlimited Times
$100% of Medicare RBRVS 80% of RBRVS not to exceed charges
$80% of Medicare RBRVS $10,000 ScheduleMax of 2 Times/yr.
$8,000 Schedule
Anesthesia 25% of Surgical benefit 25% of Surgical benefit, Max of $500
20% of Surgery benefit 20% of Surgery benefit 25% of Surgical benefit 20% of Surgical benefit
Wellness $200 mammogram,$100 PSA, $50 PAP
$30 X 1 visit/yr or $20 Copay "in network"
1 X $150/yr. $100 x one visit/yr. $20 Copay X 5 in network$40 X 5 out of network
X
X-Ray /Labs
X 1 X CWE at DirectLabs $75 X 3/yr. 3 visits/yr 80% coins. to $1,000 annual max, shared with Dr.
Office benefit
X Discount
Maternity Covered as any illness10 month wait
X X X X X
OP Sickness( Doctor's Office )
4 X $75 per insured category+ 5 X $30 or $20 Copay "in network"
$75 X 3/yr. 5 X $30 Copay, 100% coins. to $1,000 annual max
$20 copay X 5 in network$40 X 5 out of network
$75 X 5/yr.
Emergency Room Increases OP Sick. benefit to $112.50
1 per year up to $100 X $75 per visit,1 visit per year
Max of 2 visits to receive Max of $1,000.yr. $100 ded.
per visit
X
Prescription Medicine X X 4-Tiered RxDiscount Rx
Discount Program X Discount
CriticalIllness
X X X X X X
Private Duty Nursing $150/day for20 days/yr.
X X X X X
AD&D $20,000 $10,000 X X $15,000 X
Accident % of $1,800 schedule + 4 X $150 per accident
1 per year. $5000 - $200 ded.
$5,000 annual max$100 ded, then 80%
X $5,000 less $100 ded. All other benefits pay first.
$75/visit X 2 visits/yr.
Mental Health X X 60 x $500/day Inpatient10 x $25 Outpatient
60 x $250/day Inpatient40 x $50 -75% Coins. Outpatient
X X
Substance Abuse X X 60X $500/day inpatient20 x $25 outpatient
( Combined with Mental Health benefit above )
X X
Ambulance 300/ trip, max of 1 trip/yr. X $100/trip X 2 trips/yr.
PRICE $156/mo. $245/mo. $282.72/mo. $241/mo. $199.90 18-39= $85/mo * 40-49=$180/mo.
50-59=$266/mo. * 60-64=$288/mo.
FIRSTChoice Plan Design
Remember that all FIRSTChoice plans are GUARANTEED
RENEWABLE POLICIES, not certificates of some Group Master
policy or Association Plan. This provides much greater protection for the insureds!
FIRSTChoice Plan Design
FIRST Choice Plans are true “Defined Benefit” plans. As
such, the stipulated benefit is always paid in full, regardless of the billed amount. There is no “pays UP TO $$$” language
in FIRST Choice policies!
FIRSTChoice Plan Design
Unlike the competition, many of which have no benefit for Intensive Care, or pay it “in lieu” ( instead of! ) the DRB, FIRSTChoice policies pay all Intensive
Care benefits IN ADDITION TO any and all other benefits of the policy,
including the DRB. This is a HUGE advantage to the policyholder!
FIRSTChoice Plan Design
Virtually ALL Guaranteed Issue Plans address
SURGERY in one of two ways. Many pay a percentage, often 100%, of the Medicare
reimbursement rate ( RBRVS, or Resource Based Relative Value Scale ). What many agents and
most clients do not realize is that this amount IS NOT based upon the total cost of the procedure,
but simply on the amount charged by the PRIMARY SURGEON ONLY! This does not include the Operating Room, Suture Kits, dressings, etc.!
Another problem is this; at a time when an estimated 46% of doctors
are threatening to boycott Medicare over what they feel is inadequate compensation, how will a client
under age 65, and not covered by Medicare, compel their doctor to accept this discounted amount?
FIRSTChoice Plan Design
FIRSTChoice Plan Design
The rest address Surgery with an established Surgical Schedule,
usually with a maximum benefit of $10,000. Often, the benefit from a $10,000 Surgical Schedule will be
more than for the identical procedure under a 100% RBRVS Medicare Reimbursement rate!
FIRSTChoice Plan Design
One drawback to most plans with Surgical Schedules is
that they tend to limit coverage to one or two
surgical procedures per year, maximum!
FIRSTChoice Plan Design
FIRSTChoice incorporates the best of both, with a
$10,000 Surgical Schedule that can be accessed an UNLIMITED number of times each year, for either inpatient or outpatient
procedures!
The FIRSTChoice benefit for Anesthesia is the highest
percentage paid, 25% of the amount paid for Surgery. Since our Surgical Schedule will deliver more benefits
and do it more often than other plans, the Anesthesia Benefit is correspondingly higher as well!
FIRSTChoice Plan Design
FIRSTChoice Plan Design
Unlike the vast majority of competitors, FIRSTChoice plans
provide benefits for MATERNITY, both Natural Delivery as well as Caesarian Section, effective 10
months after the policy effective date!!
FIRSTChoice Plan Design
FIRSTChoice plans are the only “Guaranteed Issue” plans currently known to include
Private Duty Nursing benefits. The Platinum Plan also has the
highest levels of AD&D protection, $30,000!
FIRSTChoice Plan Design
The total paid for an Accident will come from several different plan
benefits. They are:1) Accident Rider2) Specific Injury Rider3) Surgery Schedule, with
Anesthesia
FIRSTChoice Plan Design
Accident Rider: Pays a (first dollar) benefit for each accident.
Specific Injury Rider: Pays as much as $1,800 per accident from a (first dollar) schedule of procedures.
Surgery Schedule: Pays a (first dollar) percentage of the Surgery Schedule, plus 25%+ for anesthesia!
FIRSTChoice Plan Design
There are benefits absent from FIRSTChoice that appear with other Guaranteed Issue plans.
They include Prescription Drugs, Outpatient Labs & X-Rays, Critical
Illness, and “Association Junk”
FIRSTChoice Plan Design
Prescription Drugs tend to fall into one of two
categories, Maintenance Drugs and
Occasional Drugs.Let’s consider each!
FIRSTChoice Plan Design
Maintenance Drugs are taken regularly, and are often available in
generic or generic equivalents. Literally hundreds are available at
discount chains, often for $4.00 each, or less! These are less
expensive than when using a discount drug card!
Maintenance Drugs can also be very expensive. For that reason, ALL BMC Agents are provided access to
a quality PPO repricing and Discount Medical benefits card.
This optional benefit can reduce the cost of procedures by 30%
and more!
FIRSTChoice Plan Design
Occasional Drugs are most commonly Antibiotics, used
infrequently, and Pain Medication, usually very inexpensive. We
believe it is less costly over time for the client to ‘pay as you need’
these, as opposed to building in costs that drive up plan premiums.
FIRSTChoice Plan Design
FIRSTChoice Plan Design
X-Rays and Lab tests are legitimate medical procedures, but have
become abused as doctors increasingly practice ‘defensive
medicine.’ We have chosen to avoid coverage for these elements in favor of additional coverage for expensive
confinements/procedures.
FIRSTChoice Guaranteed Issue Health Plans
Critical Illness plans normally require even more scrutiny in underwriting than Major Medical. To include CI
benefits within a Guaranteed Issue program adds a disproportionately high premium cost that we feel is
an ineffective use of our clients premium dollars.
Prior to 2003, the only option for “Uninsurable” clients was an expensive ‘state pool’ or an
“Association Package” that featured “discounts” on some medical services, but mostly benefits
unrelated to Health Insurance.
FIRSTChoice Plan Design
FIRSTChoice Plan Design
Today, even though numerous “Guaranteed Issue” plans exist that
feature solid Health Insurance benefits, most plans are still littered
with movie tickets, rental cars, Disney discounts, and vitamins.
With FIRSTChoice, you get quality INSURANCE BENEFITS, period.
FIRSTChoice Plan Design
By limiting eligibility to employees who work an average of 30+
hours/week, and avoiding marginal benefits subject to abuse, we are able to provide what we believe to be the
strongest package of “Guaranteed Issue” benefits available in our
industry today!
FIRSTChoice Premiums
Ranging from the HSA Supplement for less than a dollar a day, to the
PLATINUM plan design with the richest benefits available in any Guaranteed
Issue chassis, FIRSTChoice plan designs are available in a variety of
configurations, all of which are lower in price than competitor plans with fewer
and smaller benefits!
FIRSTChoice COMPEN$ATION
Almost all “Guaranteed Issue” plans today pay a ‘levelized’ commission, and
very few offer annualization.
FIRSTChoice plans provide ‘heaped’ first year commission with 6 months advanced commissions available to
agents that qualify!
The highest commission levels available from competitors for top
IMO/FMO contracts is 30% First Year Commission.
*********************************************************************************************************************
This same 30%, (with 8% renewals), is what we pay
AGENTS with FIRSTChoice!
FIRSTChoice COMPEN$ATION
FIRSTChoice COMPEN$ATION
Higher Contracts can be earned by General Agencies and
Managers with active production teams.
Details are available from the BMC Marketing Partner
that provided you with this PowerPoint presentation!
BMC Agency, Inc. and CUL FIRSTChoice
STRONG BENEFITS!************************************************************************************************************
Low Premiums!***********************************************************************************************************
High Compensation!**************************************************************************************************************
“The FIRSTChoice in Guaranteed Issue Health Plans!”