The Essentials and the Ultimate Triple Choice: A Creative Approach for Enhancing Employer Affordability of Group Health Coverage

The Essentials and the Ultimate Triple Choice:

A Creative Approach for Enhancing Employer Affordability of Group Health Coverage

Sekure Healthcare, Symetra Life Insurance Company and Contractor’s Choice have teamed up to enhance employer affordability with:

• The Essentials1 – an affordable health coverage product; and

• The Ultimate Triple Choice – A coordinated offering of coverage products with a wide spectrum of affordability (benefits for all budgets)

Healthcare Innovation Announcement

Notes: 1. It is important to understand that the Essentials is not a replacement for major medical/comprehensive health coverage

It’s an innovative health coverage that uses a Limited Benefit Medical Insurance (MiniMed Plan) with provider networks, 24/7 patient advocacy & other health resources inside an ERISA Trust managed by Contractor’s Choice.

Consumer Driven – Members have freedom of choice with no managed care utilization controls.

Guaranteed Issue - No pre-existing conditions limitations or health questionnaires.

No Deductibles - First dollar fixed benefits coverage the day Member is effective.

Participation - Minimum of 5 enrollees.

Applicability - Ideal for employers who: Offer no health benefits Have low participation on major medical plans Have a large Hispanic workforce, part-time and/or seasonal workers

What is The Essentials?

The Essentials consists of two separate product components coupled with a unique sales distribution/administration platform:

Select Benefits - A Limited Benefit Medical Insurance Plan underwritten by Symetra Life Insurance (“Symetra”); and,

Sekure Healthcare Program - PPO provider networks in US & Mexico, patient advocacy & other health resource services

When used together, these two product components work in tandem for a more effective benefit plan

What is The Essentials Product Structure?

Contractor’s Choice uses an ERISA Trust coupled with unique distribution & administration that increases market reach, accessibility & visibility

• The Symetra Select Benefits Insurance Policy is a fixed indemnity/limited benefit medical plan.

• The Plan pays a predetermined cash benefit with a maximum limit to the covered person - this is different from an HMO Copay Plan.

• The benefit is paid without regard to the selected provider or amount of charges.

• Benefit categories include doctor office visits, preventive care, hospital care, lab/X-ray and more.

• Symetra (www.Symetra.com) is “A” rated by A.M. Best, has nearly $19B in assets & over 2 million customers.

Insurance Benefits

Select Benefits is not a replacement for a major medical policy or other comprehensive policy. It is designed to cover benefits at preselected fixed dollar amount used on a routine basis. Coverage may be subject to exclusions, limitations, reductions and termination of benefits provisions.

Sekure Healthcare Program• The Sekure Healthcare Program helps to reduce medical

expenses.

• Sekure integrates access to healthcare services (medical, hospital, dental, pharmacy, vision, chiropractic, acupuncture & more) in the US & in Mexico.

•

• National PPO networks offer Members savings with 20% to 35% discount before benefits are paid.

• Health Advocate Unit available toll-free to assist Members in finding network providers.

• 24/7 toll-free nurse line provides helpful medical information & assistance.

www.MySekure.com

The Essentials has 3 Standard Plans & 1 Core Buy-Up Plan

The Standard Plans are 100% paid for by employer, available on super composite or 4 tier levels. Pricing on super composite tier from $99/month to $312/month.

The Core Buy-Up Plan is an innovative plan design - employer pays 100% of core level benefits. Each employee has option to buy up to higher levels of benefit coverage. Employer contribution is as low as $50 for the core level benefits on super composite tier.

Insurance Benefit Plan Designs

Note: Super composite pricing is one tier for employee and includes all eligible dependents

To Skip Viewing The Essentials Plan Designs and Proceed to Next Slide in the PresentationClick Here

Essentials 300 Plan Design

Benefit Category Benefits Paid to Members (or assigned to Provider)Doctor’s Office Visit Benefit $35 per visit, with a max of $300 PP/CY (per person per calendar year)Preventive Care Benefit $50 per visit, up to $100 PP/CYDiagnostic X-ray & Lab $40 per visit, up to $300 PP/CYAccident Benefit Discount OnlyHospital Indemnity Maternity covered as any other condition

• $300 per day for hospitalization, up to 30 days PP/CY• $600 per day for intensive care, up to 30 days PP/CY• $300 per day for Substance Abuse, up to 30 days PP/CY• $150 per day for Mental Health, up to 30 days PP/CY• $150 per day for Skilled Nursing, up to 60 days per consecutive stay PP/CY

Surgical Benefit Discount OnlyPharmacy Benefit Discount OnlySurvivors Benefit Extended benefits to surviving dependents for two years

Employer Rates Monthly 100% employer contribution

4 Tier : EE - $77.61, EE+SP - $129.61, EE+C - $93.75, and EE+Fam - $132.61Super-composite: $99.72/employee (includes all eligible dependents)

Essentials 600 Plan DesignBenefit Category Benefits Paid to Members (or assigned to Provider)

Doctor’s Office Visit Benefit $50 per visit, with a max of $300 PP/CY (per person per calendar year)Preventive Care Benefit $75 per visit, up to $150 PP/CYDiagnostic X-ray & Lab $55 per visit, up to $300 PP/CYAccident Benefit $500 PP/CY maximumHospital Indemnity Maternity covered as any other condition

• $600 per day for hospitalization, up to 30 days PP/CY• $1,200 per day for intensive care, up to 30 days PP/CY• $300 per day for Substance Abuse, up to 30 days PP/CY• $300 per day for Mental Health, up to 30 days PP/CY• $300 per day for Skilled Nursing, up to 60 days per consecutive stay PP/CY

Surgical Benefit $1,000 PP/CY maximumPharmacy Benefit $15 Gen/$30 Brand Copay with max of $500 PP/CY & $1,000 per family/CYSurvivors Benefit Extended benefits to surviving dependents for two yearsEmployee Life Insurance; AD&D $10,000; $10,000Dependent Life Insurance Spouse - $5,000; Child - $2,500; and Infant - $400



Essentials 800 Plan DesignBenefit Category Benefits Paid to Members (or assigned to Provider)

Doctor’s Office Visit Benefit $50 per visit, with a max of $300 PP/CY (per person per calendar year)Preventive Care Benefit $75 per visit, up to $150 PP/CYDiagnostic X-ray & Lab $60 per visit, up to $300 PP/CYAccident Benefit $500 PP/CY maximumHospital Indemnity Maternity covered as any other condition

• $800 per day for hospitalization, up to 30 days PP/CY• $1,600 per day for intensive care, up to 30 days PP/CY• $800 per day for Substance Abuse, up to 30 days PP/CY• $400 per day for Mental Health, up to 30 days PP/CY• $400 per day for Skilled Nursing, up to 60 days per consecutive stay PP/CY

Surgical Benefit $3,000 PP/CY maximumPharmacy Benefit $15 Gen/$30 Brand Copay with max of $500 PP/CY & $1,000 per family/CYDental Benefit Deductible of $50 PP/CY, $150 per family/CY; $500 PP/CY max benefitSurvivors Benefit Extended benefits to surviving dependents for two yearsEmployee Life Insurance; AD&D $10,000; $10,000Dependent Life Insurance Spouse - $5,000; Child - $2,500; and Infant - $400



Essentials Core Buy-Up Plan Employer Pays as low as $50 for Core Plan and Employee has option to Buy Up for higher benefits

Description of Benefits Paid to Members (or assigned to provider)Available Benefits Core Plan Buy Up #1 Buy Up #2 Buy Up #3Doctor's Office Visit Benefit $35/visit; $300 PP/CY max $40/visit; $300 PP/CY max $45/visit; $300 PP/CY max $45/visit; $300 PP/CY max

Preventive Care Indemnity Benefit

No benefit – discount through Sekure Healthcare


$50/visit; $150 PP/CY max $50/visit; $150 PP/CY max

Outpatient Diagnostic X-ray and Lab Benefit $35/visit; $300 PP/CY max $45/visit; $300 PP/CY max $55/visit; $300 PP/CY max $55/visit; $300 PP/CY max

Additional Accident Benefit


$300 PP/CY max $300 PP/CY max $300 PP/CY max

Hospital Indemnity Benefits

Maternity coverage as any other condition

• $100/day for hospital; up to 30 days PP/CY• $200/day for intensive care; up to 30 days PP/CY• $100/day for Substance Abuse, up to 30 days PP/CY• $50/day for Mental Health, up to 30 days PP/CY




Surgical BenefitNo benefit – discount through Sekure Healthcare



$500 PP/CY maximum

Prescription Drug BenefitNo benefit – discount through Sekure Healthcare




Survivors Benefit – For surviving dependents

Extended benefits for 2 years Extended benefits for 2 years Extended benefits for 2 years Extended benefits for 2 years

Employee Life Ins/AD&D $5,000 / $5,000 $5,000 / $5,000 $5,000 / $5,000 $5,000 / $5,000

Dependent Life Insurance Spouse - $2,500; Child - $1,250; Infant - $200

Spouse - $2,500; Child - $1,250; Infant - $200



Monthly Cost to Employer $50.00 $50.00 $50.00 $50.00Monthly Cost to Employee (includes eligible dependents) $17.00 $39.90 $66.17 $91.05

Sekure Healthcare Program Networks

Medical/Hospital Beech Street PPO Network - average savings of 25% - 35%

Dental First Dental Health - average savings of 30% - 35%

Pharmacy Caremark - average savings of 20%

Vision Care National Vision Administrators - average savings of 25%

Chiropractic, Massage Therapy, Acupuncture

American Specialty Health has wide range of complementary care - average savings of 25% - 30%

Nurse-line Health Contact Partners – No charge

Health Advocacy Health Contact Partners – No charge

Mexico Health Access Sekure Healthcare – average savings of 25% - 35%

For healthcare not covered by insurance or for when insurance coverage limits are reached, the Sekure Healthcare Program offers substantial discounts.

Several important cultural considerations have been designed into The Essentials.Coverage becomes more relevant to Latinos who make up 57% of California’s 6.6 million uninsured.Sekure Healthcare is expanding its network of community clinics throughout CA.

Some Latinos prefer to have option to access community clinics. Clinics offer low cost visits and some accept assignment of benefits.

24x7 bi-lingual patient advocacy and nurse-line

Cross-border health coverage – healthcare access in Mexico is a feature requested by many Latino workers throughout CA.

Integrating Cultural Considerations

• Members may use insurance benefits and other services in Mexico -

• Call center in Mexico City performs 24/7 toll-free patient advocacy, appointment facilitation and unlimited “tele-consults” with trained physicians

• Providers available in 300+ cities throughout Mexico in the Sekure Network

• Healthcare costs in Mexico are lower than in US - contracted rates for Doctor’s Office Visits: $250 pesos for GP; $350 pesos for Specialist (about $25 US dollars) (about $35 US dollars)

• Greater geographical reach - as an example, a worker in Fresno can enroll his dependents who live in Guadalajara

Innovation - Health Access in Mexico

• Contractor’s Choice provides an industry first with a PPO/HMO/Mini-Med Plan Offering to an employer - it’s the “Ultimate” Triple Choice.

• The Ultimate Triple Choice is an innovative coordinated product offering.

• It addresses issues of high cost and minimum participation by providing employer with a much wider spectrum of affordability.

• It is available to employers in certain industries - construction, landscaping, contract manufacturing, agriculture – that meet requirements of the Trust.

What is the Ultimate Triple Choice?

Affordability within the Healthcare ContinuumFor Group Coverage

Limited Benefits Major Medical/Comprehensive Insurance

LOW COST OF HEALTHCARE COVERAGE HIGH For Family <$100/mo $200/mo $500/mo $600/mo $800/mo $1,000/mo >$1,200/mo

Limited Benefits Medical

Insurance/ MiniMed

Plans

Traditional Indemnity Coverage

Hi Deductibles Low Deductible

PPOs

Hi Copays Low Co Pays

HMOs

The Ultimate Triple Choice has a much wider spectrum of health coverage affordability!

Example of Super Composite Monthly Rates* Mini-Med Plan Options HMO Plan Options PPO Plan Options Start at $99 $392 to $687 $949 to $1,125

* In Southern California

• A unique offering for employers needing more affordable choices due to price sensitivity of HMO/PPO Plans.

• The affordability of the Essentials allows employers to provide something to all classes of employees.

• Contractor’s Choice provides enrollment support for all products.

• Contractor’s Choice administers consolidated billing of all 3 products to employer on one monthly bill.

• Minimum number of enrollees: 1 on PPO Plan, 2 on HMO Plan, and 5 on the Essentials.

• A new approach in addressing some of the affordability challenges.

The Ultimate Triple Choice

For more information or a quote, please contact:

Thank YouFor Your Interest

Nidia SandovalExecutive Account ManagerCONTRACTOR'S CHOICETelephone: (866) 358-9456 Fax: (714) 542-9309Email: [email protected]

mailto:[email protected]

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The Essentials and the Ultimate Triple Choice: A Creative Approach for Enhancing Employer Affordability of Group Health Coverage